Search

Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures.To study the results of RIRS in patients with nephrolithiasis and various renal disorders.A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done.RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications.RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.

Background. Urinary fistulas (UFs) are one of the most significant complications after partial nephrectomy. Placement of an ureteral stent eliminates urine extravasation in the majority of patients. However, some of them have persistent UFs despite upper urinary tract drainage. Such cases require retrograde injection of fibrin glue into the renal cavity through a ureteroscope or via the percutaneous approach. Some authors reported cases of simultaneous use of 2 stents and percutaneous cryoablation of the fistula, but these techniques are rare and, therefore, it is problematic to evaluate their efficacy.Objective: to evaluate the results of the new treatment method for the elimination of persistent UFs using the retrograde endoscopic percutaneous approach.Materials and methods. This study included 5 patients (3 males and 3 females) with UFs developed after kidney resection. Mean age of the patients was 55.8 years. The tumor size was 2.5 to 4.8 cm; mean R.E.N.A.L. score was 7.8. All patients had earlier undergone minimally invasive partial nephrectomy; the time between surgery and UF development varied between 3 and 10 days. Four out of 5 patients had a large amount of discharge from their paranephral drainage system, examination of which confirmed high creatinine level. Patients underwent flexible ureteropyelography in the lithotomy position. During this procedure, we identified the damaged calyx and then performed percutaneous puncture targeting the distal end of the endoscope at this calyx, ensuring that the tip of the needle appeared in the paranephral cavity in front of the injured calyx. Using the flexible ureteroscope, we inserted the needle into the pelvis, dilated the puncture opening along the string, and installed a nephrostomy drainage system (12 Fr). Then the endoscope was removed and the ureter was additionally drained with a stent. The stent was removed after 8-10 days with subsequent antegrade pyelography. If there was no extravasation, the nephrostomy tube was removed and the patient was discharged from hospital to continue treatment in outpatient settings.Results. All patients with UFs resulting from partial nephrectomy was successfully operated on. No complications were registered. The mean surgery time was 45.0 ± 20.5 min (range: 40-65 min). Only two patients had some discharge from the fistula within 1 day after nephrostomy tube removal and it stopped without any additional interventions. Three patients had their fistula healed immediately. The treatment efficacy during the whole follow-up period of 18 ± 4 months (range: 6-26 months) was 100 %.Conclusion. Ureteral stenting ensures elimination of UFs in the majority of patients after partial nephrectomy. In individuals with persistent UFs, retrograde endoscopic percutaneous drainage of the pelvicalyceal system is the method of choice, because it allows rapid and effective treatment of UFs.

Актуальность. Современная электрокардиография, несмотря на качественное улучшение в аппаратном обеспечении ивозможности обработки данных, на сегодняшний день практически исчерпала ресурс получения дополнительной диагностическойинформации. В статье сделана попытка создания нового метода обработки электрокардиограмм на основе использования моделиЭКГ-сигнала, которая учитывает пьезоэлектрический эффект в некоторых биологических тканях и клеточных соединениях (кровь,стенки сосудов).Цель работы. Вероятностное обоснование возможности формирования принципиально новых информативных диагностическихпризнаков, использующих частотно-временную корреляцию между двумя вейвлет-спектрами ЭКГ-сигнала и его линейногопреобразования.Метод. В качестве экспериментальной модели используется аддитивная модель потенциала сердечной мышцы (наведенногоэлектрического поля) и пьезоэлектрического потенциала системы «кровь-сосуды», вызванного сокращением миокарда. Для выделениявлияния вызванного потенциала в работе предложен метод линейного преобразования ЭКГ-сигнала, обладающий высокойчувствительностью к локальной спектральной нестационарности. Для реализации этого метода использовано вейвлет-преобразованиеи предложен количественный показатель спектральной нестационарности ЭКГ-сигнала – коэффициент нормированной межспектральной корреляции (КНМК). Разработанный математический аппарат в работе использован для анализа двух электрокардиографических сигналов, условной нормы и с последствием инфаркта миокарда.Результаты. В результате рассчитанных КНМК показана возможность количественного различия этих состояний с достаточновысокой статистической достоверностью. Базовым результатом работы является вероятностное обоснование возможностиформирования принципиально новых информативных диагностических признаков, использующих частотно-временную корреляцию между двумя вейвлет-спектрами ЭКГ-сигнала и его линейного преобразования. Высокая чувствительность и информационная значимость корреляционных диагностических признаков подтверждены примерами дискриминации параметрически неоднородных ЭКГ-сигналов.Выводы. Теоретически и экспериментально подтверждена спектральная нестационарность кардиосигнала; полученафункциональная связать спектральной нестационарности ЭКГ-сигнала с эффектами квантованности скорости его изменения; разработанметод параметрического определения коэффициента межспектральной корреляции, позволяющий количественно описать динамику локально-спектральных изменений кардиосигнала для задач автоматического экспресс контроля и диагностики кардиосостояний ипроведена его апробация., Contex. Modern electrocardiography, in spite of qualitative improvement in hardware and data processing capabilities, for today haspractically exhausted a resource of reception of the additional diagnostic information. In the article an attempt is made to create a new methodfor processing electrocardiograms based on the use of the ECG signal model, which takes into account the piezoelectric effect in somebiological tissues and cell connections (blood, vessel walls).Objective. Probabilistic justification of the possibility of forming fundamentally new informative diagnostic features, which uses thetime-frequency correlation between two wavelet spectra of the ECG signal and its linear transformation. Method. As such a model is used the additive model of the potential of the cardiac muscle (induced electric field) and the piezoelectricpotential of the blood-vessel system caused by myocardial contraction. To isolate the influence of the induced potential is proposed a methodof linear transformation ECG signal. This method has a high sensitivity to local spectral nonstationarity. Wavelet transform is used toimplement this method. The coefficient of normalized inter-spectral correlation (CNIC) is proposed as a quantitative indicator of the spectralnonstationarity of the ECG signal. The developed mathematical apparatus in the work is used for the analysis of two electrocardiographicsignals: conditional norm and with the consequence of myocardial infarction.Results. As a result of the calculated CNIC, the possibility of a quantitative difference of these states with a sufficiently high statisticalreliability is shown. The basic result of the work is a probabilistic justification for the possibility of forming fundamentally new informativediagnostic features using the time-frequency correlation between two wavelet spectra of an ECG signal and its linear transformation. Highsensitivity and information significance of correlation diagnostic features are confirmed by examples of discrimination of parametricallyinhomogeneous ECG signals.Conclusions. Main results of the study: the spectral non-stationarity of the cardiac signal has been confirmed theoretically andexperimentally; The functional interrelation of the spectral nonstationarity of the ECG signal with the effects of quantization of the rate of its change is obtained; A method for the parametric determination of the coefficient of inter-spectral correlation was developed, which makes it possible to quantitatively describe the dynamics of the local spectral changes in the cardiac signal for the tasks of automatic express control and diagnostics of cardiac states and carried out its approbation.

The article presents an analysis of the development of the Lviv tram network from the end of the XIXth century till nowadays and for the near future. The stages of construction of tram depots and development of tram lines in the context of the city territory servicing, their changes, and connection with the configuration of the city street network are shown. City planning approaches to further development of the tram network infrastructure are presented.