Introduction. Urolithiasis is one of the most common pathologies in modern urology. This disease is registered in 10% of the population and is manifested by an annual increase. Despite all the effectiveness and safety of Ho:YAG, in recent years, the thulium laser has attracted more and more interest. At the moment, in the modern literature there is not enough information about thulium and holmium ureterolithotripsy. The aim of this study is to compare the effectiveness of thulium and holmium ureterolithotripsy. Material and Methods. Since from October 2018 to October 2019 in City Centre Endoscopic Urology and New Technologies Clinical Hospital of St. Luke; St. Petersburg, 420 patients underwent contact ureterolithotripsy with using of thulium (group Б) or holmium (group А) lasers for calculi localized in the ureter. Results. Patients in group B had an advantage in terms of such indicators as the time of surgery, the time of lithotripsy in the Dusting and Fragmentation modes for ureteral calculi of any localization compared with group A. The SFR level in the two groups was relatively identical. Patients in group B had a lower rate of retropulsion during lithotripsy compared to patients in group A. And also in group B there was no migration of calculus into the renal cavity system. Conclusion. Our data indicate the same level of stone free rate when using both thulium and holmium lasers in the dusting and fragmentation modes. However, there is a higher efficiency during ureterolithotripsy using a thulium laser compared to ureterolithotripsy using a holmium laser, regardless of the lithotripsy mode.
The article presents the results of treatment of cows with sole ulcer with the use of orthopedic shoeing. It is known that the foot diseases in the cows are quite common. In particular, the damage to the digit horn occurs almost on all dairy farms with a level of distribution from 5 to 23 % of cows. The research was conducted on high-yield milked cows with a productivity of 6-8 thousand liters per lactation.Cows with ulcerous soles, which were diagnosed during 6 months period, were randomly assigned into two groups, control and experimental. To all animals with sole alcers there were applied functional orthopedic treatment of all digits. The destroyed horn and necrotic tissues in the area of ulcers were removed and defect zone was treated with antiseptics. Subsequently, the animals of the control group imposed bandages with Hoofgel, every three days, 4-6 times until complete wound epithelization. For the cows of the experimental group additionally there was used a wooden block for the adjacent healthy digit. The Technobase 8000 set was used for wooden block application. The essence of treatment of cows with lameness and ulcers is associated with the use of a wooden block on the unharmed hoof. Steps to apply correctly the hedge block include the following. First, proper functional trimming and therapeutic treatment for both claws. Second, mechanical antiseptic processing to ensure normal adhesion of the wooden block and comfort for the animal. Removal of dirt and dumpness of the claw that is going to be blockaged. The tried step is selecting the appropriate size of the block. The correct size of the block depends on the size of the hoof. Blocks should cover the hoof sufficiently from the hook to the pulp. A wider blade should be evenly spaced that would provide greater stability. In most cases, there is a greater potential for damage when a used block is too short or too long. The block of the appropriate size should go beyond the surface of the digit pulp. In most cases, the length of the block is from 13.3 to 16.2 cm. The block, which is too long, can lead to a primary damage to a healthy hoof because of the excessive load on it. The thickness of the block is determined by the rate of wear created by the amount of cows movement, and the time necessary for the infection development. Cows with severe lesions may require additional thickness of the block for a long period of application and protection from subsequent exposure. For more severe damage, the most durable type of block is required. A less durable unit will not provide sufficient weight transfer from the affected digit for the required period of time to ensure complete healing of the sole. The forth step is preparation of glue for blocking. For this purpose, in a measuring cup, which comes with a set, add 80 g (70-75 g) of powdered substance and add 40 ml of solution, which is also measured with a glass that is included in the set. They are mixed to form a homogeneous paste/ One should made it quickly prevent polymerisation phenomena. Subsequently, the cooked mass is applied to the wooden block with the help of a stick, since the mass has a high temperature. Fifth step consist of positioning the unit at the right angle. The wooden block is pressed moderately to the sole so that there is a layer of glue between the sole and the block, about 0.5 cm thick. The block is placed at an angle of 90 degrees or less to the uncovered wall. In this case it is guaranteed that the weight will decrease on the affected hoof and is not transferred to the outer wall of the affected hoof. Blocks tend to shift over time to incorrect positioning, as shown above. To counteract this situation, it is recommended to use blocks at the specified angle. The next requirement for positioning is to verify that the block is supported with the angle to hoof wall from 50 to 52 degrees. In cases where the above requirements can not be met, the unit is rebalanced or changed. Attach a block at the level of the hook or slightly retract back with the hoof knife. The waiting time to give the adhesive mass to harden – from 1 to 3 minutes before putting the limb on the floor. A re-examination of cows is carried out in about 4 weeks. So, in cases where we correctly use wooden blocks there have been created the best conditions for proper healing. After these steps, it is necessary to ensure proper wear of the blocks. The should not stay on the foot for too short or too long time. The time of the block demolition is affected by the type of litter and floor surface. To ensure sufficient healing of the ulcers, the blocks should remain for at least 4-6 weeks. If the unit remains for a shorter period of time, treatment is unlikely to be complete, and the return of the load on the affected hoof will delay recovery and increases the recurrence of an ulcer. Comparative effectiveness of treatment of cows while using the wooden blocks. After the opening of the pathological focus, the removal of non-viable tissues and excessive granulation, the local treatment of the surface of the defeat of the Chemy Spray and Hoofgel's lubrication was performed. The defect, formed as a result of ulcerous damage to the tissues of the sole, was closed by the keratinous epidermis more quickly in the experimental group of animals than the control group. Comparing the effectiveness of treatment of sole ulcers in the experimental and control animals, we found the advantage of orthopedic treatment: its use decreases (p <0,01) the number of treatments – from 6,4 ± 0,125 to 5,7 ± 0,09 times in the experimental group. Also, the reduction (p <0.01) of the period of recovery was noted: in the experimental group it was 18-24 days (20,7 ± 0,33), and in the control group – 19-28 days (24,06 ± 0,39) . Key words: highly productive cows, sole ulcers, orthopedic shoes.