UJR 2003, vol XI, # 4
THE CONTENTS
2003, vol 11, № 4, page 421
A. B. Shapran
Diagnosis of urinary bladder diverticula
Annotation
Objective: To study the efficacy of various examination techniques in diagnosis of urinary bladder diverticula.
Material and Methods: Retrospective and prospective study of the case histories of 42 patients treated at urology departments of Kharkiv Regional Clinical Center for Urology and Nephrology was performed. Urinary bladder diverticula were revealed by endoscopic and/or x-ray, ultrasound study, computed tomography. In 32 patients the diagnosis was verified during the operation.
Results: The diagnosis of urinary bladder diverticula is a complicated multistage process. General clinical study is not valuable and allows only to suggest the presence of inf ravesical obstruction or inflammation in the urinary bladder. Endoscopy cannot be performed in all cases or it is poorly informative. X-ray study is informative only in case of large (not less than 5 cm in the diameter) diverticula, only when the procedure is done very carefully. The most informative is ultrasound study and computed tomography. But taking into consideration the high cost and low accessibility of computed tomography, ultrasound study is more preferable.
Conclusion: General clinical signs of urinary bladder diverticula are not specific, they are caused by the presence of infravesical obstruction and the inflammatory process. The most informative diagnostic techniques in urinary bladder diverticula are ultrasound and computed tomography.
Key words: urinary bladder diverticulum, diagnosis.
2003, vol 11, № 4, page 425
O. М. Fedik
Peculiarities of diagnosis of calcaneus bone osteomyelitis
Annotation
Objective: To study and generalize the peculiarities of calcaneus osteomyelitis the in patients of various age depending on the localization and dessimination of the purulent focus. To evaluate the capabilities of different radiological methods in diagnosis of the pathological process.
Material and Methods: The results of clinical laboratory and radiological examination of calcaneus of 65 patients (children, teenagers and adults) were analyzed, of 65 patients 41 were men, 24 women aged from 8 days to 59 years. The methods of classical radiological investigation in the up-right and lateral axial projections were used. During the first 3-4 days of signs manifestation, to specify the presence of small distraction centers, radiography with primary image magnification and computer tomography were used.
Results: Radiological bindings of the calcaneus osteomyelitis were generalized and systematized. The indications for every method of radiological investigation were grounded. In case of hematogenic osteomyelitis of the calcaneus part lesions pathological process usually spread to overlaying talo-calcaneus and calcaneo-cuboidal joints.
In acute phase small centers of distruction were noted. In patients from different age groups different terms of distractions appearance were defined. Children chiefly had isolated lesions of the calcaneus tuber. In chronic phase the combination of distraction and expressed reactive sclerosis is were noted.
Conclusions: Radiological methods are decisive for specifying the type of inflammation in the calcaneal sponge bones.
Authentic symptoms of the calcaneus osteomielitie are foci of destruction. Peculiarity of the evolution and outcome of the disease depend on timely and correct diagnosis, localization and spreading of the purulent focus.
Key words: foot, calcaneuse bone, osteomyelitis, center of distruction.
2003, vol 11, № 4, page 432
L.V. Derimedvid, L.І, Simonova, V.Z. Gertman
Experimental study of antiradiation properties of recombinant superoxide dismutase
Annotation
Objective: To study antiradiation properties of a new antioxidant preparation, genetic-engineering recombinant superoxide dismutase in the experiment with mice exposed to lethal doses of ionizing radiation.
Material and Methods: The study involved 250 mongrel white male mice weighing 18-22 g. The animals were exposed to single x-ray irradiation at a mean lethal dose (5.8 Gy) and minimal absolute lethal dose (7.5 Gy). The indices of survival, mean life span and death rate of the animals were studied. The efficacy of the preparation was investigated according to 3 protocols: a) administration of the preparation 1 hour before the exposure at a dose of 0.2000 mg/kg, intraabdominally; b) 1 hour after the exposure at a dose of 0.065 mg/kg; c) administration of the preparation before and after the exposure in the above doses.
Results: It was shown that the preparation had a marked radioprotective effect. The experiments on animals exposed to ionizing radiation at a absolute and mean lethal doses demonstrate considerable increase of survival rate, mean life span of the dead animals, shifts in the peaks of lethaliry to later terms, reduction in the percentage of animals with intestinal sundrome. The most effetive was the protocol of double administration of the pre paration, i.e. 1 hour before and 1 hour after the exposure.
Conclusion: A new antioxidant preparation, recombinant superoxide dismutase has marked radioprotective properties at lethal doses of ionixing radiation. Radioprotective effect of the preparation provides modification of main clinical manifestation of acute radiation sickness.
Key words: recombinant superoxide dismutase, ionizing radiation, lethal doses, survival.
2003, vol 11, № 4, page 438
A.V. Svinarenko
First results of neoadjuvant chemoradiotherapy for rectal cancer
Annotation
Objective: To improve the efficacy of treatment for resectable rectal cancer by intensification of neoadjuvant radiation and chemotherapy and its administration in chronomodulated mode.
Material and Methods: Main group consisted of 15 patients with rectal cancer aged 35-76, of them 8 with stage 1 (T2N0-XM0) and 7 stage 2 (T3-4N0-XM0) disease. Chemoradiotherapy (CRT) was administered in chronomodulated mode using the original technique to prevent immunohematological and gastrointestinal toxic effects. The treatment lasted 5 days, the patients were admi nistered Leucovorin 20 mg/m 2 and FU-5 500 mg/m2 daily as well as distant gamma-therapy (mean focal dose on the small pelvis 25 Gy in 5 daily fractions). The controls were 10 patients treated according to the standard protocol (25 Gy + surgery). In the both groups the operation was performed 24 hours after CRT.
Results: The patients tolerated chronomodulated CRT well, though 9 (60%) of them complained on increase of pain, nausea, weakness during CRT. All these side effects either did not require drug treatment (grade 1 toxicity, 7 (46.7%) or were easily controlled by 1-2 injections of analgesics and antiemetics (grade 2 toxicity, 2 (13.3%) cases). Grade 3-4 toxicity was not noted. The toxicity of CRT could be considered minimal as it did not require stoppage of the treatment, reduction of the dose or changes in the term of the operation.
Conclusion: In resectable rectal cancer five-day neoadjuvant CRT (when done in chronomodulated mode) is characterized by low toxicity. Simultaneous pre-operative radiation therapy and chemotherapy do not increase the number of post-operative complications.
Key words: rectal cancer, radiation therapy, chemotherapy, chronomodulation.
2003, vol 11, № 4, page 441
R.V. Senyutovich, A.O. Gonca, L.I. Paholko, G.М. Skrindica, V.I. Krivchanskiy, I.O. Dacyuk
Combination of radiation and electrochemotherapy: validatioaequi pment, preliminary findings
Annotation
Objective: To study some biological effects of combined use of electrochemotherapy and radiation therapy. To develop technique and equipment for electrochemotherapy, to analyze the most perspective fields of use of combined electrochemo- and radiation therapy.
Material and Methods: Some biological effects of electrochemotherapy were studied in 5 women with breast cancer and 52 healthy rats and rats with Guerin carcinoma. The blood circulation of the tumor was measured by rheomammography, concentration of 5-FU in the tissue, oxidation and antioxidation system of the carcinoma, proteolytic and fibrinolytic activity were studied. Electrochemotherapy and radiation were used in 54 patients with breast cancer (21), cancer of the cervix (19), cancer of the vulva (2) and head and neck (12).
Results: After electrochemotherapy vascularization of the tumor increased 2—3 times, concentration of 5-FU by 27.78— 54.17 %, oxidation processes (malonic dialdehyde by 123.83 %). Different rate of voltage and resistance were discovered to depend op the method of electrochemotherapy. The best results were obtained at combined use of neoadjuvant electrochemotherapy and radiation in breast cancer (complete and partial regression increased by 12.5 %).
Conclusion: Combined radiation and electrochemotherapy with DC is perspective, but requires a more detiled study and improvement.
Key words: cancer, electrochemotherapy, radiation, breast, uterine cervix.
2003, vol 11, № 4, page 446
O.V. Мercalova
The course of pregnancy, delivery and their outcomes in high-risk pregnant women with amnion pathology
Annotation
Objectives: To study the influence of amnion pathology on the course of pregnancy, delivery, and perinatal outcomes in high-risk pregnant women.
Material and Methods: Two hundred and forty high-risk pregnant women were examined at 32-40th week of gestation. Clinical examinations, MRI determination of amniotic fluid volume, Dopplerometry, determination of the fetal biophysical profile, investigations of the acid-base blood state in the vessels of the umbilical cord were performed.
Results: A distinct dependence between the level of amnion pathology and the level of hemodynamic impairments in the "mother-placenta-fetus" system was revealed. It was found out that the amnion pathology is characteristic for different variants of fetal CNS hypoxic injuries, and it was the most prononuced in the group of pregnant with combined variants of fetal CNS hypoxic injuries. Perinatal outcomes in amnion pathology are determined by the amount of amniotic fluid, the level of fetal CNS hypoxic injuries, terms of pregnancy, efficacy of the administered therapy, and the method of delivery.
Conclusions: MRI of pregnant women allows to define the most precisely both the volume of amniotic fluid and fetal CNS conditions. The pathology of the amniotic fluid is accompanied by reduction of the hemodynamic level in the "mother-placenta-fetus" system. It may be a marker for presence of fetal CNS hypoxic injuries.
Key words: MRI, deficiency of amniotic fluid, fetal CNS hypoxic injuries, Dopplerometry.
2003, vol 11, № 4, page 449
І.М. Homazyuk, O.S. Kovalyov, G.V. Sidorenko
Tolerance to physical load in victims of Chornobyl accident with hypertension disease the data 15 years after the accident
Annotation
Objective: To study long-term tolerance to physical load (TPL) and the factors which chiefly determine its changes in victims of Chornobyl accident with hypertension (H).
Material and Methods: The study involved 210 participants of Chornobyl accident clean-up. The monitoring of their health was performed for 15 years after the accident. Of them 47 had stage I hypertension and 130 stage II hypertension, 33 did not have any disease of the blood circulation system. The dose of external irradiation of the patients was 5-50 cSv, mean 16.4 ± 1.9 cSv. Standard interrogation, analysis of radiation exposure and risk factors, physical examination, tonometry, ECG, Doppler ultrasound study and veloergometry were performed.
Results: Fifteen years after the accident, threshold power (Wt) and total volume of the work (TVW) reached the proper values for the given age and body mass in 70 % of cases.
More significant limitation of TPL was observed in stage II hypertension. Significant reduction in Wt compared with by 27.5 % , TVW by 42 % was noted when compared with healthy subjects. Threshold power in stage II hypertension decreased up to 50 W in 35 % of cases. In contrast to the victims without diseases of the circulatory system, in hypertension load provision was characterized by prevail of systolic arterial pressure (CAP) increase, less pronounced changes in the heart rate (HR), increase of energy loss per unit of the work done. Linear dependence of increase or reduction of Wt and the dose of external exposure within the range of 550 cSv was not observed in the victims.
Conclusion: Together with the degree and duration of arterial hypertension, TPL in the victims was associated with disturbances of diastolic filling of the left ventricle. Correlation of Wt and the ratio of maximal rate of early and late diastolic filling of the left ventricle ( LV ) r = 0.36 (p < 0.05) to the time of isovolumetric weakening r = -0.36 (p < 0.05) was established. Considerable reduction in TPL was observed at developmend and prog ress of LV hypertrophy. At concentric remodelling of the LV, the changes of Wt and TVW were more marked at further remodelling of the heart with TPL reduction precursor was combination of remodelling of the LV and the adjacent chamber of the left atrium.
Key words: tolerance to physical load, victims of Chornobyl accident, hypertension.
2003, vol 11, № 4, page 455
O.V. Taciy
The experience of application of various types of laser radiation (alexandrite and helium-neon) to correction of hypertrichosis in women with hormonal disturbances who lived in contaminated territories after Chornobyl accident
Annotation
Objective: To study the efficacy of combined action of helium-neon and medical high-intensity pulsed alexandrite laser in women with hirsutism and hormonal dysmenorrhea caused by ovarial dysfunction who were evacuated from contaminated territories.
Material and Methods: The efficacy of hirsutism treatment with helium-neon and medical high-intensity pulsed alexandrite laser was evaluated during combined laser therapy in 27 women with hormonal dysmenorrhea who were evacuated from contaminated territories in 1986-1987. The efficacy of the treatment was assessed visually and by hormone parameters.
Results: It was shown that combined action of medical high-intensity pulsed alexandrite laser radiation applied locally in the zones of pilosis and He-Ne laser radiation, which normalized reproductive hormonal homeostasis, was effective in post-radiation verilization in patients with hormonal dysfunction. After 6-8 treatments with medical high-intensity pulsed alexandrite laser in case of reversible disturbances of hormonal state and 12-25 treatments in amenorrhea abundant pilosis was eliminated in 100% of the patients. The epilation effect was more pronounced in reversible disturbances of ovary function.
Conclusion: Combined application of helium-neon and medical high-intensity pulsed alexandrite laser (wave length 755 nm) is a new up-to-date safe and effective method of medical correction of abundant pilosis.
Key words: hirsutism, hormonal dysbalance, laser epilation, alexandrite laser, helium-neon laser.
2003, vol 11, № 4, page 460
L.P. Sarichev, O.S. Stavnichiy, Y.V. Sarichev
The role of ultrasound monitoring in the choice of treatment tactics in renal abscess
Annotation
Objective: To evaluate the efficiency of ultrasound (US) monitoring in the choice of treatment tactics in renal abscess.
Material and Methods:The study involved 35 patients with renal abscess aged 11- 75. In 19 cases renal abscess was preceded by purulent-inflammatory diseases of another localization (skin furuncles, phlegmonous appendicitis, liver abscess, periodontitis, osteomyelitis) and only in 1 case it had obstructive etiology.
Results: In 30 patients (85.7%) the disease was accompanied by development of systemic inflammatory response syndrome. The diagnostic sensivity of ultrasonography in case of renal abscess was 91.4 % . Addition of the kidney puncture biopsy to US monitoring increased the efficiency of diagnosis up to of 100 %. In 23 cases (65.7 %) US monitoring allowed to avoid more complex and expensive examinations.
In the initial (predestructive and destructive) phases of purulent-inflammatory process in 11 patients with the foci of destruction measuring 2.5- 5.0 cm (mean 3.3 ± 0.2 cm ) the course of antibacterial therapy was successful (full regression of the inflammatory process was achieved). In 20 patients with ultrasound signs of purulent fusion of the inflammatory foci measuring mean 2.5-6.4 cm (mean 4.4 ± 0.3 cm ) the antibacterial therapy was supplemented by percutaneous drainage of the renal abscess. Four patients with renal abscess measuring 2.5-12.0 cm (mean 6.8 ± 2.0 cm ) with accompanying paranephritis underwent open surgical intervention.
Conclusion: The US monitoring of pathological process development is a leading method in the choice of renal abscess treatment tactics.
Key words: renal abscess, ultrasound monitoring, conservative wait-and-see tactics.
2003, vol 11, № 4, page 464
Y.O. Vinnik, I.Y. Neffa, G.S. Іslyamova
The results of preoperative chemotherapy administration in complex treatment for cervical cancer
Annotation
Objective: To study immediate and long-term results of preoperative chemoradiotherapy (CRT) in complex treatment of cervical cancer.
Material and Methods: Using temporal randomization 86 patients with cervical cancer were divided into 2 groups, group 1 — 34 patients who were administered preoperative CRT and group 2 (controls) — 52 patients who were administered pre operative radiotherapy (RT).
In group 1 carboplatin was used as RT modifier (400 mg/m2) in combination with hemcytablatin (2000 mg/m2); mean focal dose of pre-operative distance gamma-therapy was 20 Gy. The dose was not modified. 48 hours after neoadjuvant therapy extensive panhysterectomy according to Wertheim was performed. After the operation all patients were administered RT, MFD 50 Gy.
Results: The use of pre-operative CRT cause side effects of minimal degree of toxicity (WHO, 0—1) which suggests good tolerance by the patients. It was determined that early radiation lesions of the wrinary bladder reduced by 5 % and those of the rectum reduced by 8 % when neoadjuvant CRT was administered. The use of pre-operative CRT allowed to reduce the incidence of post-radiation cystitis by 14 %, to improve the results of treatment due to increase in the number of positive responces by 21 %, to increase 3-year relapse-free survival by 14 % and 3-year total survival by 12 % .
Conclusion: The use of the suggested technique of neoadjuvant CRT in parients with cervical cancer improves the efficacy of complex treatment and its results.
Key words: cervical cancer, chemoradiotherapy, hemcytabin, treatment efficacy, immediate and long-term results.
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