[Clinical and biochemical aspects of pathogenesis of urolithiasis]

AIM

To investigate the role of infection in the pathogenesis of urolithiasis using chromatography mass spectrometry analysis.

MATERIALS AND METHODS

The study analyzed clinical and laboratory data of 316 urolithiasis patients hospitalized between February 2005 and January 2015. All patients underwent a comprehensive clinical examination, including laboratory tests (hematological and biochemical blood tests, clinical and bacteriological tests of urine) and chromatography mass spectrometry analysis urine and blood. The laboratory testing was carried out both during the patients hospital stay and outpatient follow-up.

RESULTS

We analyzed the biological material for the presence of characteristic ions. Urine samples of 316 urolithiasis patients were found to contain activators of "cooperative sensitivity." Moreover, there was a significant increase in the concentration of signaling compounds of the "cooperative sensitivity" of microorganisms in patients with complicated urolithiasis in comparison with the control indices (lactones-0.006 plus/minus 0.0004 mmol/L, normal values less than 0.002, quinolones 0.004 plus/minus 0.0003 mmol/l, normal values - less than 0.002 and furan esters - 0.005 plus/minus 0.0004, normal values less than 0.002). Threshold values of the activators of "cooperative sensitivity" demonstrated the readiness of the microbial community to initiate an inflammatory process. The presence of activators such as lactones, quinolones and furan esters in the samples of urolithiasis patients predisposes to the activation of pathogenic genes in a large group of microorganisms, including gram positive and gram negative species.

DISCUSSION

In our opinion, to improve the quality of diagnostic, treatment and preventive measures in patients with different types of stone formation, it is advisable to use chromatography mass spectrometry analysis, which allows determination of priority clinical and laboratory indicators.

CONCLUSION

The data on the role of infection in the pathogenesis of urolithiasis obtained by chromatographic methods suggest the possibility of using the indicators of the activators of the "cooperative sensitivity" of microbes in patients with various forms of urolithiasis to assess the disease severity.

[The role of biliary decompression and correction of dysbiosis in the treatment of obstructive jaundice]

The article providing in-depth analysis of pathogenesis of obstructive jaundice shows that this disease is manifest not only as changes at the hepatic level (cholestasis, cholehemia, cholangitis, cholangio- and lymphovenous shunts, hepatic encephalopathy) but also as marked dysbiotic disturbances due to anacholia and toxic metabolites that cause bacterial translocation and endotoxemia complicating liver insufficiency. Based on the literary data and original observations, a new scheme for the treatment of obstructive jaundice is proposed including simultaneous correction of both components of hepatoenteric turnover, also, it permits to improve the outcome of the postoperative period.

[Urolithiasis morbidity in Tadzhikistan regions: some biogeochemical and environmental factors]

The aim of the study was to investigate urolithiasis prevalence in the main administrative regions of Tadzhikistan, to ascertain effects of drinking water quality, water pollutants and other environmental factors on urolithiasis morbidity in endemic regions of Tadzhikistan. It was found that high urolithiasis incidence rate in some regions was associated with high water pollution (class III and IV), its high natural mineralization and hardness, high content of chlorides, sulphates and other components of salt composition, organic and non-organic pollutants. Chemical and microbiological tests showed that sanitary standards were not strictly observed in the regions with high urolithiasis morbidity. These regions are also characterized by high incidence of acute intestinal infections, thyphoid, nephropathies, high environmental pollution, high density of population.

[Potentialities of current methods for laboratory analysis in the evaluation of the severity and prevalence of nephrolithiasis in Tajikistan]

The investigation was undertaken to study a relationship between some biogeochemical and environmental factors and nephrolithiasis morbidity rates in the regions of Tajikistan. The paper presents the data of an integrated examination involving biochemical, chromatographic, and mass-spectrometric studies of 1180 patients aged 14 to 76 years who have been treated at the Dushanbe Urology Medical Center. The investigation established a relationship of an increase in ICD morbidity in poor environmental regions of the Republic of Tajikistan to the high organic and non-organic pollution, the high natural mineralization and hardness of water, and the elevated levels of chlorides, sulfates, and other salt components, which in turn influences the severity of a pathological process.

[Chromatographic mass spectrometric assessment of the course of different forms of urolithiasis]

The study has been undertaken to improve the methods for diagnosing urolithiasis, which comprehensively evaluate the severity of a pathological process and the results of treatment in patients with nephrolithiasis. The paper gives the data of investigating the processes of chromatographic mass spectrometric urinalysis in 82 patients aged 15 to 81 years urgently admitted to the units of urology of Moscow City Clinical Hospital Seven for a renal colic attack. The levels of lithogenic substances were measured in patients with different types of metabolic disturbances. There was evidence that the chromatographic mass spectrometric parameters of the level of lithogenic substances and hydrolytic enzymes might be used as diagnostic criteria for the progression of urolithiasis, the prediction of the severity of a pathological process, and the development of preventive methods against lithogenesis in patients with a renal colic attack.

[Some new guidelines for the diagnosis of urolithiasis]

The purpose of the study was to develop diagnostic and prognostic criteria for the development of urolithiasis (UL), by using the chromatographic mass spectrometric and aggregatometric techniques, in order to determine the type of a metabolic disturbance and the type of stone formation, as well as to create an algorithm of pathogenetically grounded prevention of the disease. According to the type of a metabolic disorder, all the patients were divided into 4 groups: (1) 47 (43.1%) patients with uric acid UL; (2) 26 (23.9%) with calcium oxalate UL; (3) 25 (22.9%) with calcium phosphate UL; (4) 11 (10.1%) with mixed UL. The specific feature of Group 4 was a preponderance of patients with calcium phosphate and calcium oxalate stones. Analysis of the findings has led to the conclusion that the new guidelines for the diagnosis and pathogenesis of UL, by applying the current chromatographic mass spectrometric techniques make it possible to detect the type of metabolic disturbances, to assess a risk for stone formation with the elevated urinary levels of lithogenic substances, to simulate a stone formation process by aggregatometry, which is of no importance in developing an algorithm of the pathogenetic treatment and prevention of stone formation in UL patients mainly at the early stage of the pathological process.

[Principles of concervative therapy of urolithiasis and prevention of stone formation recurrence]

The modern view of treatment for various forms of nephrolithiasis reflects the main features of nephrolithiasis pathogenesis, but changes in metabolic condition, the presence of dysmetabolism, and the course of pathologic process are not taken into account. Considering that the disease is easier to prevent than to treat, it would be more appropriate to base preventive measures not only on the data from general clinical and biochemical examination, but also on the results of aggregatometry and complex chromato-mass-spectrometric examination allowing prediction of the development of the pathologic process.

[The role of agregatometry in diagnosis of urolithiasis]

Processes of aggregatometry induced by addition of refined compounds in urine from 109 patients aged from 15 to 81 years urgently hospitalized to the urological department of Moscow hospital N 7 from June 2002 to September 2005. The patients had the first episode of renal colics. Main kinds of aggregatograms in urolithiasis patients were determined. Aggregation parameters may be used as diagnostic criteria of urolithiasis development and in design of methods of prophylaxis of urolithiasis in patients with new-onset renal colics.

[Gas chromatography for diagnosis and prognosis of destructive pancreatitis]

One of modern and highly effective methods of diagnostics and differential diagnostics of infected pancreonecrosis is chromatographic technique, which allows for identification of anaerobic non-clostridial infection in the foci of pancreatic destruction by the presence of volatile fatty acids, the specific end products of anaerobic bacterial metabolism. Gas chromatography (GC) - mass spectrometry (MS) also make it possible to detect in peripheral blood of patients with pancreatitis certain metabolites (di-, polyamines, and aromatic amines) that are markers of tissue (protein structure) disintegration and the degree of pancreonecrosis, which is a valuable indicator of the degree of pancreonecrosis. The presence, according to GC - MS analysis, of natural inhibitors of transamidinase (compounds of thiourea and its metabolites, the group of mercaptopurines and mercapto-derivates of imidazole) in peripheral blood at the maximum level--0.71 to 0.78 mmol/l on days 7 to 10 upon the onset of the disease--is a prognostically favorable criterion. At the same time, the presence of the maximum level of anaerobic non-clostridial infection metabolite in peripheral blood 1.12 to 1.31 mmol/l on days 7 to 10 upon the onset of the disease--is prognostically infavorable. These chromatographic criteria in combination with clinical manifestations can be considered indications to surgical treatment of infected pancreonecrosis, and the prognosis of the disease can be based on them.

[Hemostasis system disturbances and their correction in patients with pyonecrotic forms of diabetic foot]

Severe hypercoagulation syndrome was diagnosed in patients with various forms of diabetic foot. Pathology at coagulogram parameters reflects systemic metabolic and inflammatory disturbances. Anticoagulant therapy should be combined with correction of glycemia, treatment of infection and critical ischemia. Only this complex therapy can normalize coagulation parameters and reduce the risk of thrombotic complications.

[Evaluation of diagnostic criteria of syphilitic infection by means of gas chromatography and mass-spectrometry]

In order to estimate possibility of chromatographic criteria application in diagnostics of syphilitic infection, the authors researched in three directions: evaluation of dysmetabolism of carbohydrate, lipid and amino acid components in patients' serum; search of signal compounds that serve as microbe "cooperative sensitivity" activators (lactones, quinolones, furan boron ethers) with evaluation of the risk of luetic infection generalization; indication of organ lesion markers (the brain, liver, bone structures). The factor analysis performed by the researchers allowed to determine priorities of clinical, laboratory and chromatographic data according to their value. The diagnostic value of various diagnostic chromatographic criteria was estimated as follows: the diagnostic sensitivity was 79.6% to 97.2%, the diagnostic specificity was 50.0% to 92.7%, the positive diagnostic predictability was 61.8% to 94.7% and the negative diagnostic predictability was 60.9% to 95.1%.

[Clinical importance of early diagnosis of anaerobic non-clostridial infection]

Anaerobic infection is one of the most complicated problems of pyosurgery. The algorithm of examination of patients with anaerobic infection including intraoperative diagnosis is proposed. Surgical treatment playing also diagnostic role is the basis of combined treatment of soft tissues anaerobic infection. Early diagnosis and active surgical policy is one of the main ways of problem solving.

[Microbiological aspects of effective antibiotic therapy early after operation in chronic maxillary ethmoiditis and tonsillitis]

Microbiological and chromato-mass-spectrometric examinations were made in 53 patients with chronic maxillary ethmoiditis and 52 patients with chronic tonsillitis. The microflora showed strong resistance to unprotected penicillines and cephalosporins, 100% sensitivity to amoxicilline clavulanate and mupirocine. The role of opportunistic microflora as pathogens of ENT inflammation is growing as well as the percentage of anaerobic microorganisms detected chromato-mass-spectrometrically in chronic inflammation. Administration of mupirocine on polyethylenglicol base early after operation in patients with chronic maxillary ethmoiditis accelerated recovery of the study group patients by 2-3 days vs control patients.

[Pathogenesis and combined surgical treatment of the pyonecrotic diabetic foot]

Three hundred and fifteen patients with necrotic forms of diabetic foot were examined and treated. Neuropathic infected form of diabetic foot was diagnosed in 45.7% patients, neuro-ischemic form--in 54.3%. Mixed aerobic-anaerobic infection in foot's necrotic focus was detected in 87.6% diabetic patients, only aerobic--in 12.4%. High level of intoxication was seen in these patients. Algorithm of complex surgical treatment of different forms of diabetic foot is presented.

[Rationale for removal of fibrous capsule in echinococcectomy from the liver]

Experience of radical surgical treatment in 253 patients with hepatic echinococcosis is presented. Twenty-six patients underwent hepatic resection; 218, pericystectomy, 9 patients, combined interventions. Based on comparative analysis of the results of surgical treatment in 109 patients from the study and control groups, it is concluded that radical operations have significant advantages and show fever postoperative complications and recurrences. Removal of fibrous capsule is a token of successful treatment for hepatic echinococcosis.

[Electron microscopic and mass spectrometric studies of lymphedema pathogenesis aspects]

A comprehensive examination was made, which included histological, electron microscopic and chromatographic mass spectrometric studies of biological specimens obtained from 18 patients with leg lymphedema. The development of lymphedema was found to accompanied by the specific connective tissue structure being formed along with the presence of low-differentiated and necrotic areas associated with the cytopathology of blood and lymph vessels and impaired microcirculation. The connective tissue areas under study were demonstrated to have a pronounced antigenicity and aggressive properties against other tissues and structures. The morphological changes revealed are directly related to the impaired metabolism of protein, fatty acids, and complex polysaccharides.

[Etiopathogenetic principles fo surgical treatment for purulent wounds]

Application of gas-liquid chromatography methods and mass-spectrometry enabled the authors to develop objective criteria, which provided prompt acceptance of quantity information about the stage ams severity of the wound process, its influence on the organism and prognosis of expectant complications (taking into account aerobic or anaerobic components of microflora) and early correction of surgical policy.

[A permanent magnetic field in the combined treatment of acute endometritis after an artificial abortion]

117 patients with acute endometritis after induced abortion were examined using markers of wound process phases and treated according to the original method. This consists in combination of constant magnetic field with other modalities. Application of the constant magnetic field produced a significant clinical response and reduced the hospital stay through positive effect on healing of the endometrial wound.

[The effect of the physicochemical structural properties of urinary calculi on the results of extracorporeal shockwave lithotripsy]

The relation of chemical composition and structure of uroliths to lithotripsy effects was evaluated with regard to the concrement size, location, time of the intraureteral persistence, etc. Besides, a prognosis of the remote impulse lithotripsy (RIL) outcome was attempted by x-ray picture and crystallization alterations in the urine. 54 patients with nephroliths and 73 patients with ureteroliths (overall 137 concrements) were examined. By RIL results, the patients were divided into 2 groups: those who benefited from RIL and those who failed it. Worse results were obtained in cases of oxalate concrements with radial-concentric structure and with phosphate ones composed primarily of hydroxylapathite. RIL efficacy was found to depend on a number of interrelated factors (chemical structure, location, size of the concrement, duration of its existence in the ureter). In long-standing ureteroliths the outcomes are associated with stone structure. The denser is the concrement the more probable is its strangulation and more apparent is periureteritis. Changes in crystallization can prompt RIL prognosis as well as it is possible by x-ray picture.

[The effect of remote-controlled shock-wave lithotripsy on kidney function]

Leucine arylamidase (LAA) excretion in circadian urine of 79 patients suffering from nephroureterolithiasis was measured before and after the session of remote impulse lithotripsy (RIL) to investigate the effect of the impulse on renal function. The stones were localized in the calyces, pelvis and upper third of the ureter. The patients were divided into 2 groups: 43 patients with noncomplicated nephroureterolithiasis (group 1) and 36 patients with complicated one including 12 subjects exposed to the second RIL (group 2). The enzyme excretion was significantly reduced in group 1 patients. Its activity recovered in group 1 within 6-7 days, in group 2 for 10-14 days. After the second RIL procedure LAA activity in the urine enhanced more rapidly, especially in group 2 patients. In calyceal, intrarenal pelvic and fused kidney location of the stone, LAA activity got more elevated than in the extrarenal pelvis or in the upper third of the ureter. It is demonstrated that RIL exhibits a short-term effect on the kidneys which depends on the presence of inflammation, the number of sessions, stones location and the number of impulses.

[Risk factors for the occurrence of nephrolithiasis in the Aral Sea region]

The effects of environmental hazards on nephrolithiasis onset were studied for population of the regions exposed to ecological catastrophe sequelae by the sea Aral. Blood and urine levels of organic acids and trace elements were measured using chromato-mass spectrometry, absorption plasma spectrophotometry and ion-exchange chromatography, respectively, as well as urinary peptide hydrolases activity in 178 patients with nephrolithiasis. The levels of lithogenic substances in the blood and urine were distributed differently in patients living in different ecological zones. The above ecologically detrimental zones were denoted as zone 1--most distant from the Aral, zone 2--less distant from it and zone 3--the most ecologically damaged regions of the Aral catastrophe. The multivariate statistical analysis revealed factors of risk to develop nephrolithiasis for these zones: high and moderate risk was stated for 26%, 28.5% and 42.5% of the patients from zones 1, 2 and 3, respectively. The findings confirm the conception on an essential role of environmental factors in initiation of Aral-region nephrolithiasis.

[The taxonomy of obligate anaerobic bacteria]

Studies on the chemotaxonomy of obligate anaerobic bacteria have been made. The combination of gas chromatography and mass spectrometry with computer-assisted analysis, permitting the multicomponent analysis of all products of bacterial metabolism and bacterial cell components, has been shown to be a research method, quite suitable for such studies. The chromatographic profiles of the end products of metabolism in anaerobic cultures of different age have been found to differ not in the set and number of peaks indicating various metabolites, but only in the concentration of metabolites, increasing in the process of prolonged incubation. The authors believe that the national microbiological "library" of the chromatographic profiles of anaerobic organisms should be created and the album of typing chromatographic profiles should be published; besides, data on new profiles should regularly appear in magazines.

[Microflora of the paratonsillar abscesses]

The species composition of aerobic and anaerobic microflora of paratonsillar abscesses was investigated in 20 patients. It was found that obligate nonspore-forming anaerobic bacteria predominated in the pus of the abscess cavity. Anaerobic infection was diagnosed rapidly by gas-liquid chromatography. Anaerobic bacteria were shown to be highly sensitive to clindamycin and metronidazol.

[Diagnostic role of the determination of the plasma fatty acid spectrum in patients with suppurative surgical infection]

The determination of spectrum of blood plasma fatty acids was performed in patients with purulent surgical infection. The surgical infection was shown to bring about changes in the content of free fatty acids (FFA) in blood plasma. In patients with sepsis undulatory changes in the content of FFA of blood plasma were typical. Sharp and stable decrease of FFA content was observed in patients with critical development of sepsis and lethal outcome. The increased content of FFA was established in patients with septic shock.