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Biomedical subjects

B K Komiakov

Publications and source records attributed to B K Komiakov.

36 records · Page 2Linked to original sources
PubMedDate not supplied

[Fluorescent cystoscopy and transurethral electroresection in diagnosis and treatment of patients with invasive cancer of the urinary bladder].

From 1996 to 2002 we examined and treated 224 patients with invasive cancer of the urinary bladder (ICUB). The examination complex included clinical, laboratory, radiation tests, endoscopic and morphological investigations of the surgical material. The patients received four types of treatment: transurethral resection (TUR) of the bladder wall (n = 102) alone; TUR+MVAC chemotherapy (n = 56); open resection of the urinary bladder only (n = 38); open resection+MVAC chemotherapy (n = 28). In diagnosis of papillary lesions sensitivity of cystoscopy (CS) was 66.6%, fluorescent CS (FCS)--95.2%. Sensitivity in diagnosis of squamous tumors was 33.3 and 91.6%, respectively. The best results were achieved in patients with pT2A tumor invasion depth, G1 differentiation of tumor cells after TUR with adjuvant polychemotherapy (PCT) recurrences in these patients arose by 41.2% less frequently than in patients after TUR only, 5-year survival in patients after TUR+PCT was 83.3%. Thus, FCS improves diagnosis of urinary bladder tumors (sensitivity of CS was 70.0% vs that of FCS--95.0%). In cancer of the urinary bladder the organ can be saved only at stage pT2G1. A method of choice is TUR of the bladder wall with adjuvant PCT.

Adult↗
PubMedDate not supplied

[Intestinal plastic surgery of the ureter].

Intestinal plastic surgery for ureteral stricture was made in 25 patients (10 unilateral and 15 bilateral strictures). Stricture of the lower third of both ureters was primarily second to operations for colorectal cancer, urinary bladder diverticulesis and scars after radiotherapy. Unilateral strictures resulted from postradiation changes in 9 patients and a shotgun wound of the ureter in 1 patient. Grafts of an isolated segment of the ileum and the vermiform process on the mesentery were transplanted in 22 and 3 patients, respectively. Postoperative intestinal ileus was observed only in one patient who was treated with relaparotomy, intestinal intubation and abdominal drainage. Another patient was reoperated for failure of ureteroappendicoanastomosis. The results of the reoperations were successful. No lethal outcomes were recorded. Upon 0.5-7 year follow-up, all the patients restored normal urodynamics and function of the affected kidney. Thus, use of an isolated segment of the small intestine ensures repair of the defects of one or both the ureters of any location and length. Intestinal repair in extended ureteral lesion is an operation of choice as it reestablishes urine outflow from the kidney, improves its function, relieves symptoms of chronic pyelonephritis and puts away continuous renal and ureteral fistulas.

Adult↗
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[Plastic repair of the urinary tract with intestinal graft].

Enteroplasty of the urinary tract was made in 224 patients (175 male and 49 female, age 21-72 years): enteroplasty of the ureter (n = 25), augmentation cystoplasty (n = 38), replacement of the urinary bladder after radical cystectomy for cancer (n = 161). The grafts were made of the small intestine segments--149 (66,5%), sigmoid--45 (20%), stomach--25 (11.2%), appendix--3 (1.3%). Total postoperative lethality reached 2.7%. Early and late complications occurred in 26.8 and 32.2% patients, respectively. In half the cases complications were related to the derivation method. Fifty three reoperations were made, most frequent of them was percutaneous nephrostomy. Thus, use of gastrointestinal tract segments for replacement of the urinary tract provides adequate urine outflow from the kidneys, close to natural micturition. Introduction of advanced methods of urine derivation prevents formation of urinary fistulas and improves quality of the patients' life.

Adult↗
PubMedDate not supplied

[Testosterone production by tumor tissue in partial androgen deficiency in aged men (PADAM)].

The aim of the study was examination of cause-effect relationships between PADAM, extragonadal production of androgens and high proliferative activity in aged men. The study group included 15 patients aged between 53 and 79 years with prostatic cancer (n = 5), urinary bladder cancer (n = 5) and cancer of the rectum (n = 5). Control samples of tissues of the prostatic gland, urinary bladder and rectum were obtained from dead bodies of men at the age between 18 and 29 years killed in the accidents at the age from 18 to 29 years. Testosterone levels in the tissues of peritumor zone of the prostate, in tumor tissue of patients with cancer of the prostate, urinary bladder and the rectum were higher than in blood serum. In prostatic cancer, testosterone in the tumor tissue was higher than in the tissues of prostatic peritumor zone. The values of Histochemical score AR of the peritumor zone in prostatic cancer patients were higher than those of the control group. It was detected that ER, PR, bcl-2, Ki-67 and p53 in prostatic tissue of young controls were absent while in patients with prostatic cancer these factors were expressed in the peritumor zone. In cancer of the urinary bladder, peritumor zone showed expression of PR, bcl-2, Ki-67 and p53, while no such expression was in the controls. ER, bcl-2, Ki-67 and p53 were registered in the peritumor zone of patients with cancer of the rectum but the controls had neither ER, bcl-2 nor p53 while Ki-67 expression in rectal cancer was higher than in the controls. The results of the study suggest that testosterone production by some tumors and tissues of the peritumor zone accompanied with high proliferative activity and dysregulation of the cell cycle is secondary to PADAM. These changes arise to compensate testicular deficiency and are manifestations of metabolic syndrome (X-syndrome). In this situation immune system fails to utilize all atypical cells.

Adolescent↗
PubMedDate not supplied

[Endoprosthesis of the ureter].

A stent made of titanium nikelide monothread was used in the treatment of 37-63 year old male patients with recurrent and long strictures of the ureters. A metal stent was used in 3 patients with recurrent and long structures of the ureter. A long pyeloureteral stricture developed in two patients with allotransplanted kidney after several operations. The stricture in one patient was caused by a failed resection of the pyeloureteral segment and subsequent attempts of endoscopic correction of the upper urinary tract. Metal stents were used in all the cases. No serious postoperative complications were observed. The operations were effective. No lethal outcomes occurred. Follow-up for 6 to 13 months stated normalization of urodynamics and function of the affected kidney. Thus, a metal stent in some cases of recurrent and long ureteral strictures reestablishes passability of the upper urinary tract and improves quality of life.

Adult↗
PubMedDate not supplied

[Urodynamics of artificial urinary bladder].

Radical cystectomy with creation of orthotopic reservoir from various segments of gastrointestinal tract was made in 120 patients (99 males, 21 females, age 37-74 years) with muscular-invasive cancer of the urinary bladder (UB) in 1996-2004. Replacement of UB was made according to the Studer and Hautmann method in 38 and 27 patients, respectively. S-cystoplasty was performed in 31 patients. The gastric segment was used for creation of the reservoir in 24 patients. Three patients died. Three to twelve month follow-up recorded the best functional results in patients after Studer cystoplasty.

Adult↗
PubMedDate not supplied

[Extracorporeal shockwave lithotripsy on the Sonolith-3000 apparatus].

The authors observed 812 patients with nephrolithiasis who underwent 876 sessions of shock-wave lithotripsy on Sonolith-3000 lithotriptor supplied with an ultrasonic system of the stone localization. The size of nephroliths ranged from 0.7 to 4.2 cm. Large-size nephroliths required repeated sessions and pretreatment establishment of the stent. The procedure proceeded without anesthesia. Subsequent renal colic was reported in 126 (15.5%), an exacerbation of pyelonephritis in 45 (5.5%), subcapsular hematoma in 4 (0.5%) of the patients. 790 patients showed clinical response (97.3%), with a complete destruction of the stone in 446 (54.9%) and partial one in 344 (42.4%) cases. 27 subjects were treated in outpatient setting. According to the authors, lithotripsy is contraindicated in urinary tract obstruction below the stone, renal failure, chronic pyelonephritis in the active phase of inflammation, marked impairment of cardiac rhythm.

Adolescent↗
PubMedDate not supplied

[The surgical treatment of urethral strictures].

The authors reviewed the results of surgical management of 233 patients aged 8-76 years who had suffered urethral strictures. A total of 266 operations were made in the period of 1970-1989. Urethral tunneling which had been widely used in clinical practice for strictures of the urethra until 1980 yielded 91.2% recurrences of the disease, which made surgeons modify the surgical policy. During the past decade 127 patients with urethral strictures and obliterations have undergone 138 surgical interventions: 91 (65.9%) urethral resections, 34 (24.6%) internal optical urethrotomies and transurethral resections of scarring tissue, 7 (5.1%) cutaneous urethral plastic surgeries and only 6 (4.4%) urethral tunnelings. The number of relapses was reduced to 13.4%. The authors consider that urethral resection should be the operation of choice in urethral strictures and obliterations. Endoscopic treatment techniques (urethrotomy and transurethral resection) are indicated in short strictures and scarring deformity of the posterior urethra after prostate operation. It is advisable to apply cutaneous urethral plastic surgery in case of extended strictures.

Adolescent↗
PubMedDate not supplied

[Endoscopic ureterolithotripsy using a pulsed dye laser].

Endoscopic laser ureterolithotripsy (ELUL) has been conducted in 67 patients admitted to an urologic hospital at St.-Petersburg Medical Institute from 1989-1992. The patients aged 19-72 were exposed to He-Ne color pulsed laser (France) irradiation with the following parameters: wave length 504 nm +/- 3%, impulse duration 2 +/- 1 mus and energy 70-120 mJ. Ureteroscopy for delivery of the laser fibre was carried out in 60 (89.6%) patients, a sound and x-ray control of lithotripsy was performed in 7 (10.4%) patients. The stones were crushed completely in 89.6% of the patients. Laser-related complications were not registered. It is stated that ELUL holds promise in fragmentation of ureteroliths. The method introduction can be accomplished in large, well-equipped urologic clinics.

Adult↗
PubMedDate not supplied

[Urinary diversion in cystectomy in bladder cancer patients].

From 1985 to 1991 the author operated on 21 bladder cancers, forming cross anastomoses on the upper urinary tracts. 19 patients underwent cystectomy. Stage T2, T3, T4 was diagnosed in 4.8%, 80.9% and 14.3% of the patients, respectively. Hydroureteronephrosis was detected in all the patients, chronic pyelonephritis developed in 16 (76.2%), chronic renal failure in 9 (42.9%). Upper and low transureteroureteronephrostomy (TUUN) was performed in 13 (61.9%), transureteropyelonephrostomy (TUPN) in 3 (14.3%), transureteropyelo-ureterosigmoidostomy in 5 (23.8%) patients. The latter technique implies successive connection of the kidneys with the sigmoid. This provided less exposure of one of the kidneys to the intestinal infection, urinary fistulas did not form. Two deaths in the postoperative period were due to metastases and thromboembolism. The authors believe that the best functional conditions for the kidneys are secured by upper TUUN, TUPN and transureteropyelo-ureterosigmoidostomy applicable in cystectomy and in normal tonicity of the upper urinary tracts.

Adult↗
PubMedDate not supplied

[Reconstruction of the bladder with a reservoir made from the ileocecal portion of the intestines].

14 cases are reported of bladder replacement for ileocecal intestine reservoir according to the technique developed in the Mintz clinic. All the patients aged 40-65 years have been treated for the last 6 years in urological clinic of Medical University in St. Petersburg. 9 (64.3%), 3 (21.5%), 1 (7.1%), 1 (7.1) patients underwent surgery after bladder extirpation for cancer, for interstitial cystitis, tuberculous microcysts and pelvic trauma, respectively. In 10 (71.4%) cases an intestinal bladder has been created with resultant recovery of urination. 4 (28.6%) patients underwent ureterocecoileocutaneostomy with providing mechanisms of urine retention. Postoperative lethality made up 14.3%. Follow-up and urodynamic findings 6 months after the operation showed good function of the intestinal reservoirs. The above operative technique proved effective in medicosocial rehabilitation of patients in need of supravesical derivation of urine.

Adult↗
PubMedDate not supplied

[Diagnosis and surgical treatment of tumors of the upper urinary tract].

The author believes that in diagnosis of tumors of the upper urinary tracts more information can be obtained at ureteropyeloscopy with retrograde contrasting of the urinary tracts and, if necessary, biopsy of abnormal urothelium regions. 19 patients with pelvic and 4 patients with ureteral tumor were operated on. 2(8.7%) patients with tumor in the lower third of the ureter underwent resection with Boari operation, classic nephroureterectomy with bladder resection was made in 15(65.2%) patients, transurethral resection of the wall of the bladder, ostium and distal ureter followed by nephroureterectomy was performed in 6(26.1%) patients. The latter operative procedure is radical but less traumatic. Five-year survival made up 73.9%.

Aged↗