Biomedical subjects
Publications and source records attributed to Iu A Pytel'.
Combined therapy for chronic nonobstructive pyelonephritis introduced by the authors includes such components as etiological, pathogenetic, resistance-stimulating. The cure was achieved in 60% of the patients.
Metastases of renal carcinoma (RC) to lymph nodes were revealed in 121 (18.1%) patients from 667 operated on RC subjects. The frequency of lymph node involvement increases with T: T1--7.5%, T2--10.8%, T3--21.5%, T4--53.3%. In 42 patients the metastases were found only morphologically. In carcinoma of the right kidney the metastases most frequently affected paracaval and interaortocaval lymph nodes, in left kidney carcinoma para-aortal lymph nodes. Preoperative diagnosis of RC metastases to the lymph nodes is not feasible in N1, doubtful in N2 and quite possible in N3. Computed tomography is the most informative procedure as it detects lymphogenic metastases in 82% in N2 and 96% in N3. Overall 5-year survival of RC patients with lymph node metastases was 34.1% (T1N1--80%, T2N2--66.6%, T3N1--41.9%, T3N2--23.5%. All the patients with N3 died within 3 years. The authors think it necessary to perform regional and juxta-regional lymphadenectomy in any surgical intervention for RC in visually unaffected lymph nodes, in N1 and solitary N2. In multiple N2 and in N3 lymphadenectomy is useless.
The drug proskar (finasteride) belongs to 5 alpha-reductase blockers breaking the steps of prostatic adenoma pathogenesis. Proskar (Merck and Co. Inc., USA) was given to 38 patients with prostatic adenoma stage I and II (residual urine < 50 ml) admitted to urological clinic of the Moscow Medical Academy in 1993-1995. Daily dose was 5 mg. In patients with associated inflammation it was treated prior to proskar administration. To reject carcinoma, patients with elevated levels of prostatic specific antigen (< 4 ng/ml) were subjected to polyfocal biopsy of the gland. In any case, these patients received antiandrogens flutamide or androkur. Subjective response was achieved in 33 of 38 patients (86.8%). Better urination was reported in 29 patients (76.3%). Abdominal and transrectal ultrasonic scanning registered a decrease in the size of the prostate in 25 (65.8%) patients. Proskar was well tolerated, sexual disturbances occurred only in 2 patients. Proskar is effective in therapy of prostatic adenoma stage I. However, its intake must be long and regular, otherwise recurrent clinical symptoms and further growth of prostatic adenoma are possible.
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Upper urinary tract drainage in patients with chronic calculous pyelonephritis (CCP) results in not only successful anti-inflammatory and antibacterial treatment but also in more effective and safe ESWL. In 21 CCP patients with upper urinary tract drainage by means of catheter-stent, ESWL was performed using Lithostar-Plus (Siemens). Active inflammation with marked pyuria, bacteriuria and even moderate upper urinary tract dilation were indications for the upper urinary tract drainage with catheter-stent before and during ESWL in CCP patients. Upper urinary tract drainage with catheter-stent contributed to effective treatment of chronic pyelonephritis and allowed to perform ESWL. There were neither attacks of acute pyelonephritis nor upper urinary tract obstruction after catheter-stent removal. The catheter-stent allows to create closed drainage system with active evacuation function as it functions in physiological conditions. ESWL in patients with upper urinary tract drainage using catheter-stent is more effective and has lower risk of complications.
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Successful disintegration of the calculus in nephrolithiasis patients is impossible without normalization of the upper urinary tracts urodynamics in dyskinesia. We employ combined treatment with high-selective beta-2-adrenomimetic hexoprenalin (hinipral) to improve migration of the concrement fragments and therefore to prevent ureteral occlusion, acute pyelonephritis and renal colic. Hexoprenalin (hinipral) is taken 6 tablets a day or intravenously in drops (5 ml per 100 ml of saline) 3-5 days before and for 10-12 days after extracorporeal shock-wave lithotripsy. Adjuvant use of hexoprenalin in combined treatment of nephrolithiasis complicated by ureteropelvic dysfunction allows effective conduction of lithotripsy.
Recently, drug polyuria has found wide application in diagnosis and treatment: to detect latent urinary insufficiency, to assess functional performance of the contralateral (unaffected) kidney in nephrolithiasis and calculous pyelonephritis, to stimulate elimination of fragments of the disintegrated concrement, to check up suture impermeability after surgical repair of the urinary tracts, to outline afunctional zone in hydronephrosis. Clinical experience gives grounds for use of saluretics at certain stages of pyelolithotomy for mobilization of intrarenal pelvis and its dissection, removal of the calculus and subsequent suturing of the intrarenal pelvis. Therapeutic polyuria can also facilitate ureterolithotomy.
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