THE AIM of the work was to study the features of the endothelial dysfunction in patients with chronic kidney disease (CKD) at the preclinical stage of atherosclerosis depending on the type of hyperlipoproteidemia. PATIENTS AND METHODS. The investigation included 180 patients with CKD having no clinical signs of atherosclerosis. Parameters of lipidogram, lipid peroxidation, intima-media thickness, reactivity of microvasculature were determined. RESULTS.Lowering glomerular filtration rate was accompanied by disturbances of endothelium-independent and thenendothelium-dependent vasodilatations. CONCLUSION. CKD is an independent factor contributing to impairment of vessel functions.

THE AIM of the investigation was to study possible usage of brain natriuretic peptide (BNP) in diagnostics of chronic heart failure (CHF) in patients with chronic kidney disease (CKD) treated by chronic hemodialysis. PATIENTS AND METHODS. Under observation there were 52 patients with CKD. Clinical-functional indices of CHF and BNP level were studied. RESULTS. The concentration of BNP in 77% of patients with clinico-laboratory signs of CHF was found to be reliably higher than that in patients without CHF. The BNP level was the higher the higher the stage of CHF. CONCLUSION. The data obtained have shown that the level of BNP 100 pg/ml and more can be used as a diagnostic criterion of CHF in CKD patients treated by chronic hemodialysis.

THE AIM of the investigation was to sum up the authors’ personal experience with using Nutricomp® ADN Braun Renal (B/Braun, Germany) in practice of nutrition maintenance of patients on regular hemodialysis (HD). PATIENTS AND METHODS. Under examination there was a group of 20 patients (12 men and 8 women) treated by regular HD and having symptoms of protein-energetic insufficiency (PEI). The patients were given daily doses of the drug (45g a day). The laboratory and anthropometrical indices characterizing the presence and degree of PEI were studied in dynamics. The observations were carried out during 6-12 months. RESULTS. It was found that the postdialysis body mass grew clearly greater by the end of observations (from 62.8±13.3 to 64.2±13.5 kg; p<0.002) ; body mass index from 21.5 ±3.20 to 22.0±3.36 kg/m2; p< 0.001); shoulder circumference (from 22.92± 3.41 to 23.51±3.50 cm; p<0.001); circumference of the shoulder muscles (from 21.02 ±4.06 to 28.39±3.34 cm; p<0.001); thickness of the skin-fat fold over triangularis and biceps (from 6.11±4.70 to 6.87±4.94 mm; p<0.02) as well as the absolute content of lymphocytes in peripheral blood (from 1.0±0.36 to 1.63±0.54 х 109/l; p<0.001). The predialysis level of total calcium in blood serum (from 2.42±0.28 to 2.25±0.15 mmol/l; p<0.02) became reliably lower. No reliable changes were found in other laboratory parameters under study such as concentration of albumin in blood serum, of inorganic phosphorus, total cholesterol, content of hemoglobin and erythrocytes in peripheral blood. On the whole, an analysis of the degree of malnutrition has shown that its symptoms disappeared in 3 patients, its degree became less in 16 patients and only in 1 patient the PEI became more severe. CONCLUSION. Our experience with using Nutricomp® ADN Braun Renal in patients with the terminal stage of renal failure treated by regular hemodialysis shows good perspectives of this drug as an additional enteral nutrition.

THE AIM of the investigation was to assess the renoprotective and hypotensive efficiency of antihypertensive agents of different classes for patients with gout glomerulonephritis. PATIENTS AND METHODS. Results of using different classes of antihypertensive agents were assessed in 82 hypertensive patients with gout glomerulonephritis. RESULTS. Renoprotective and cardioprotective effects are characteristic of the inhibitors of angiotensin-converting enzyme and blockers of angiotensin-2 receptors. Cardioprotective effects (less incidence of development of myocardial infarction and chronic heart failure) are peculiar to angiotensin-converting enzyme inhibitors and blockers of angiotensin-2 receptors. Blockers of angiotensin-2 receptors have a hypouricamic property. The inhibitors of angiotensin-converting enzyme and blockers of angiotensin-2 receptors and calcium channels blockers contribute to lowering the cholesterol concentration in blood while the inhibitor of imidazoline receptor moxonidine proved to be metabolically neutral, and beta-adrenoblockers on the contrary increased the serum concentration of cholesterol. CONCLUSION. So, the greatest frequency of getting the required figures of pressure was obtained against the background of administration of the inhibitors of angiotensin- converting enzyme, calcium channels blockers and beta-adrenoblockers. The least (as compared with other classes of agents) hypotensive effect was established for blockers of angiotensin-2 receptors.

THE AIM of the investigation was to assess changes to the right heart chambers depending on the blood flow along arteriovenous fistulas of different localization as a permanent vascular access in patients treated by hemodialysis. PATIENTS AND METHODS. Echocardiographic and dopplerographic examinations were carried out in 62 patients with chronic renal failure (CRF), treated by hemodialysis. RESULTS. Convincing data were obtained concerning the influence of the shunt blood flow along the arteriovenous fistulas on changes to the right heart chambers, size and rated pressure in the pulmonary artery, as well as intensity of the clinical picture of heart failure. For possible correction of the appearing alterations five reconstructive operations were performed followed by distinct positive dynamics including decreased shunt blood flow and echocardiographic sizes of the right heart chambers. CONCLUSION. The work resulted in determination of the volume of optimal blood flow (500 ml/min or 5% of the heart output) and indications for operative interventions on the present anastomosis (greater sizes of the right auricle > 50 mm, shunt blood flow > 1000 ml/min or 10% of the cardiac output).

THE AIM of the study was to assess the ability of heart rate to determine physical capacity of dialysis patients. PATIENTS AND METHODS. Under investigation there were 147 dialysis patients. In all the patients spiroergometry and echocardiography were used. RESULTS. The decreased stroke volume was registered in 45% of the patients despite the absence of clinical signs. Heart rate did not reflect the volume of the fulfilled work and its power. CONCLUSION.A combination of heart rate at the peak of loading and the time of achieving the maximal capacity for work allowed adequate assessment of the physical capacity for work both with and without heart failure.

THE AIM of the investigation was to assess effects of a combination of thermal and toxic factors of the fire environment on dynamics of kidney lesions. MATERIAL AND METHODS. Pieces of the kidneys from 47 corpses of humans dead due to action of fire factors, and corresponding medical case histories of stationary patients were used as objects of the investigation. For modeling a combined thermo-chemical injury 48 outbred white rats were used. Sections of the renal tissue were stained with hematoxylin-eosin after Van-Gieson. RESULTS. In victims of the combined thermo-chemical injury the concentration of urea after the first day was 9.1± 0.78, on the second day – 10.9 ±1.06 mmol·l -1, amounting to 14.6 ± 2.51 mmol·l -1 by the 6th day. A correlation analysis has shown that during the first 3 days the urea concentration depended both on severity of trauma and the content of COHb at the moment of admission to hospital. Later the connection with these features of injury became weaker. Histological investigations of cases of combined effects of high temperature and CO have found more pronounced alterations as compared with an isolated thermal trauma, that possessed a malignant course and were characterized by necrosis of the epithelium of not only convoluted tubules, but also of the straight tubules; in the peritubular spaces there was sharp plethora of the capillaries and diapedesic hemorrhages. In the glomerular apparatus there was plethora of capillary loops and an extension of the area was also accompanied by protein exudates into the urinary space of the glomeruli. The detected changes at the early posttraumatic period can be accounted for by effects of hypoxia and biologically active substances excreted in great amounts in burns. CONCLUSION. Combined thermochemical injuries resulting from action of fire factors are characterized by a marked nephrotoxic effect with morphological manifestations typical of glomerulonephritis. Clinicolaboratory findings, dynamics of lethality during the posttraumatic period and morphological alterations in the kidneys suggest that lesions of the kidneys are a substantial factor influencing the outcome of the combined trauma.

THE AIM of the work was to comparatively investigate effects of low intensity laser radiation (LILR) with wave length 632.6 nm on mechanical activity of cardiomyocytes and contractility of smooth muscle cells of the portal vein in the same rats with chronic renal failure (CRF). MATERIAL AND METHODS. An analysis of effects of LILR on contractility of the papillary muscle of the heart in Wistar rats with CRF (resection of 5/6 of the kidney mass) was made under conditions of isometric and physiological regimens of loads. Effects of LILR on the autorhythmical contractile activity of the portal vein were investigated in the same animals. RESULTS. Progression of CRF was accompanied by growing functional activity of smooth muscle cells of the portal vein (general amplitude of the phasetonic contractions and the work fulfilled by the vein became 1.5 times greater) and decreasing force of contractions and rate of relaxation of cardiomyocytes. Laser radiation of the heart papillary muscle resulted in a considerably improved contractility of the myocardium in rats with CRF but failed to influence the autorhythmical contractile activity of the portal vein. CONCLUSION. It was shown that effects of laser radiation on the portal vein and cardiomyocytes depended on the initial functional state of the irradiated object.

THE AIM of the investigation was to analyze the question of possible fluctuation of the effect of diuretics, drugs that are also widely used in cardiologic clinics, depending on the circadian biorhythms in rats. MATERIAL AND METHODS. Furosemide was injected intraperitoneally (20 mg/kg) to rats weighing 200-250 g. Effect of the drug following the injection was assessed at 12pm and at 12 am. Diuresis, excretion of Na+ , K+ and creatinine were measured every 6 hours during a day. Then effects of furosemide were investigated in rats, half of which were kept in the dark during 7 hours, and another half – in the light. In the third series of experiments the biorhythms were distorted: the animals were placed in the dark for 12 hours in the daytime, and at night the light was switched on. Part of the animals was given the drug at 12 a.m., the other part – at 12 p.m. RESULTS. The rats given the diuretic at noon had the level of diurnal urination about 40%, and excretion of Na+ about 30% higher, than in the animals given firosemide at midnight. The growth noted took place at night, since no difference in the action of the drug was observed during the first 6 hours after injection. Injection of furosemide to the rats long kept in the dark resulted in the development of diuresis and natriuresis, that were the same 30-40% higher than the action of the drug in the rats kept in the light. Under conditions of the distorted circadian rhythm no differences in the diuretic and natriuretic effects of furosemide were detected, since the fluctuation depending on the circadian rhythm disappeared. At the same time, sharply increased diurnal excretion of Na+ was noted in animals kept in the light over a long period of time and under conditions of distorted biorhythms. It might be explained by stress effects of a continuous exposure to light and of changed circadian rhythms on sodium excretion in nocturnal animals – rats. CONCLUSION. The effects observed appear to be due to the involvement of regulatory properties of epiphysis and suprachiasmic nuclei of the hypothalamus by means of dophamine and melatonin, as well as to changed formation of the sympathetic system and the hypothalamus-hypophysis-adrenals axis.

THE AIM of the investigation was to carry out a complex study of the state of glutathione and intensity of lipid peroxidation processes in poisoning with cyclophosphamide in dose of 200 mg/kg of body mass. MATERIAL AND METHODS. Concentrations of reduced glutathione, sulfhydril groups of proteins, malonaldehyde, diene conjugates and activity of glucose-6-phosphatedehydrogenase, glutathione reductase, glutathione peroxidase, glutathione-S-transpherase, catalase were determined spectrophotometrically in the kidney and liver tissues of 50 white outbred rats. RESULTS. It was shown that this form of intoxication was followed by pronounced changes in the glutathione system in the liver and kidney tissues of poisoned animals (reduced content of reduced glutathione, impaired activity of glutathione reductase, glucose-6-phosphatedehydrogenase, glutathione reductase, glutathione-S-transferase).Causes of the appearance of the data of bio-chemical shifts, their interstitial distinctions and their role in realization of the cytotoxic action of cyclophosphamide were discussed. CONCLUSION. So, the pathogenetical role of exhaustion of the functional resources of the glutathione system was established as well as of activation of free radical processes in realization of the cytotoxic effects of alkilating preparations. 

THE AIM of the investigation was to assess efficiency of sling operation using a bi-needle-shaped applicator of Eikenberg and prolene gauze in treatment of stress urinary incontinence in women. PATIENTS AND METHODS. Sling operations using a bi-needle-shaped applicator of Eikenberg and prolene gauze were fulfilled on 63 women having stress urinary incontinence. The patients had not been operated before. The examination failed to reveal urodynamic signs of neurogenic bladder and clinical symptoms of imperative incontinence. The average time of operation was 40 minutes. RESULTS. All the patients endured the operation well. Perforation of the bladder with applicator needles taking place as an intraoperative complication was noticed and eliminated during operation. Impossible independent urination was noted after operation in 2 patients. Clinical and urodynamic signs of hyperactivity of the bladder were noted in 7 patients (not longer than for 3 months).The 3-year follow-up has shown that in 2 patients there occurred recurrent stress urine incontinence. CONCLUSION.The operation described is effective in treatment of women with stress urine incontinence and can be widely used in clinical practice. 

THE AIM of the investigation was to improve results of treatment of patients with hyperplasia of the medial lobe of the prostate. PATIENTS AND METHODS. An examination of 1325 patients with benign hyperplasia of the prostate has shown that 198 (14.9%) of them had hyperplasia of the medial lobe; 49 (24.7%) patients of this group had an increase of only medial lobe, while 149 (75.3%) patients simultaneously had also hyperplasia of the lateral lobes (3-lobed form of benign hyperplasia of the prostate). RESULTS. It was found that in the clinical picture of the disease prevailing were the obstructive symptoms, the W.Schafer nomogram being 5.09±0.35 units. Medicines failed to influence the volume of the medial lobe of the prostate. Operative treatment of the patients consisted in transurethral resection either of the hyperplastic medial lone or of the medial lobe coupled with the lateral lobes. CONCLUSION. Hyperplasia of the medial lobe developed mainly at an expense of the stromal rather than epithelial tissue of the prostate. The main method of treatment is transurethral resection.

THE AIM of the investigation was to study the prognostic value of a cytological investigation of urine sediment in patients with superficial cancer of the bladder. PATIENTS AND METHODS. Materials of 76 patients were analyzed after transurethral resection for cancer of the bladder. The ratio of men and women was 4:1, mean (±SD) age was 65±10 years. A histological investigation of the tumor tissue has shown that the depth of invasion of cancer Tis, Ta, T1, T2 and T4 was found in 2 (3%), 11 (16%), 37 (53%),19 (27%) and 1 (2%) patients respectively, the degree of differentiation G1, G2, and G3 – in 35 (50%), 19 (27%) and 16 (23%) patients respectively. A single cytological investigation of the sediment of the diurnal portion of spontaneous urination was carried onafter centrifugation at 1000 r during 4 min. The preparations were dried in the air and stained with azure[1]eosin by the method of Leischman. The cellular composition and cytological signs of malignization were assessed in the light binocular microscope with magnification 100×and 1000×according to cytological criteria of L.G. Koss classification. The cancer stage was determined in a histological investigation of the ablated tumor tissue according to TNM classification, the degree of differentiation of the tumor cells being estimated according to recommendations of F. Mostofi et al. RESULTS. The cytological investigation of the urine sediment has confirmed the clinical diagnosis of bladder cancer in 61 (80%) patients, 54 (89%) patients were found to have transitional cell carcinoma. The sensitivity of the cytological investigation in detection of bladder cancer of degrees G1, G2 and G3 was 74%, 93% and 94% respectively, with depth of invasion Tis, Ta,T1, T2 and T4 proved to be equal to 50%, 71%, 83%, 92% and 100% respectively. Differences of determination of category G in the tumor tissue and urine sediment were noted in 19 (58%) patients. Survival of patients with bladder cancer in the postoperative period of follow[1]up, recurrences of cancer and durationof periods without recurrences were closely connected with the degree of differentiation of the tumor cells (t=2.55; p=0.013, t=2.00; p=0.028 and r= 0.38; p=0.039 respectively). CONCLUSION. The cytological investigations in most cases gave information of histological characteristics and degree of anaplasia of carcinoma and made it possible to determine as early as at the preoperative period the belonging of patients to a group of high risk of recurrence and progression of cancer.