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The Aim: To assess the diagnostic performance of dual-energy computed tomography (DECT) in the evaluation of the composition of urinary stones "in vivo"., Materials and Methods: A total of 91 patients aged from 20 to 70 years old (mean 42.7) with urinary stone disease were examined at Sechenov University, including 68 men (75%) and 23 women (25%). Prior to surgery, all patients underwent DECT (Canon, Japan) in order to predict the chemical composition of urinary stones in vivo. Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) was performed in 53 (58.2%), 18 (19.7%) and 20 (22.1%) patients, respectively. Postoperatively, all stones or stone fragments (n=91; 100%) were examined using a comprehensive physical and chemical analysis (X-ray phase analysis, electron microscopy, infrared spectroscopy)., Results: In 6 patients (6.6%) staghorn stones were diagnosed, while in 15 (16.5%), 17 (18.7%), 22 (24.2%) and 31 (34.1%) stones were located in ureteropelvic junction, pelvis and ureter, respectively, including 24 patients with lower ureteric stones (26.4%). Prediction of the stone composition in vivo was carried out on the basis of the one indicator, the dual energy ratio (DER). The threshold values of DER for different types of stones were taken from the literature. All stones were divided into 4 groups according to the DECT results: vevellite stones (n=40, 43.9%), Ca-containing stones without vevellite (n=34, 37.3%), uric acid stones (n=10, 10.9%) and struvite stones (n=7, 7.9%). Thus, when comparing the results of DECT and physical and chemical analysis, in the first group four stones were incorrectly assigned by DECT to the group of Ca-containing stones without vevellite and three stones were incorrectly assigned to the group of struvite stones; in the second group four stones were incorrectly assigned to the group of vevellite stones; in the third group one stone was incorrectly assigned to the group of struvite stones; in the fourth group one stone was incorrectly assigned to the group of vevellite stones and one stone in the group of uric acid stones. In order to increase the diagnostic efficiency of DECT, we performed a comprehensive analysis of five specific DECT indicators (stone density at 135 kV, Z eff of the stone, DER, DEI, DED) using discriminant analysis. Thus, the sensitivity, specificity and overall accuracy of DECT with the use of just one indicator (DER) were 83.3%, 89.8%, 86.8% for vevellite, 88.2%, 92.9%, 91.2% for Ca-containing stones without vevellite, 90%, 98.8%, 97.8% for uric acid stones and 60%, 95.3%, 93.4% for struvite stones, respectively. When using discriminant analysis with five specific DECT indicators, higher values of sensitivity, specificity and overall accuracy were seen: 95.2%, 89.8%, 92.3% for a vevellite, 85,3%, 96,4%, 92,3% for Ca-containing stones without a vevellite and 100%, 100% and 100% for both uric acid and struvite stones, respectively., Conclusions: Dual-energy computed tomography is a highly informative method which allows to perform preoperatively the reliable assessment of the chemical composition. DECT in patients with urinary stone disease allows to optimize the treatment strategy and carry out preventive measures on individual basis, taking into account the stone type.

The purpose of the study was to develop diagnostic and prognostic criteria for the development of urolithiasis (UL), by using the chromatographic mass spectrometric and aggregatometric techniques, in order to determine the type of a metabolic disturbance and the type of stone formation, as well as to create an algorithm of pathogenetically grounded prevention of the disease. According to the type of a metabolic disorder, all the patients were divided into 4 groups: (1) 47 (43.1%) patients with uric acid UL; (2) 26 (23.9%) with calcium oxalate UL; (3) 25 (22.9%) with calcium phosphate UL; (4) 11 (10.1%) with mixed UL. The specific feature of Group 4 was a preponderance of patients with calcium phosphate and calcium oxalate stones. Analysis of the findings has led to the conclusion that the new guidelines for the diagnosis and pathogenesis of UL, by applying the current chromatographic mass spectrometric techniques make it possible to detect the type of metabolic disturbances, to assess a risk for stone formation with the elevated urinary levels of lithogenic substances, to simulate a stone formation process by aggregatometry, which is of no importance in developing an algorithm of the pathogenetic treatment and prevention of stone formation in UL patients mainly at the early stage of the pathological process.

The authors present the analysis of therapy of 72 patients under 70 years of age (40 males - 55.6%, 32 females - 44.4%) with urate nephrolithiasis. Recurrent nephrolithiasis occurred in 51 (70.8%) patients, metabolic disturbances were registered in 38 (52.8%) patients. Efficacy of litholytic therapy with blemoren was 58.3%. In the rest cases the concrements were removed by extracorporeal shock-wave lithotripsy (ESWL). The authors believe that in concrements more than 2 cm in size ESWL should be made in the presence of internal stent, while litholytic therapy prior to ESWL improves treatment results even if ineffectiveness of the former.

Aim: To examine gastric biopsies with polarization microscopy for detection of sodium monourate crystals (SMC)., Material and Methods: The trial included 20 patients with gout diagnosis (mean age 55.7 years, mean duration of the disease 12.3 years) in whom esophagogastroduodenoscopy was made with biopsy of gastric mucosa from the antral part of the stomach and middle third of the gastric body., Results: Crystals in the biopsy specimens were detected in 11 of 20 examinees. The crystals were characterized by strong double refraction, length 3-20 mcm, acicular or planiform shape, blue or yellow color depending on position in compensated polarized light. Quantitative distribution of the crystals within one biopsy specimen was uneven and varied from solitary crystals to clusters of 70-80 crystals in sight, up to formation of tophus-like structures. Clinical picture in detection of SMC was characterized by more frequent occurrence of cases with subcutaneous tophuses of various location combined with higher hyperuricemia., Conclusion: One of the essential lines in the research of gout concerns mechanisms of SMC formation in organs and tissues and microcrystalline gastroduodenal inflammation. Methods of correction of this inflammation are to be designed.

Aim: To evaluate the occurrence of immunoresistance (IR) syndrome in gout and its correlation with a gout course., Material and Methods: Anthropometric parameters, blood lipid spectrum, levels of glucose, uric acid (UA), immunoreactive insulin, HOMA index were studied in 55 male patients with gout (mean age 50.1 +/- 7.9 years, mean duration of the disease 7.5 +/- 7.2 years). Statistic processing was made with computer program Statistica 6.0., Results: IR was revealed in 49% patients. Immunoresistant patients had visceral obesity, arterial hypertension, abnormal lipid profile, high UA concentrations, longer disease, chronic articular syndrome, high occurrence of diabetes mellitus and vascular events significantly more frequently., Conclusion: IR in gout patients is the risk factor of cardiovascular diseases; combination of IR and hyperinsulinemia is characterized by marked hyperuricemia and a trend to chronic course of the articular syndrome. Longer duration of gout, especially treated inadequately, raises the risk of IR. IR deteriorates prognosis in relation to cardiovascular diseases, diabetes mellitus type 2, course of gout itself.

Structure of stones influences effects and sequelae of extracorporeal shock-wave lithotripsy (ESWL). Clinical sequelae of ESWL in oxalate stones are the worst because of the fragments size and physical qualities of these stones. Oxalates are firm and sharp. Such qualities may cause injury and swelling of the ureter when the fragments pass it. A JJ stent and catheter are proposed to prevent complications of oxalate stone ESWL in the stones size more than 1.5 cm.

The examination of 30 patients with purin disbolism (mean age 23.8 years) has demonstrated that microalbuminuria higher than 20 mg/day may serve a diagnostic criterion of early damage to the kidneys. The level of microalbuminuria correlated with the degree of purin metabolism disorder.

The content of urea in a tear is close to that in the blood both in health and uremia. This fact permitted development of a new method of laboratory diagnosis of uremia from the content of urea in a tear. The method may be used to diagnose uremia in renal diseases and various endogenous poisonings with clinical manifestations of renal insufficiency. A method for the diagnosis of hyperuricemia from the content of uric acid in a tear has been developed. The method was used for the diagnosis of gout and hyperuricemia in renal diseases. The suggested methods are reliable and available for common clinical biochemical laboratories. Biochemical analysis of a tear is much simpler, rapid, and atraumatic than analysis of the blood collected from the vein.

The authors review the experience gained in search for the prognostic and diagnostic criteria of coronary heart disease and its various forms. They recommend using the index of red blood cell fatty acid unsaturation as the characteristic, indicating liability to coronary disease; lysosomal beta-glucosidase activity for assessment of the severity of myocardial injury; simultaneous measurements of hydroxyproline and uric acid for estimation of the completeness of cicatrization and of the myocardial injury severity; and the fatty acid unsaturation index and hydroxyproline level for the assessment of the efficacy of rehabilitation measures.

The screening program directed towards a detection of patients with hereditary enzymopathy allowed to reveal 8 boys from 4-14 years with the Lesch-Nyhana syndrome. Among these children 4 were studied in detail clinically and biochemically. The study demonstrated that there were different degrees of mental retardation, autoagressive or agressive behaviour. The activity of erythrocyte hypoxanthinguanine phosphoribosyltransferase (HGPRT) in 2 cases was not changed, in 1-decreased and in 1--was absent. In 1 case of a decreased activity of hypoxanthinguanine phosphoribosyltransferase there was a drastic drop in the activity of adeninphosphoribosyltransferase (APRT). The study showed that there was a double increase in the cerruloplasmin activity in the blood plasma and of the cytochromoxydase in the leukocyte mitochondria. This indicates that the genetically determined drop in the HGPRT or APRT leads to disturbances in the other links of metabolism in the organism. The clinical manifestation of the disease due to a disturbed metabolism of biogen amines in the CNS is postulated.

The authors considered an important problem of in vivo verification of urolith composition as specifying the choice of drug treatment and prevention of urolithiasis. 84 nephrolithiasis patients were allocated to 4 groups according to their concrement compositions (after spontaneous or surgical removal): 23 patients with urate calculus, 19 with oxalate, 20 with phosphate and 22 with oxalate-phosphate concrements. Polarizing microscopy, x-ray structural analysis and infrared spectrophotometry were employed for verification of calculi composition. Biochemical assay was used for the assessment of serum and circadian excretion of calcium, phosphates, sodium, potassium, uric acid, oxalates and uroacidimetric values. The findings were subjected to discriminant computed analysis which resulted in 6 linear computable functions defining 4 selective groups with regard to biochemical blood and urine data. The aforementioned functions were used in diagnostic routine for the in vivo assessment of calculous composition in 26 controls. In 61.5 per cent of the patients the diagnosis was confirmed, in 34.6 per cent it was verified, and only in 3.9 per cent the diagnosis turned to be erroneous.

The distribution of purine compounds in the skeletal muscles of the anterior and posterior limbs of 129/Re mice with hereditary muscular dystrophy (HMD) was investigated in a comparative study. The results revealed unidirectional metabolic disorders in both groups of muscles which was manifested in a quantitative redistribution of phosphorus-containing purine components and a decrease in the pool of adenylates in muscle tissue. Elevated concentrations of purine metabolites (inosine, hypoxanthine, xanthine, and uric acid) indicated an augmented metabolism of purines in this abnormality. Impairment of metabolic transformations of purines in the muscle tissue in HMD may be one of the factors responsible for the development of the pathological process in the muscle in the given disease.

The authors studied the arthroscopic picture of the knee joint in 50 male patients, 40 of whom had a genuine gout and 10 a doubtful one. A high diagnostic significance of arthroscopy was emphasized, it rose with the use of a morphological analysis of samples of synovial membrane and villi obtained by means of target biopsy, microscopy and chemical identification of urate.