[The substantiation of efficiency of modern techniques of laboratory control under implementation of metaphylactic activities in patients with various forms of urolithiasis.]

The article presents the results of evaluation of treatment and subsequent five-years observation of 316 patients with urolithiasis that were individually recommended a complex of curative preventive activities with repeated annual dynamic control after a complex of analyses including chromatographic mass-spectrometric detection of content of lithogenic substances, of activity of hydrolytic enzymes, establishment of type of metabolism disorders. The application of chromatographic tests for evaluation of efficiency of implemented preventive treatment with detection of temporarily variations of analyzed parameters in patients with various types of lithogenesis permitted to decrease rate of relapses of lithogenesis in examined group up to 16.5% as compared with the results in control group of patients (32.5%). It is reasonable, considering data of chromatographic indices, to apply them in evaluation of efficiency of applying preventive treatment with detection of temporarily variations of analyzed parameters in patients with various types of lithogenesis.

[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.

[Tactics by the acute intestinal ischemia]

Treatment results of the acute intestinal ischemia in 72 patients were analyzed. Patients aged 69.2 ± 5.8 years. Occlusive vascular lesions of the intestinal vessels (thrombosis and embolism of the superior mesenteric artery and thrombosis of the superior mesenteric vein) were obliged to the ischemic disorders in 84.5% of patients. The rest 15.5% of patients demonstrated microvascular disorders (nonocclusive ischemia). The issue presents the novel algorithm for treatment and diagnostics of the acute intestinal ischemia.

[The clinical laboratory evaluation of impact of shock wave on the activity of peptidohydrolase in urine of patients with urolithiasis]

The article presents the results of comprehensive clinical biochemical study of 79 patients with urolithiasis admitted to the urologic department of public clinical hospital No 7 in 2007-2009. The diagnostic evaluation of the impact of shock wave on kidney parenchyma and crystallization processes was implemented. The chromatography-mass spectrometry was applied to analyze the activity of hydrolytic enzymes in urine of patients with urolithiasis underwent the remote lithotripsy sessions. The dependence of the peptidohydrolase activity alteration in urine of patients with urolithiasis after remote lithotripsy from presence/absence of concomitant pyelonephritis was substantiated. This outcome permitted not only to implement the laboratory-based prevention during the pre-operational stage but to plan properly the ratio of repeated sessions of lithotripsy.

[Role of an infectious factor in the pathogenesis of urolithiasis]

The paper gives the data of complex clinical and biochemical examination in 122 urolithiasis (ULT) inpatients treated at the Urology Unit, Moscow City Clinical Hospital Seven, in February 2004 to January 2008. The levels of lithogenic substances and compounds, inhibitors and activators of lithogenesis have been determined. The authors show it possible to use the level of hydrolytic enzymes and activators of cooperative microbial sensitivity as diagnostic and prognostic criteria in diferent forms of ULT, which is in turn of no small importance in developing the science-based methods for the treatment and prevention of recurrent lithogenesis.

[Evaluation of biogeochemical factors influence on the prevalence of urolithiasis in the regions of Tajikistan]

The investigation has been undertaken to study a relationship between some biogeochemical and environmental factors and nephrolithiasis morbidity in the regions of Tajikistan. The paper presents the data of a comprehensive study comprising the biochemical, chromatographic, and mass-spectrometric studies of 1180 patients aged 14 to 76 years, treated at the Dushanbe Urology Medical Center. The performed examination has established a relationship of the higher urolithiasis mortality rates in the poor environmental regions of the Republic of Tajikistan to the high pollution by organic and inorganic substances, the high natural mineralization and hardness of water, the high levels of chlorides, sulfates, and other components of salt composition, which in turn affects the course of a pathological process.

[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.

[The infusion therapy of the acute bleeding]

Intravenous colloid and crystalloid solutions are the mainstay of the acute bleeding therapy. Infusion therapy normalizes the blood circulation volume and improves its flow characteristics. The conducted study revealed that the method normovolemic hemodilution lead to an early unknown type of oxygen insufficiency called the dilutional anemic hypoxia. Authors set up and proved the hypothesis, that decompensated dilutional anemic hypoxia lead to cardiac insufficiency, leading finally to the so called dilutional circulatory hypoxia.

[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.

[Surgical treatment of patients with perforated peptic ulcers]

Results of surgical treatment of 782 patients with perforated gastric and duodenal ulcers are analyzed. Gastric ulcers of I type were diagnosed at 86 (10.9%) patients, prepyloric and pyloric ulcers - at 441 (56.4%), duodenal ulcers - at 255 (32.6%) patients. Perforation was combined with bleeding and stenosis at 24 (3.1%). Palliative operations have been performed at 172 (22.0%) patients, stem vagotomy with ulcer excision and pyloroplasty - at 58 (7.4%), various types of stomach resection - at 54 (6.9%), proximal gastric vagotomy with excision of gastric, pyloric or duodenal ulcer - at 77 (9.8%), proximal gastric vagotomy with excision or suturing of ulcer and pyloro- or duodenoplasty - at 421 (53.8%) patients. The rate of postoperative complications after proximal gastric vagotomy was 3.6%, after stomach resection - 18.2% (p<0.01). Early postoperative complications after vagotomy with ulcer excision and pyloroplasty were diagnosed at 8.3%, after stomach resection - at 18.2% patients (p<0.01). The quality of patients life was higher after organ-saving operations. Proximal gastric vagotomy with excision of ulcer and pyloro- or duodenoplasty should be regarded as operation of choice at perforated duodenal ulcers.

[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.

[Efficacy of moxifloxacin in the treatment of secondary peritonitis]

Moxifloxacin efficacy was studied in a prospective open controlled incomparable surveillance of 22 patients at the age of 24 to 78 years (the average of 56.6 +/- 15.9 years old) with extended secondary peritonitis that developed before the hospitalization or not later than 48 hours after the hospitalization. Moxifloxacin (Avelox) was used in a dose of 400 mg every 24 hours at first intravenously as infusions and then orally in the same dose. The abdominal infection was severe (APACHE II of 6 to 12, the average of 8.0 +/- 2.2), in 6 (27.3%) patients signs of severe sepsis with polyorganic insufficiency were observed. The intravenous therapy was used for 3 to 7 days (the average of 3.91 +/- 0.92 days) and the oral therapy was used for 2 to 7 days (the average of 4.50 + 1.37 days). The total time of the treatment was 7 to 12 days (the average of 8.45 +/- 1.53 days). The recovery was recorded in 20 out of the 22 patients (90.9%), disappearance of the main signs of peritonitis being observed within 3-5 days of the treatment. Before the treatment 34 microbial strains were isolated. The most frequent pathogens were E.coli (35.4%) and Enterococcus faecalis (20.6%). In the etiological structure of the community-acquired peritonitis gramnegative enterobacteria prevailed (65%). All the isolates (except 1 strain of E. faecalis) were susceptible to moxifloxacin. The pathogen eradication was stated in 17 out of 18 patients (94.4%). Moderate adverse reactions were observed in 3 patients. Moxifloxacin evidently showed high clinical and bacteriological efficacies in the hospitalized patients with complicated intraabdominal infection including severe abdominal sepsis with the syndrome of polyorganic insufficiency. It can be used for monotherapy of patients with secondary extended peritonitis.