Inter-Rater Reliability of Collateral Status Assessment Based on CT Angiography: A Retrospective Study of Middle Cerebral Artery Ischaemic Stroke

The importance of assessing the collateral status (CS) in patients with ischaemic stroke (IS) has repeatedly been emphasised in clinical guidelines. Various publications offer qualitative or semiquantitative scales with gradations corresponding to the different extents of the collaterals, visualised mostly on the basis of CTA images. However, information on their inter-rater reliability is limited. Therefore, the aim of this study is to investigate the inter-rater reliability of the scales for collateral assessment. CTA images of 158 patients in the acute period of IS were used in the study. The assessment of CS was performed by two experts using three methodologies: the modified Tan scale, the Miteff scale, and the Rosenthal scale. Cohen's kappa, weighted kappa and Krippendorff's alpha were used as reliability measures. For the modified Tan scale and the Miteff and Rosenthal scales, the weighted kappa values were 0.72, 0.49 and 0.59, respectively. Although the best measure of consistency was found for the modified Tan scale, no statistically significant differences were revealed among the scales. The impact of the CS on the degree of neurological deficit at discharge was shown for the modified Tan and Rosenthal scales. In conclusion, the analysis showed a moderate inter-rater reliability of the three scales, but was not able to distinguish the best one among them.

[Mathematical modeling of high-flow extra-intracranial bypass in the treatment of a complex cerebral aneurysm]

BACKGROUND

Intracranial aneurysms (IAs) pose a high risk of spontaneous subarachnoid hemorrhage. In the most complex cases, the only way to exclude the aneurysm from the circulation is to perform a high-flow extracranial-to-intracranial bypass, thus creating a new bloodstream. This avoids severe ischemic complications; however, it requires careful consideration of individual anatomy and hemodynamic parameters. Computational fluid dynamics (CFD) can be of great help in planning such a surgery by creating 3D patient-specific models of cerebral circulation.

OBJECTIVE

Assessment of the perspectivity of high-flow extracranial-to-intracranial bypass planning using computational modeling.

MATERIAL AND METHODS

In this research work, we have applied the CFD methods to a patient with a giant thrombosed IA of the internal carotid artery (ICA). Preoperative CTA images and Gamma Multivox workstation were used to create a 3D model with current geometry and three additional models: Normal anatomy (no IA), Occlusion (with ligated ICA), Virtual bypass (with bypass and ligated ICA). The postoperative data were also available. Boundary conditions were based on PC-MRI measurements. Calculation of hemodynamics was conducted with a finite element package ANSYS Workbench 19.

RESULTS

The results demonstrated an increase in the blood flow on the affected side by more than 70% after the virtual surgery and uniformity of flow distribution between the affected and contralateral sides, indicating that the treatment is likely to be efficient. Later, postoperative data confirmed that.

CONCLUSION

The study showed that virtual preoperative CFD modeling could significantly simplify and improve surgical planning.

[Microbiota of the urogenital organs]

A review of modern literature on the study of microbiota of the genitourinary system by methods of chromatography-mass spectrometry and sequencing of urine specimens is presented in the article. The sequencing method is used to analyze microbiota of different organs. Obtained results of the genomic analysis have revealed cases of infection by potential pathogenic microorganisms, which are often not diagnosed during standard urine culture due to specific requirements for culture media.

[Change in anatomo-functional state of the parenchyma in early unilateral renal cell carcinoma before and after surgical treatment]

The aim of the trial was to study compensatory potential of renal parenchyma in the presence of renal cell carcinoma (RCC) and after organ-saving and radical surgical treatment as shown by one-photon emission computed tomography (OPECT). OPECT before the treatment and 6 and 12 months after it evidences that in unilateral RCC, irrespective of the focus location, both kidneys as a single organ respond to tumor growth with compensatory hypertrophy. Compensatory reserve is limited. In tumor size more than 6 cm the affected kidney starts losing the volume of the functional tissue while infiltrative growth is most likely. Assessment of the compensatory potential of the kidneys provides additional information. If the volumes of the kidneys differ by more than 30%, RCC growth is infiltrative. In this case only radical nephrectomy is recommended. If the size of the kidneys is by 60% more than normal one and parenchymas of the affected and contralateral kidney reach their compensatory limit but are equal, indications to organ-saving surgery extend as greater hypertrophy of the remaining kidney is excluded. After organ-saving surgery, a compensatory increase was observed in the contralateral kidney. This is explained by effective distribution of protein material and separate processes of proliferation (healing) and hypertrophy (compensation). Assessment of anatomo-functional condition of renal parenchyma helps better selection of patients for organ-saving surgery.

[Acute scrotum: clinical picture, diagnosis, treatment]

The purpose of this study was to evaluate the potentialities of ultrasonic dopplerography and radioisotope scanning of the scrotal organs for the diagnosis of acute scrotal diseases and defining the indications to surgery in patients with acute epididymoorchitis. A total of 128 subjects were examined (23 healthy controls and 105 patients with scrotal diseases). 139 ultrasonic and 76 radioisotope scannings of the scrotum were carried out. Ultrasonic scanning plays the key role in the diagnosis of traumatic and inflammatory epididymoorchitis. Radioisotope study is more informative in the diagnosis of torsion of the testicle. The data indicate high informative value of ultrasonic and radioisotope studies in differential diagnosis of acute scrotal diseases and diseases simulating an acute process in the testicle and appendage. A positive feature of both methods is the possibility of their repeated use for evaluating the treatment efficiency. Analysis of 241 cases with acute epididymoorchitis showed that early surgical treatment of patients with pyodestructive inflammation promotes rapid recovery. Ultrasonic monitoring helps timely detect the complications and correct the treatment strategy. Wide use of ultrasonic and radioisotope methods of examination in patients with acute scrotal diseases promote timely detection of pathological changes and better results of treatment.

[Chronic obstructive prostatitis]

The authors review current classifications of chronic prostatitis and propose their own classification which reflects routes of prostatic infection, division of infectious prostatitis into obstructive and non-obstructive forms, etiology of chronic prostatitis. Original methods and facilities for prostatic drainage via transurethral and transrectal approaches are described.

Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens

This 3-month double-blind, randomized, parallel-group study compared the efficacy and tolerability of two regimens of the lipido-sterolic extract of Serenoa repens (Permixon) (two 160-mg capsules once daily [OD] and one 160-mg capsule twice daily [BID]) in 100 outpatients with symptomatic benign prostatic hyperplasia (BPH). Both regimens significantly (P < .0001) reduced the International Prostate Symptom Score (I-PSS) mean total score from baseline; improvements achieved statistical significance after the first month and were maintained for the duration of the study. Significant (P < .05) and rapid improvements from baseline to the end of month 1 also occurred in I-PSS quality-of-life (QoL) scores, maximum and mean urinary flow rates, and residual urine volume; this benefit was further increased at month 3 for I-PSS total score and QoL and residual volume, and was maintained for maximum and mean flow rates. A highly significant decrease (P < .001) in residual urine was observed in both groups. No significant differences were noted between regimens. Clinical adverse events occurred at a similar incidence in both groups (BID, 24%; OD, 22%) and were deemed unrelated or unlikely to be related to Permixon.

[Ultrasound studies in varicocele]

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.

[Intraepithelial prostatic neoplasia]

44 patients seeked medical advice for low urinary symptoms. Their examination consisted of digital rectal investigation, test for prostate-specific antigen (PSA) in the serum, transurethral ultrasonic investigation, fine needle multifocal biopsy of the prostate. Three groups were identified by the PSA levels. 7 patients of group 1 had PSA up to 6 ng/ml. Cancer was diagnosed in 3 of them, prostatic intraepithelial neoplasia (PIN) in 4 patients. 16 patients of group 2 had PSA within 7-10 ng/ml. In this group only 1 patient had cancer, the rest 15 had PIN. 21 patients of group 3 with PSA at least 10 ng/ml had cancer, benign prostatic hyperplasia, PIN (12, 2 and 7 patients, respectively). 3 patients with high-grade PIN and PSA above 10 ng/ml in 6 months were diagnosed to have adenocarcinoma, in 6 such patients signs of dysplasia disappeared after antiandrogenic therapy. Further investigations on diagnosis and treatment of PIN are desirable.

[The laparoscopic treatment of abdominal cryptorchidism in adults]

Three patients aged 18, 25 and 31 years with abdominal cryptorchidism and concomitant diseases were treated laparoscopically. Macroscopic amd microscopic evidence said in favor of removal of the testis. In one case this removal was done in line with removal of the dysplastic kidney. In another case plastic surgery was conducted of the inguinal hernia on the side of cryptorchidism.

[The prediction of the results of extracorporeal shockwave lithotripsy]

The disease history, objective, x-ray and aggregatometry evidence has been analyzed for 188 nephroureterolithiasis patients to make the prognosis of extracorporeal impulse lithotripsy (EIL). If the concrements presented at x-ray picture as structurally homogeneous, medium-contrast, with even margins, fragmentation occurred after 3-4 sessions in 81% of the cases. Low or high contrast calculi with heterogeneous margins disintegrated after 1-2 EIL sessions. Flat calculi were easier to crush than round ones. A decline or absence of changes on the aggregatometry curves prompted the decision on efficacy of further EIL. The calculi which existed for 6 months maximum were the easiest to crush. The outcome of the previous EIL is also essential for prognosis. Inflammation and obesity worsen EIL results. Variant of EIL regimen and the number of impulses are also prognostically significant.

[The laparoscopic treatment of varicocele]

Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice.

[Extracorporeal shockwave lithotripsy in patients with the long-term presence of stones in the ureter]

28 patients with long-standing ureteroliths (present in the ureter for 2 months and longer, size 0.8-1.5 cm) were exposed to extracorporeal impulse lithotripsy (EIL). 26 of them were found to have inflammation in the kidneys and upper urinary tracts. Comparative data on EIL effect show that patients with long-standing ureteroliths need more intensive and long EIL treatment, that fragmentation is more troublesome in oxalate monohydrates and phosphate stones with hydroxylapatite. 4 cases eventuated in operative intervention, in 3 cases ureterolith extraction was performed. EIL results in long-standing ureteroliths depend on the presence of renal and urinary tract inflammation, severity of periureteritis, chemical composition, density and structure of the stones.

[Role of radiographic signs of urinary calculi in the effectiveness of extracorporeal shock-wave lithotripsy]

The value of X-ray signs of urinary calculi for the efficiency of shock-wave teletripsy (SWTL) was assessed in 188 patients with nephro-ureterolithiasis. The calculi were studied from the general X-ray film by means of a routine 4-5x magnifier. All the patients were divided into 2 groups. Group 1 comprised patients with effective SWTL, i.e. those undergone 1 or rarely 2 sessions. Group 2 included those with low effective SWTL, 2-4 sessions. Comparative analysis of X-ray films indicated that the calculi which were homogeneous in structure, moderate in intensity and had even edges in the general X-ray pictures in 154 (82%) cases were fragmented after 3-4 sessions (the average number of impulses were 7500, at 19.0 kV). With their heterogeneous structure, low and high intensity, irregular rough edges, they were fragmented after 1 or rarely 2 sessions in 34 (18%) patients. The number of impulses was fewer, on an average of 2300, the voltage was less -17.5 kV. It was noted that the pattern of the edges of a calculus and its geometric form are of highly value in the prediction of SWTL. Calculi having even edges were more frequently encountered in patients from Group 2 (in 81.1% of cases), but in patients of Group 1 they were only in 18.1%.

[Conservative surgery in tumors of the renal parenchyma]

Policy in diagnosis and conservative therapy of renal parenchyma tumors is considered for bilateral lesion, single kidney, combination of renal tumor with renal failure, small-size tumors in normal renal function. The authors advocate all kinds of renal resection. Enucleation is feasible in the single kidney having encapsulated tumor of 3 and less cm in size.

[Cyproterone acetate (Androcur-depo) in the treatment of inoperable prostatic cancer]

The authors consider fundamentals of hormone therapy in prostate cancer, mechanism of long-term androgenic stimulation, detail mechanism of action of antiandrogen (ciproteron acetate-androcur) on the basis of discovered key role of cellular receptor in endocrine regulation of physiological functions in metabolism. Monotherapy with androcur-depo (300 mg once a week) was given to 24 patients with prostatic cancer stage T2-T4. Eight patients had metastases to the bones. The age of the patients ranged from 58 to 80 years. Alleviation of pain, reduction of the prostate size and density, positive uroflowmetric changes (maximal urination rate increased from 2-5 to 10-15 ml/s), residual urine fall occurred as early as treatment week 5-7. There was also a decrease in the activity of acid phosphotase from 5-10 to 0.3-0.8 units according to Bodansky. Serum level of prostate-specific antigen (PSA) dropped from 388-23 to 116-4 ng/ml. Androcur-depo monotherapy demonstrated high efficacy in the treatment of local prostatic cancer.

[The treatment of patients with benign prostatic hyperplasia with Proscar MSD (finasteride)]

53 patients have undergone 1-year conservative treatment of benign prostatic hyperplasia with the drug proskar MSD. All the patients had the disease stage I-II, maximal urination rate at least 5 ml/s, residual urine to a maximum 150 ml. Benign nature of the disease was confirmed by the test with prostate-specific antigen. Selection of patients, follow-up and assessment of treatment results were conducted according to the scale of the International System of Overall Assessment of Prostatic Lesions. Proskar MSD was found active in benign prostatic hyperplasia basing on the shifts in the main three indices (symptom status, maximal urination rate, prostate size).

[The role of urinary peptide hydrolase in the laboratory diagnosis of urological diseases]

The authors determined activity of leucine arylamidase (LA) or microsomal aminopeptidase locating in tubular cell microsomes and as a specific enzyme indicating parenchymal damage in the urine of 28 healthy subjects and 187 patients with nephroliths (103), renal injury (13 contusions, 11 rupture) before and after extracorporeal lithotripsy. Changes in LA were followed up spectrophotometrically. LA levels in healthy controls, nephrolithiasis patients free of pyelonephritis or with it in remission were similar, elevated in latent course and significantly elevated in complicated by inflammation nephrolithiasis, renal injury and in patients with associated pyelonephritis after lithotripsy. The highest LA activity was recorded in patients with renal injury and after lithotripsy with latent or active inflammation before lithotripsy. LA urinary content may serve indication of inflammation in the kidneys, parenchymal involvement. It is a helpful adjuvant diagnostic method in urology.

[The role of ultrasonic study in the diagnosis of the multilocular kidney cyst]

The paper reports 5 cases of rare renal disease, multilocular cyst. Pathogenetic, pathomorphological, clinical and visual diagnostic aspects of the cyst presented in the literature are reviewed. Special emphasis is placed on diagnostic potential of ultrasound investigation. Current values of computed tomography and conventional X-ray urological techniques, difficulties in differential diagnosis of multilocular cyst with other cysts and renal carcinoma are shown. The authors think it valid to use combined radiological methods in determination of pathological process origin and its details, calcificates, in particular.

[The intraoperative ultrasonic control of the radicalness of transurethral resection in bladder cancer]

72 patients with bladder cancer stage T1, T2 underwent transurethral resection of the bladder wall affected with tumor under ultrasound control of the removal radicality. The evidence obtained at transurethral ultrasound scanning was compared to the findings of histological examination of the tissue removed. The accuracy of the control made up 87.3%. This made it possible to follow tumor invasion from the tumor margins along the periphery in accordance with blastomatosis stage. The authors have developed a technique of transurethral resection of bladder wall under transurethral ultrasonic scanning as control of the removal radicality.

[The effect of the physicochemical structural properties of urinary calculi on the results of extracorporeal shockwave lithotripsy]

The relation of chemical composition and structure of uroliths to lithotripsy effects was evaluated with regard to the concrement size, location, time of the intraureteral persistence, etc. Besides, a prognosis of the remote impulse lithotripsy (RIL) outcome was attempted by x-ray picture and crystallization alterations in the urine. 54 patients with nephroliths and 73 patients with ureteroliths (overall 137 concrements) were examined. By RIL results, the patients were divided into 2 groups: those who benefited from RIL and those who failed it. Worse results were obtained in cases of oxalate concrements with radial-concentric structure and with phosphate ones composed primarily of hydroxylapathite. RIL efficacy was found to depend on a number of interrelated factors (chemical structure, location, size of the concrement, duration of its existence in the ureter). In long-standing ureteroliths the outcomes are associated with stone structure. The denser is the concrement the more probable is its strangulation and more apparent is periureteritis. Changes in crystallization can prompt RIL prognosis as well as it is possible by x-ray picture.

[The effect of remote-controlled shock-wave lithotripsy on kidney function]

Leucine arylamidase (LAA) excretion in circadian urine of 79 patients suffering from nephroureterolithiasis was measured before and after the session of remote impulse lithotripsy (RIL) to investigate the effect of the impulse on renal function. The stones were localized in the calyces, pelvis and upper third of the ureter. The patients were divided into 2 groups: 43 patients with noncomplicated nephroureterolithiasis (group 1) and 36 patients with complicated one including 12 subjects exposed to the second RIL (group 2). The enzyme excretion was significantly reduced in group 1 patients. Its activity recovered in group 1 within 6-7 days, in group 2 for 10-14 days. After the second RIL procedure LAA activity in the urine enhanced more rapidly, especially in group 2 patients. In calyceal, intrarenal pelvic and fused kidney location of the stone, LAA activity got more elevated than in the extrarenal pelvis or in the upper third of the ureter. It is demonstrated that RIL exhibits a short-term effect on the kidneys which depends on the presence of inflammation, the number of sessions, stones location and the number of impulses.

[The role of transperitoneal fine-needle aspiration biopsy in the diagnosis of obstructive uropathy in patients with cervix uteri cancer]

Upon the exposure to remote or combined radiotherapy, the patients with uterine cervical cancer often develop ureterostenosis due to recurrence or postradiation alterations in the walls and adjacent tissues of the ureter. Etiology of the urodynamic defect is essential for the treatment policy choice. Therefore, in attempt to find out effective means of differential diagnosis between ureteral obstruction due to cervical cancer relapse and due to postradiation lesion, the authors tried transperitoneal aspiration biopsy with thin needle as a tool of such diagnosis. The biopsy was obtained from 19 females. In 14 of them the obstruction was attributed to recurrent cancer, in 5 to radiotherapy. No errors in the diagnosis were made. Thus, the accuracy of the method reached 100%.

[Emission-computed tomography in the diagnosis of kidney tumors and cysts]

Emission computed tomography (ECT) was used to examine 48 patients with suspected renal lesions. Sectional images of renal cysts diagnosed in 14 of them were characterized by well-defined outlines surrounded by uniformly declining radiopharmaceutical accumulations. Renal tumors were detected in 25 patients. ECT pattern of the tumor had obscure borders suggesting the tumor invasion into the renal tissue. Accumulation of the radiopharmaceutical round the tumor was less pronounced than in functioning renal tissue. According to ECT findings, 8 subjects were free of urological pathology. It is concluded that ECT is a promising diagnostic tool in urology as it permits sectional visualization of renal neoplasms structure, is highly sensitive, informative and noninvasive. It can identify mass lesions of the kidneys and warrants exhaustive information on functional performance of the renal parenchyma.

[Transabdominal and transurethral scanning in the diagnosis of the bladder cancer stage]

Diagnostic potential in staging cancer of the urinary bladder was evaluated in 54 relevant patients aged 37-74 for transabdominal versus transurethral ultrasound scanning. In transabdominal scanning stages T2 and T3 cannot be distinguished separately, stage T1 was recognized definitely in 66.6%, T2-T3 in 65.6%, T4 in 70% of cases. Transurethral scanning appeared valid in staging T1 in 91.6%, T2 in 88.8%, T3 in 92.8%, T4 in 90% of cases. Histological studies in 54 patients showed that transurethral scanning can provide accurate results in staging cancer of the urinary bladder in 90.7% of cases. The findings support clinical value of the method as highly informative in staging cancer of the bladder. Basing on both transabdominal and transurethral scanning, ultrasound picture for each stage of the cancer was characterized.

[The combined treatment of urinary incontinence after adenomectomy]

Treatment was applied in 55 patients with enuresis after removal of adenoma of the prostate. Nonoperative treatment of 46 patients included therapeutic exercises, drug therapy (anti-inflammatory agents and tonics), and physical methods: transurethral direct electrical stimulation of the vesical sphincters (25 patients), transperineal ultrasonic stimulation (21 patients). After nonoperative treatment enuresis was completely cured in 31 patients. Fifteen patients with poor results were subjected to a second course of treatment: a satisfactory result was produced in another 6 patients, an improvement was recorded in 9 patients. Operative treatment was carried out in 9 patients: 4 of them by A. Puigvert's method (satisfactory result in 1, improvement in 1, poor result in 1, acute ischuria in 1) and 5 by a modified Puigvert's operation the techniques of which consisted in forming 2 rectangular grafts from the tunica albuginea of the cavernous bodies of the penis, suturing the medial grafts to one another above the urethra on the midline, and suturing to their bases the lateral grafts (satisfactory results in 4, improvement in 1). Thus, complex treatment of 55 patients for enuresis consequent upon removal of adenoma of the prostate caused a satisfactory result in 42 (76.4%), an improvement in 11 (20%), and a poor result in 2 (3.6%) patients.