Biomedical subjects
Publications and source records attributed to N A Lopatkin.
Sparfloxacin efficacy evaluation for the treatment of urogenital tract infections is presented. The trial was performed on 43 patients with chronic complicated infections of urogenital tract (pyelonephritis, prostatitis). Sparfloxacin (once daily for 7-14 days) was highly effective in the infection management according to clinical and bacteriological results (83.7 per cent and 78.1 per cent subsequently).
Data on changes of etiological structure of the complicated urinary tract infections treated at the Research Institute of Urology and Hospital No. 47 at the 5-year period (1996-2000) are given. It was shown that the most important microorganisms were the following: Enterobacter spp., E. coli, Proteus spp., Staphylococcus spp., Enterococcus faecalis. The correlation between frequency of the microorganisms isolation and their susceptibility to antimicrobial agents at different periods was analysed. The results of analysis allowed to elaborate algorithm of etiotropic therapy. Choice of the drug depends on pathogen susceptibility to antibiotics, bacteriuria level and clinical symptoms severity.
BACKGROUND AND PURPOSE: Complete stricture of the ureteropelvic junction (UPJ), ureter, or both represents a secondary upper tract obstruction and is a challenge for surgical management. The endourologic repair of these complete strictures remains controversial because of the many unsatisfactory results in the literature. The aim of this study was to achieve recanalization of the ureter or the UPJ using endourologic techniques to prove durable success of this technique. PATIENTS AND METHODS: We present data on the 21 patients with complete UPJ or ureteral strictures treated over 5-year period. The length of the obliterated portion of the ureter or UPJ ranged from 0.3 to 1.7 cm. The stricture was at the UPJ level in 12 patients (57%), in the upper ureter in 3, and in the lower ureter in 4. The technique was a combined approach, with antegrade introduction of the guidewire and retrograde cold-knife incision in the majority of the cases. In five cases, the incision was carried out in the reverse direction with a guidewire introduced retrograde up to the stricture level. An originally designed 6F to 7F polyethylene double-J stent with a movable 12F to 16F silicon sheath or percutaneous tube was placed at the completion of the procedure. RESULTS: The follow-up period ranged from 6 to 48 months. Recanalization was achieved in 17 patients (81%), of whom 14 became symptom free. Other surgical outcomes necessitated open surgical intervention (pyeloplasty, nephrectomy) in two patients. One patient developed a clinically significant recurrent urinary tract infection and deterioration of kidney function. Thus, the overall success rate of the endourologic management of the complete UPJ and ureteral strictures was 67% in our series. CONCLUSION: Endourologic management with retrograde or antegrade pyeloureterotomy can be successful in patients with short (up to 1.0-cm) obliterative strictures who are without extensive hydronephrosis and with preserved renal function.
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The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.
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The factors defining the therapy efficacy were studied in 15 patients with purulent inflammatory diseases of the kidneys and urinary tract. It was found that after the use of pefloxacin, urine bactericidal properties against a pathogen was pH-dependent due to high urinary norfloxacin levels. To predict the efficacy of pefloxacin therapy in renal and urinary diseases, the pathogen should be tested for sensitivity to pefloxacin and norfloxacin within a wide range of pH values. Pefloxacin concentrations correlated with plasma bactericidal properties with respect to the pathogen and was applicable in defining the optimal treatment schemes and doses based on the data of individual drug pharmacokinetics. Monitoring of plasma and urine bactericidal properties in regard to the pathogen proved to be useful in estimating the therapy efficacy.
Results of the research on the concentration of zink ions in the blood serum and prostate tissue, urine excretion level by means of heterotropic transplantation of the ovary to castrated rats (males) are presented. The degree of the organism estrogenization was assessed by determining the estradiol concentration in the blood serum by the radio-immune method. The research has shown that castration leads to a zink concentration decrease in the blood serum and its reduced excretion with the urine. A significant rise in the concentration of estradiol in the blood serum did not influence the zink metabolism in the organism.
Experience gained in the use of the first Soviet unit and western lithotriptors is based on the treatment of over 2500 patients of different age groups. Comparative characteristics of lithotriptors are provided to mark substantial advantages of the Soviet unit. Distant lithotripsy (DL) is much more effective and atraumatic as compared with conventional surgical interventions. The use of DL provides positive effect in 97-99% of cases. The rate of complications is extremely low, amounting to 5-10%. Indications and contraindications as to the use of DL are given. Contraindications include cases requiring reconstructive surgical interventions and the presence of coral-like calculi and acute inflammation. The Soviet unit appeared especially effective in the treatment of children with urolithiasis. The cure was attained in 97.2% of the patients, no serious complications occurred. Functional studies of the kidneys did not reveal any changes both in the short- and long-term periods after DL.
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The incidence of morphological and functional changes of the upper urinary passages and the kidneys obtains 78% in chronic prostatitis. The predominant localisation of the inflammation in the prostate and of the changes on the upper urinary passages and the kidneys on the same side confirms the importance of the chronic prostatitis in the pathogenesis of pathological conditions of the uropoetic system. Chronic pyelonephritis and nephrolithiasis can be proved in 24.5 and 78% of the patients with chronic prostatitis, respectively. Thus, the incidence of these diseases is significantly higher in patients with chronic prostatitis than in patients without such a disease. In 47% of the patients with chronic pyelonephritis and nephrolithiasis a latent chronic prostatitis can be proved, when an exact diagnosis was made.
In recent years the morbidity of the acute gestational pyelonephritis increased nearly double. From the anamnesis of 234 female patients who were hospitalised on account of chronic pyelonephritis or urolithiasis in 34.9% renal complications during pregnancy could be established. In these cases a sixfold increased coincidence of the lateral localisation of urological disease compared with the lateral localisation of the obstetrical complications. From the catamnestic data of 32 patients resulted a pathogenetic connection between chronic urological disease and acute gestational pyelonephritis. Pregnant women with contracted pelvis, megafetus, multigravidity and hydramnion fell ill from acute pyelonephritis 4 to 6 times more frequently than those in whom these risk factors which we intend to call compression factors were not existing. 72 pregnant women with compression factors and asymptomatic bacteriuria were given prophylactically antibiotics and carried out position exercises. In none of these pregnant women an acute pyelonephritis appeared during pregnancy. Apart from the primary prevention of the acute gestational pyelonephritis in 108 pregnant women also a prophylaxis of the recidivation of pyelonephritis has been performed. This consisted of a therapy with antibiotics for the persisting, asymptomatic bacteriuria as well as position exercises. Only in 2.7% of the metaphylactically cared patients a recidivation of the acute gestational pyelonephritis developed. Thus incomparison to other authors the number of recidivations of acute gestational pyelonephritides could bei reduced by the four- to sixfold.
In 19 urological patients with pyointoxication and urosepsis 49 plasmaphereses for the purpose of detoxication were performed in the complex with other therapeutic measures. The causes for the pyoseptic complications were as follows: urolithiasis in connection with acute pyelonephritis, acute pyelonephritis (among others in pregnancy, cystic renal dysplasia, carcinoma of the urinary bladder), renal insufficiency in the terminal stage. The treatment of these diseases with haemodialysis and haemoperfusion was complicated by a pyosepsis. Two methods of the plasmapheresis were used: the intermitting plasmapheresis with use of a refrigeration centrifuge K-70 (GDR) and the permanent membrane plasma separation with the device A2008 RG of the firm "Fresenius" (FRG). The plasma perfusion was experimentally proved and in 5 cases used on 5 columns with activated charcoal. The efficacy of the plasmapheresis and the plasma perfusion was apart from the clinical condition judged according to the values of the middle molecules in the blood, or urea, creatinine and the normalisation of the hypoproteinaemia as well as of the humoral immunity. To this are added the increase of diuresis, the normalisation of the haematological parameters and the bacteriological findings of blood and urine. Furthermore, several pathogenetic mechanisms of the positive effect of the plasmapheresis were analysed (mechanic removal of bacteria and their toxins, effect of "deplasmation" with tissue dehydration, improvement of the functional state of the kidneys within the first 3-4 days: reduction of the azotaemic intoxication, the DWS-syndrome, improvement of the rheological properties of the blood and of the microcirculation, increase of the antitoxic function of the liver).(ABSTRACT TRUNCATED AT 250 WORDS)
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