Взаимосвязь органических и неорганических веществ при формировании мочевых камней

Macro- and microscopic structural features of human urolyths have been studied to reveal the relation between organic and inorganic components and the role of the latter in the process of urolyth formation and growth. The combined study of the shape, color, surface, mineral and organic composition, and internal structure and zoning of 788 urolyths has been performed. Crystallomorphological, polarization-optical, X-ray-diffraction, electron-microscopic, chemical, neutron-activation, and computer technologies of study of the urolyth structure have been used. It has been found that macroscopic characteristics of uroluths (color, shape, surface, and size) did not reflect the chemical composition of urolyths. In the structure of abundance of urolyths in Tomskand the Tomsk Region, oxalates (58%) and urolyths of complex mineral composition (29%)  prevail. It has been found that an urolyth is an organomineral aggregate having the internal structure formed by a rhythm of alternation of organic and inorganic layers and the character of arrangement of individual mineral crystals, and the internal structure is independent of the chemical composition of the urolyth and  uniform in urolyths of different chemical composition. The most part of urolyths has a mixed (44%) or druzy (35%) type of crystal arrangement and the  combined (45%) or grainy (31%) rhythm of alternation of organic and inorganic components.Исследованы макро- и микроскопические структурные особенности мочевых камней человека с выявлением взаимосвязи органической и неорганической составляющих и роли последней в процессе формирования и роста камня. Выполнено комплексное исследование формы, цвета, характера поверхности, минерального и органического составов, а также внутренней структуры и зональности 788 мочевых камней. Использованы кристалломорфологические, поляризационно-оптические, рентгеноструктурные, электронно-микроскопические, химические, нейтронно-активационные, а также компьютерные технологии изучения строения уролитов. Установлено, что макроскопические признаки камня (цвет, форма, характер поверхности и размеры) не отражают его химического состава. В структуре распределения мочевых камней в г. Томске и Томской области преобладают оксалаты (58%) и камни сложного минерального состава (29%). Выявлено, что мочевой камень является органоминеральным агрегатом, имеющим внутреннюю структуру, сформированную ритмом чередования слоев веществ органического и неорганического строения и характером расположения отдельных кристаллов минералов, при этом внутренняя структура не зависит от химического состава камня и однотипна у камней разного химического состава. Большая часть мочевых камней имеет смешанный (44%) или друзовидный (35%) тип расположения кристаллов и комбинированный (45%) или зернистый (31%) ритм чередования органических и неорганических составляющих

ДИАГНОСТИКА СТЕНОЗОВ СТВОЛА ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ И ПЕРЕДНЕЙ НИСХОДЯЩЕЙ КОРОНАРНОЙ АРТЕРИИ С ПОМОЩЬЮ ТРАНСТОРАКАЛЬНОЙ ЭХОКАРДИОГРАФИИ

Purpose. To detect the potential of different qualitative, semi-quantitative and quantitative transthoracic Doppler signs for successful evaluation of stenotic left main coronary artery (LMCA) and left anterior descending artery (LAD).Materials and methods. 173 patients (52±10 years; 149 men) with chest pain, sinus rhythm and scheduled quantitative coronaryangiography (CAG) were evaluated at rest by non-contrast transthoracic echocardiography (TT E). LMCA and proximal (p), mid (m) and distal (d) parts of the LAD were examined. The Doppler signs of coronary stenosis >50 % were determined as follows: 1 – local Doppler aliasing with the Nyquist limit set at 60 cm/s; 2 – maximal peak diastolic velocity (Vpd) >60 cm/s; 3 – ratio of stenotic/prestenotic Vpd >2.0; 4 – stenosis >50 % according to flow continuous equation: stenosis, % = 100 × (1 – prestenotic VTId / stenotic VTId), where VTId – diastolic time velocity integral. CAG was performed within 1 week after TT E. Stenosis >50 % of diameter reduction was considered as significant.Results. Sensitivity (Sens), specificity (Sp) and diagnostic accuracy (Ac) of different Doppler stenotic signs for stenotic LMCA andLAD are presented in Table 1. Thus, TT E is a method for correct evaluation of stenotic LMCA and LAD. Quantitative ratio of stenotic to prestenotic coronary flow velocities is a more sensitive sign for detecting stenosis >50 %, than qualitative and semi-quantitative evaluation of maximal coronary flow velocity only.Цель. Оценить возможности неконтрастной трансторакальной эхокардиографии (ТТ ЭхоКГ) для качественной, полуколичественной и количественной диагностики стенозов ствола левой коронарной артерии (ЛКА) и передней нисходящей коронарной артерии (ПНА).Материалы и методы. ТТ ЭхоКГ выполнена у 173 человек (средний возраст 52±10 лет; 149 мужчин) с болью в левой половине грудной клетки, направленных в стационар для проведения коронарной ангиографии (КАГ). Исследован ствол ЛКА, проксимальный (пр/3), средний (ср/3) и дистальный (д/3) сегменты ПНА. Доплерографическими признаками стенозирования >50 % считали: 1 – локальный aliasing при использовании предела Найквиста 60 см/с; 2 – максимальную пиковую диастолическую скорость корнарного кровотока (Vpd) >60 см/с; 3 – отношение стенотическая Vpd / престенотическая Vpd >2,0; 4 – стеноз >50 % в соответствии с уравнением непрерывности потока: стеноз, % = 100 % × (1 – престенотический VTId / стенотический VTId), где VTId – интеграл скорости кровотока в диастолу. КАГ была проведена в течение 1 недели после ТТ ЭхоКГ; стенозы определяли как значимые, если уменьшение диаметра сосуда превышало 50 %.Результаты. Чувствительность (Ч), специфичность (Сп) и диагностическая точность различных доплерографических признаков для выявления стенозов ЛКА и ПНА представлены в таблице 1. Таким образом, ТТ ЭхоКГ является корректным неинвазивным методом диагностики стенозов ЛКА и ПНА. Количественное сравнение скоростей кровотока в престенотическом и стенотическом участках является более чувствительным доплеровским признаком стенозования >50 %, чем качественная и полуколичественная оценка стенозирования по максимальной скорости кровотока

Гендерные аспекты развития уролитиаза у пациентов с метаболическим синдромом

The review summarizes and analyzes the results of domestic and major foreign studies of recent years concerning gender characteristics of the epidemiology and development mechanisms of metabolic syndrome and urolithiasis as an associated disease. A deep understanding of gender aspects in the pathogenesis of these pathologies can form the basis for development of high-quality diagnostic algorithms and pathogenetically grounded approaches to treatment. В обзоре обобщены и проанализированы результаты отечественных и крупных зарубежных исследований последних лет, касающиеся гендерных особенностей эпидемиологии и механизмов развития метаболического синдрома и мочекаменной болезни как ассоциированного с ним заболевания. Глубокое понимание гендерных аспектов в патогенезе данных патологических процессов может лечь в основу разработки качественных диагностических алгоритмов и патогенетически обоснованных подходов к лечению.

Integrated retrograde and antegrade contact electro-impulse lithotripsy in the treatment of kidneys and ureteropelvic junction stones

Introduction. Nowadays, the tactics of removing stones from the kidneys and the ureteropelvic junction are widely covered and described in detail in modern guidelines. Determination of one or another treatment way depends on stone specific features and patient`s constitutional peculiarities. However, usage of percutaneous or retrograde access only does not always allow achieving a good result. In sophisticated cases, such as a large-size branchy renal stone, a “penetrated” stone in the ureter’s upper third, or some patient`s anatomic peculiarities, search for new ways to remove such stones with integrating accesses.Purpose of the study. To evaluate the removal efficiency of kidney stones and ureteropelvic junction by a combination of retrograde and percutaneous lithotripsy using electrical impulse energy. Materials and methods. In 2014-2019 in Siberian State Medical University Clinics (Tomsk, Russia), the integrated retrograde and percutaneous lithotripsy was applied in 26 cases to patients that had differently positioned kidneys’ and ureteropelvic junction stones. The treatment was based on the usage of the electro-impulse lithotriptor Urolith-105M (Lithotech Medical, Israel, MedLine LLP, Russia). In some cases, the laser lithotriptor Calculase II (Karl Storz, Germany) was also engaged. Result. The patients were aged from 25 to 76 (women - 69.2%). The calculus average size was 19.5 mm (varying from 5 to 51 mm). The calculus average density was 1229 HU (from 510 to 1720 HU). The operation average duration was 131 minutes (from 40 to 280 minutes). The incidence of complications was 3.84%. The complete calculus destruction occurred in 92.3% of cases. The overall response rate in re-operations reached up 100%.Conclusion. Integration of antegrade and retrograde accesses with use of the electro-impulse energy in removing complex stones from ureteropelvic junctions and kidneys proved to be an efficient method of treatment and demonstrated great results. Furthermore, this option of the single-step access to the stones is the only one possible in some cases when the extracorporeal lithotripsy is contraindicated, application of upfront surgery is quite risky, or endoscopic methods as an antegrade/retrograde mono-access are not effective

Relation of organic and inorganic substances in formation of urolyths

Macro- and microscopic structural features of human urolyths have been studied to reveal the relation between organic and inorganic components and the role of the latter in the process of urolyth formation and growth. The combined study of the shape, color, surface, mineral and organic composition, and internal structure and zoning of 788 urolyths has been performed. Crystallomorphological, polarization-optical, X-ray-diffraction, electron-microscopic, chemical, neutron-activation, and computer technologies of study of the urolyth structure have been used. It has been found that macroscopic characteristics of uroluths (color, shape, surface, and size) did not reflect the chemical composition of urolyths. In the structure of abundance of urolyths in Tomskand the Tomsk Region, oxalates (58%) and urolyths of complex mineral composition (29%)  prevail. It has been found that an urolyth is an organomineral aggregate having the internal structure formed by a rhythm of alternation of organic and inorganic layers and the character of arrangement of individual mineral crystals, and the internal structure is independent of the chemical composition of the urolyth and  uniform in urolyths of different chemical composition. The most part of urolyths has a mixed (44%) or druzy (35%) type of crystal arrangement and the  combined (45%) or grainy (31%) rhythm of alternation of organic and inorganic components

Efficiency of the contact antegrade electro-pulse lithotripsy in the kidney stones treatment

Introduction. There remains a need to introduce new methods of treating kidney stones, given the increasing incidence of urolithiasis. Considering the proven efficacy and safety of retrograde electro-pulse lithotripsy, its use in the treatment of stones in the ureter, kidney and bladder, the need to expand the scope of this method is substantiated. Namely, the use in the treatment of kidney stones and the ureteropelvic junction with percutaneous approach.Purpose of the study. Assessment of the destruction effectiveness of kidney stones using an electro-pulse lithotripsy apparatus through antegrade (percutaneous) approach.Materials and methods. 229 percutaneous nephrolithotripsies were performed in patients with different locations of kidney stones in Siberian State Medical University Clinics (Tomsk, Russia) period from 2014 to 2019. We used the Urolit-105M electro-pulse lithotripter (Lithotech Medical, Israel, MedLine LLC, Russia) or the Calculase II laser lithotripter in some cases (Storz, Germany).Results. Patients were aged from 24 to 81 (women - 59.8%). The stones average size was 22 mm (from 10 to 73 mm). The stones average density was 1051.1 HU (from 360 to 1720 HU). The operation average duration was 122.3 minutes (from 40 to 300 minutes). The incidence of complications was 14.3%. The complete stones destruction occurred in 76% cases and that in combination with the laser went up to 89.95%. The overall response rate in redo operations reached 98.2%.Conclusion. Application of the electro-pulse method of kidney stone destruction with the percutaneous approach is makes a great effect, which is much higher when the stones is treated by the laser energy. Furthermore, combing with flexible endoscopes enables to apply the electro-pulse lithotripsy antegradely in hard-to-reach spots of the kidney cavitary system with no extra access to be provided. The method also enables to fight efficiently with the ureter upper part stones, also in combination with the retrograde approach to the stones

Technical issues of electric nanopulse contact lithotripsy as factors affecting lithotripsy effectiveness and probe resourses

To assess the relationship of main technical issues of electric nanopulse contact lithotripsy (CLT) with lithotripsy effectiveness and lithotripsy resources of probe.Electric nanopulses were transmitted by the flexible probes and the lithotripter «Urolit». The relationship between lithotripsy effectiveness and tip diameter of probes, pulse energy, pulse frequency was assessed, and resources of lithotripsy probes with different diameters of the tip were analyzed.Sufficient number of electric nanopulse to destroy stone models was less when tip diameter, nanopulse energy and frequency were greater.Effectiveness of electric nanopulse CLT can be enhanced with the increase of nanopulse energy, frequency and probe diameter. Complex correction of technical issues of electric nanopulse CLT can be a way of probe resources saving