[Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm]. / Matematicheskoe modelirovanie obkhodnogo vysokopotochnogo ekstra-intrakranial'nogo shuntirovaniya pri lechenii slozhnoi tserebral'noi anevrizmy.

BACKGROUND: Intracranial aneurysms (IAs) pose a high risk of spontaneous subarachnoid hemorrhage. In the most complex cases, the only way to exclude the aneurysm from the circulation is to perform a high-flow extracranial-to-intracranial bypass, thus creating a new bloodstream. This avoids severe ischemic complications; however, it requires careful consideration of individual anatomy and hemodynamic parameters. Computational fluid dynamics (CFD) can be of great help in planning such a surgery by creating 3D patient-specific models of cerebral circulation. OBJECTIVE: Assessment of the perspectivity of high-flow extracranial-to-intracranial bypass planning using computational modeling. MATERIAL AND METHODS: In this research work, we have applied the CFD methods to a patient with a giant thrombosed IA of the internal carotid artery (ICA). Preoperative CTA images and Gamma Multivox workstation were used to create a 3D model with current geometry and three additional models: Normal anatomy (no IA), Occlusion (with ligated ICA), Virtual bypass (with bypass and ligated ICA). The postoperative data were also available. Boundary conditions were based on PC-MRI measurements. Calculation of hemodynamics was conducted with a finite element package ANSYS Workbench 19. RESULTS: The results demonstrated an increase in the blood flow on the affected side by more than 70% after the virtual surgery and uniformity of flow distribution between the affected and contralateral sides, indicating that the treatment is likely to be efficient. Later, postoperative data confirmed that. CONCLUSION: The study showed that virtual preoperative CFD modeling could significantly simplify and improve surgical planning.

[Microbiota of the urogenital organs].

A review of modern literature on the study of microbiota of the genitourinary system by methods of chromatography-mass spectrometry and sequencing of urine specimens is presented in the article. The sequencing method is used to analyze microbiota of different organs. Obtained results of the genomic analysis have revealed cases of infection by potential pathogenic microorganisms, which are often not diagnosed during standard urine culture due to specific requirements for culture media.

[Change in anatomo-functional state of the parenchyma in early unilateral renal cell carcinoma before and after surgical treatment]. / Izmenenie anatomo-funktsional'nogo sostoianiia parenkhimy pri odnostoronnem rannem pochechno-kletochnom rake do i posle operativnogo lecheniia.

The aim of the trial was to study compensatory potential of renal parenchyma in the presence of renal cell carcinoma (RCC) and after organ-saving and radical surgical treatment as shown by one-photon emission computed tomography (OPECT). OPECT before the treatment and 6 and 12 months after it evidences that in unilateral RCC, irrespective of the focus location, both kidneys as a single organ respond to tumor growth with compensatory hypertrophy. Compensatory reserve is limited. In tumor size more than 6 cm the affected kidney starts losing the volume of the functional tissue while infiltrative growth is most likely. Assessment of the compensatory potential of the kidneys provides additional information. If the volumes of the kidneys differ by more than 30%, RCC growth is infiltrative. In this case only radical nephrectomy is recommended. If the size of the kidneys is by 60% more than normal one and parenchymas of the affected and contralateral kidney reach their compensatory limit but are equal, indications to organ-saving surgery extend as greater hypertrophy of the remaining kidney is excluded. After organ-saving surgery, a compensatory increase was observed in the contralateral kidney. This is explained by effective distribution of protein material and separate processes of proliferation (healing) and hypertrophy (compensation). Assessment of anatomo-functional condition of renal parenchyma helps better selection of patients for organ-saving surgery.

[Acute scrotum: clinical picture, diagnosis, treatment]. / Ostrye zabolevaniia organov moshonki: klinika, diagnostika, lechenie.

The purpose of this study was to evaluate the potentialities of ultrasonic dopplerography and radioisotope scanning of the scrotal organs for the diagnosis of acute scrotal diseases and defining the indications to surgery in patients with acute epididymoorchitis. A total of 128 subjects were examined (23 healthy controls and 105 patients with scrotal diseases). 139 ultrasonic and 76 radioisotope scannings of the scrotum were carried out. Ultrasonic scanning plays the key role in the diagnosis of traumatic and inflammatory epididymoorchitis. Radioisotope study is more informative in the diagnosis of torsion of the testicle. The data indicate high informative value of ultrasonic and radioisotope studies in differential diagnosis of acute scrotal diseases and diseases simulating an acute process in the testicle and appendage. A positive feature of both methods is the possibility of their repeated use for evaluating the treatment efficiency. Analysis of 241 cases with acute epididymoorchitis showed that early surgical treatment of patients with pyodestructive inflammation promotes rapid recovery. Ultrasonic monitoring helps timely detect the complications and correct the treatment strategy. Wide use of ultrasonic and radioisotope methods of examination in patients with acute scrotal diseases promote timely detection of pathological changes and better results of treatment.

[Chronic obstructive prostatitis]. / Khronicheskii obstruktivnyi prostatit.

The authors review current classifications of chronic prostatitis and propose their own classification which reflects routes of prostatic infection, division of infectious prostatitis into obstructive and non-obstructive forms, etiology of chronic prostatitis. Original methods and facilities for prostatic drainage via transurethral and transrectal approaches are described.

Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens.

This 3-month double-blind, randomized, parallel-group study compared the efficacy and tolerability of two regimens of the lipido-sterolic extract of Serenoa repens (Permixon) (two 160-mg capsules once daily [OD] and one 160-mg capsule twice daily [BID]) in 100 outpatients with symptomatic benign prostatic hyperplasia (BPH). Both regimens significantly (P < .0001) reduced the International Prostate Symptom Score (I-PSS) mean total score from baseline; improvements achieved statistical significance after the first month and were maintained for the duration of the study. Significant (P < .05) and rapid improvements from baseline to the end of month 1 also occurred in I-PSS quality-of-life (QoL) scores, maximum and mean urinary flow rates, and residual urine volume; this benefit was further increased at month 3 for I-PSS total score and QoL and residual volume, and was maintained for maximum and mean flow rates. A highly significant decrease (P < .001) in residual urine was observed in both groups. No significant differences were noted between regimens. Clinical adverse events occurred at a similar incidence in both groups (BID, 24%; OD, 22%) and were deemed unrelated or unlikely to be related to Permixon.

[Intraepithelial prostatic neoplasia]. / Intraépitalial'naia neoplaziia prostaty.

44 patients seeked medical advice for low urinary symptoms. Their examination consisted of digital rectal investigation, test for prostate-specific antigen (PSA) in the serum, transurethral ultrasonic investigation, fine needle multifocal biopsy of the prostate. Three groups were identified by the PSA levels. 7 patients of group 1 had PSA up to 6 ng/ml. Cancer was diagnosed in 3 of them, prostatic intraepithelial neoplasia (PIN) in 4 patients. 16 patients of group 2 had PSA within 7-10 ng/ml. In this group only 1 patient had cancer, the rest 15 had PIN. 21 patients of group 3 with PSA at least 10 ng/ml had cancer, benign prostatic hyperplasia, PIN (12, 2 and 7 patients, respectively). 3 patients with high-grade PIN and PSA above 10 ng/ml in 6 months were diagnosed to have adenocarcinoma, in 6 such patients signs of dysplasia disappeared after antiandrogenic therapy. Further investigations on diagnosis and treatment of PIN are desirable.

[Ultrasound studies in varicocele]. / Ul'trazvukovye issledovaniia pri varikotsele.

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.

[The laparoscopic treatment of abdominal cryptorchidism in adults]. / Laparoskopicheskoe lechenie briushnogo kriptorkhizma u vzroslykh.

Three patients aged 18, 25 and 31 years with abdominal cryptorchidism and concomitant diseases were treated laparoscopically. Macroscopic amd microscopic evidence said in favor of removal of the testis. In one case this removal was done in line with removal of the dysplastic kidney. In another case plastic surgery was conducted of the inguinal hernia on the side of cryptorchidism.

[The prediction of the results of extracorporeal shockwave lithotripsy]. / Prognozirovanie rezul'tatov distantsionnoi udarnovolnovoi litotripsii.

The disease history, objective, x-ray and aggregatometry evidence has been analyzed for 188 nephroureterolithiasis patients to make the prognosis of extracorporeal impulse lithotripsy (EIL). If the concrements presented at x-ray picture as structurally homogeneous, medium-contrast, with even margins, fragmentation occurred after 3-4 sessions in 81% of the cases. Low or high contrast calculi with heterogeneous margins disintegrated after 1-2 EIL sessions. Flat calculi were easier to crush than round ones. A decline or absence of changes on the aggregatometry curves prompted the decision on efficacy of further EIL. The calculi which existed for 6 months maximum were the easiest to crush. The outcome of the previous EIL is also essential for prognosis. Inflammation and obesity worsen EIL results. Variant of EIL regimen and the number of impulses are also prognostically significant.

[The laparoscopic treatment of varicocele]. / Laparoskopicheskoe lechenie varikotsele.

Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice.

[Extracorporeal shockwave lithotripsy in patients with the long-term presence of stones in the ureter]. / Distantsionnaia udarnovolnovaia litotripsiia u bol'nykh s dlitel'nym prebyvaniem kamnei v mochetochnike.

28 patients with long-standing ureteroliths (present in the ureter for 2 months and longer, size 0.8-1.5 cm) were exposed to extracorporeal impulse lithotripsy (EIL). 26 of them were found to have inflammation in the kidneys and upper urinary tracts. Comparative data on EIL effect show that patients with long-standing ureteroliths need more intensive and long EIL treatment, that fragmentation is more troublesome in oxalate monohydrates and phosphate stones with hydroxylapatite. 4 cases eventuated in operative intervention, in 3 cases ureterolith extraction was performed. EIL results in long-standing ureteroliths depend on the presence of renal and urinary tract inflammation, severity of periureteritis, chemical composition, density and structure of the stones.

[Role of radiographic signs of urinary calculi in the effectiveness of extracorporeal shock-wave lithotripsy]. / Rol' rentgenologicheskikh priznakov mochevykh kamnei v éffektivnosti distantsionnoi udarnovolnovoi litotripsii,

The value of X-ray signs of urinary calculi for the efficiency of shock-wave teletripsy (SWTL) was assessed in 188 patients with nephro-ureterolithiasis. The calculi were studied from the general X-ray film by means of a routine 4-5x magnifier. All the patients were divided into 2 groups. Group 1 comprised patients with effective SWTL, i.e. those undergone 1 or rarely 2 sessions. Group 2 included those with low effective SWTL, 2-4 sessions. Comparative analysis of X-ray films indicated that the calculi which were homogeneous in structure, moderate in intensity and had even edges in the general X-ray pictures in 154 (82%) cases were fragmented after 3-4 sessions (the average number of impulses were 7500, at 19.0 kV). With their heterogeneous structure, low and high intensity, irregular rough edges, they were fragmented after 1 or rarely 2 sessions in 34 (18%) patients. The number of impulses was fewer, on an average of 2300, the voltage was less -17.5 kV. It was noted that the pattern of the edges of a calculus and its geometric form are of highly value in the prediction of SWTL. Calculi having even edges were more frequently encountered in patients from Group 2 (in 81.1% of cases), but in patients of Group 1 they were only in 18.1%.

[Conservative surgery in tumors of the renal parenchyma]. / Konservativnaia khirurgiia pri opukholiakh parenkhimy pochek.

Policy in diagnosis and conservative therapy of renal parenchyma tumors is considered for bilateral lesion, single kidney, combination of renal tumor with renal failure, small-size tumors in normal renal function. The authors advocate all kinds of renal resection. Enucleation is feasible in the single kidney having encapsulated tumor of 3 and less cm in size.

[Cyproterone acetate (Androcur-depo) in the treatment of inoperable prostatic cancer]. / Atsetat tsiproterona (Androkur-depo) v lechenii neoperabel'nogo raka predstatel'noi zhelezy.

The authors consider fundamentals of hormone therapy in prostate cancer, mechanism of long-term androgenic stimulation, detail mechanism of action of antiandrogen (ciproteron acetate-androcur) on the basis of discovered key role of cellular receptor in endocrine regulation of physiological functions in metabolism. Monotherapy with androcur-depo (300 mg once a week) was given to 24 patients with prostatic cancer stage T2-T4. Eight patients had metastases to the bones. The age of the patients ranged from 58 to 80 years. Alleviation of pain, reduction of the prostate size and density, positive uroflowmetric changes (maximal urination rate increased from 2-5 to 10-15 ml/s), residual urine fall occurred as early as treatment week 5-7. There was also a decrease in the activity of acid phosphotase from 5-10 to 0.3-0.8 units according to Bodansky. Serum level of prostate-specific antigen (PSA) dropped from 388-23 to 116-4 ng/ml. Androcur-depo monotherapy demonstrated high efficacy in the treatment of local prostatic cancer.