Objective. To assess treatment outcomes in children with posterior urethral valve (PUV). Patients and methods. We analyzed treatment outcomes in 60 children with PUV within a non-randomized, retrospective, single-center, pilot study. Sixty patients have undergone PUV ablation; 8 of them required repeated ablation. Endoscopic treatment of vesicoureteral reflux (VUR) was performed in 31 ureters; 5 children had botulinum toxin therapy. Results. Type 1 PUV was diagnosed in 49 patients (81.6%), whereas type 3 PUV was identified in 11 patients (18.3%). VUR was detected in in 65 ureters (54.1%); obstructive ureterohydronephrosis was diagnosed in 40 ureters (33.3%). Ablation of the valve flaps improved lower urinary tract (LUT) urodynamics in 27 children. Thirty-three patients had valve bladder syndrome (VBS). Improvement of the upper urinary tract (UUT) condition was achieved in 54 cases. Fifteen children have undergone nephroureterectomy. There was a significant decrease in the activity of pyelonephritis in children after endoscopic ablation of the PUV. Fifty-three patients (88.3%) demonstrated severe UUT urodynamic disorders. The baseline grade of UUT lesions affected treatment outcome (p = 0.0009). Children with VBS symptoms had progressive UUT pathology and persistent urinary incontinence. Six patients eventually required replacement therapy. Conclusion. The majority of PUV children (88.3%) presented with severe UUT impairments. More than half of the patients (55.0%) had VBS symptoms. Their treatment should be comprehensive and include long-term monitoring of urodynamics and kidney function. Key words: posterior urethral valve, valve bladder syndrome, vesicoureteral reflux

Bilateral nephroblastoma is rare and is about 5 % of the total number of patients. The modern strategy of treatment children with bilateral Wilms tumor requires a comprehensive approach. An important task is to preserve as much of the renal parenchyma as possible, which will be sufficient for normal kidney function and development of the child. However, in subtotal kidney damage organ-preserving treatment is not always possible. In this case, the only curative option is bilateral nephrectomy followed by continuous renal replacement therapy. To date, the literature describes isolated cases of adjuvant chemotherapy in children on peritoneal dialysis. The article presents a clinical case of specific therapy with topotecan for a child after bilateral nephrectomy, a carrier of peritoneal dialysis catheter on the background of progression of the underlying disease.

Цитирование: Осипов А.Ю., Ляхтээнмяки М., Илмолахти О., Карху Я. (2019) Коммодификация природы: национальный парк «Ладожские шхеры» // Мир России. Т. 28. № 3. С. 113–131. DOI: 10.17323/1811-038X-2019-28-3-113-131 В статье исследуются проблемы коммодификации природы Северного Приладожья и мнения участников событий относительно использования природных ресурсов. Судьба уникальных природных ландшафтов, подвергшихся серьезному антропогенному воздействию, стала предметом длительной дискуссии между властями разных уровней, учеными и местными жителями. Создание национального парка «Ладожские шхеры» явилось не только гарантом сохранения природного комплекса, но и затронуло права местных жителей, объединившихся против этой идеи. На основании широкого круга неопубликованных документов, интервью и данных интернет-форумов авторы демонстрируют, как природные ландшафты Северного Приладожья выступают в качестве визуальных объектов, при этом экотуризм принимает на себя роль инструмента коммодификации. Наряду с этим, местные жители рассматривают эту территорию как жизненное пространство и объект материального потребления. Таким образом, ситуация вокруг национального парка представляется классическим примером противоречия между коллективным и индивидуальным. Анализ ответов респондентов приводит авторов к выводу, что суть конфликта заключается не только в разных способах коммодификации природы. Национальный парк нарушает невидимые границы жизненного пространства, выстроенные местными жителями, и является инородной структурой. Авторы показывают, как данная проблема выходит на политический уровень, где противники парка терпят поражение, при этом сам конфликт остается неурегулированным.

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.