Results Of Patients In Group Research Articles

Морфофункциональные параметры диабетического макулярного отека после витреоретинальной хирургии

Background. Diabetic macular edema (DME) is a socially significant disease of our time. At the moment, intravitreal administration of antivasoproliferative drugs is the “gold standard” for the treatment of DME. Currently, indication for vitrectomy and membrane peeling for macular edema is the presence of an epiretinal membrane or vitreoretinal traction syndrome. Some authors consider use of vitrectomy with internal limiting membrane peeling to be justified in patients with DME. Purpose. To evaluate changes in the morphofunctional parameters of the retina in patients after vitreoretinal intervention for resistant diabetic macular edema. Methods. 44 patients diagnosed with DME with no response to previous conservative treatment (laser coagulation, angiogenesis inhibitors) underwent surgery at the ophthalmology center of the National Medical Research Center named after N. I. Pirogov. Results When analyzing BCVA after vitreoretinal surgery, a significant increase in functional parameters was revealed in patients of group 2 (vitrectomy) compared with similar parameters in patients of group 1 (continuing treatment) within 6 months from the date of surgery (p = 0.027). There is also a statistically significant decrease in retinal thickness in patients of group 2 compared with patients of group 1 within 1 month (p = 0.035). When assessing photosensitivity, there was a significant increase in parameters in patients of group 2 compared with preoperative parameters and with similar parameters in patients of group 1 within 1 week from the moment of surgery (p = 0.023). Conclusion. It was found that vitreoretinal surgery with membrane peeling provides a higher functional result compared to the group where only angiogenesis inhibitors and retinal laser coagulation were used from 6 to 12 months of observation. By the 1st week of observation, in patients of group 2, in comparison with the results of patients in group 1, there was a more pronounced positive dynamics of photosensitivity which persisted for 12 months. More pronounced edema resorption was also observed in the group in which vitrectomy with internal limiting membrane peeling was used. Thus, these data confirm that use of vitreoretinal surgery is possible in the treatment of diabetic macular edema. Further study of this issue is required. This study was conducted on a small sample of patients. To confirm the statistical reliability of the results, it is necessary to study the data when examining a larger sample in groups. Key words: DME; diabetic macular edema; vitrectomy; membrane peeling.

Impact of the COVID-19 pandemic and the restrictions on pediatric appendicitis in Turkey: A single-center experience.

ABSTRACTBackgroundIn this study, we investigated how the incidence and course of acute appendicitis (AA) changed in children, during the pandemic.MethodsChildren diagnosed with AA during the one‐year pandemic period after the first COVID‐19 case in Turkey and the previous one year were included in the study. Children were divided into two groups: those hospitalised during the pandemic (group A) and hospitalized in the previous year of the pandemic (group B). Furthermore, we compared the findings obtained for COVID‐19‐positive and COVID‐19‐negative children in the whole study group and within group A.ResultsIn our study, a significant difference was found between the two groups in terms of gender, the rate of vomiting and number of days of vomiting. Complicated AA findings were found more frequently from the results of patients in group B than in group A. In addition, the hospital stay was longer, and the mean number of days with fever, and mean body temperature were higher in COVID‐19 positive patients in the whole study group and within group A.ConclusionsContrary to most studies in the literature, in our study patients were admitted to hospital later in the pre‐pandemic period, and therefore the frequency of complicated AA might have been more common in these patients. In conclusion, the arrangements and warnings of health authorities during the pandemic, might have reduced the anxiety and the hesitancy of the families to go to the hospital and relatively the rate of complicated acute appendicitis.

Method of Enteral Insufficiency Syndrome Correction in Patients 
 with Generalized Peritonitis

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis.
 The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis.
 Material and methods. This research was a retrospective prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm.
 Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.310.77 g/l vs 37.334.69 g/l). Whereas in Group I the albumin level was significantly lower (19.30.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.30.51 g/l vs 39.56.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I 104.7613.49 mg/l, Group II - 58.0029.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.52.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.30.9 surgical interventions (p = 0.000171), which is 1.9 times less.
 Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location.

Autologous breast reconstruction has been demonstrated to be associated with superior patient-reported outcomes, and hence is regarded as the gold standard reconstructive modality. A common drawback of this procedure, however, is related to a high abdominal scar. Recently, hybrid breast reconstruction (ie, the combination of autologous and implant-based reconstruction) was presented as an approach that would combine the benefits of both reconstructive modalities. In this study, we sought to assess abdominal aesthetic outcomes associated with this approach. Thirty-two blinded reviewers evaluated standardized pre- and postoperative abdominal images of patients following autologous reconstruction with free abdominal flap (Group 1; N = 10), hybrid reconstruction (Group 2; N = 5), and abdominoplasty (Group 3; N = 10). Aesthetic abdominal appearance, including overall result, scar position, skin redundancy, and lateral abdominal contour, was rated on a 5-point Likert scale and a comparative analysis was performed. Hybrid reconstruction was associated with significantly lower abdominal scars compared with Group 1 (P = 0.01), nearing results of patients in Group 3 (P = 0.39). Significantly higher aesthetic ratings were ascribed to Groups 2 and 3 when compared with Group 1 (P < 0.001) with regard to scar positioning (P < 0.001), skin redundancy (P < 0.001), and lateral abdominal contour (P < 0.001). No significant difference in aesthetic ratings was noted between Groups 2 and 3. When applied to the appropriate patient population, hybrid breast reconstruction is a powerful method to achieve reconstructive goals while optimizing abdominal aesthetics. A significantly lower scar position was noted and higher abdominal aesthetic ratings were given following abdominoplasty and hybrid reconstruction compared with conventional abdominal flap-based reconstruction.

Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6.

IntroductionWith coronary artery bypass grafting, patients are subjected to additional risk caused by both surgical treatment itself and pathophysiological changes in homeostasis, provoked by the action of anesthetics and cardiopulmonary bypass.Material and methodsThe study involved 60 patients, who had been subjected to coronary artery bypass grafting with cardiopulmonary bypass. All patients were divided into two groups: group I (30 patients) – low-opioid scheme of anesthesia and group II (30 patients) – standard scheme of anesthetic management. Blood interleukin-6 (IL-6) was identified before and after cardiopulmonary bypass using an ELISA test.ResultsHaving compared IL-6 values between study groups after completion of cardiopulmonary bypass, it was established that IL-6 levels were 27.51% (p = 0.001) lower in patients of group I compared with the results of patients in group II. Patients in the first group had a significantly shorter time of mechanical ventilation compared to group II (2.1 ±0.7 hours vs. 3.9 ±0.9 hours, p = 0.021). Low cardiac output syndrome was significantly less frequently reported in patients of group I (10.0% vs. 33.3%, p = 0.028). In addition, patients in group I had a significantly shorter time of intensive care unit (ICU) stay (2.5 ±0.7 days vs. 3.5 ±1.0 days, p = 0.044).ConclusionsApplication of multimodal low-opioid anesthesia was associated with significantly lower IL-6 at the end of surgery, shorter mechanical ventilation duration, less frequent low cardiac output syndrome and need for catecholamines, and shorter ICU stays.

A new method of exophthalmometry

PurposeHertel's exophthalmometer measures the position of the eyeball in relation to the lateral orbital rims and does not provide representative results in patients with orbital asymmetry. The purpose of our study was to develop an easy‐to‐use, accurate and reliable method of exophthalmometry in patients with orbital asymmetry and compare its potential with Hertel's exophthalmometer.MethodsWe performed the retrospective study of computerized axial tomography scans and ambulatory medical records of 30 patients: 7 patients with intact lateral orbital wall (group 1), 23 patients with its fracture (group 2). The scans were evaluated with RadiAnt DICOM Viewer software. With tools of the software we drew a straight line through the apices of styloid processeses of temporal bone. This line served as a reference line for all further measurements. On the image, where the cornea of the first eyeball was the most prominent, we constructed a perpendicular to the most prominent point of the cornea. In the same way, the distance from the most prominent point of cornea to the reference line was measured for the second eye. The difference between the lengths of two perpendiculars corresponded to the difference of protrusion between two eyes. The data of our method of computer exophthalmometry were compared with the results obtained with Hertel's exophthalmometer specified in the ambulatory medical records.ResultsIn patients of group 1 differences of protrusion between two eyes measured with two methods were similar. In contrary to the Hertel's exophthalmometer, the computer exophthalmometry showed reliable results in patients of group 2.ConclusionsThe developed method of computered exophthalmometry is easy‐to‐use and allows getting accurate and reliable data even in patients with different abnormalities of orbital area, in contrary to the Hertel's exophthalmometer.

Comparative Study on the Effectiveness of Early or Delayed Weight-Bearing After Anterior Cruciate Ligament Reconstruction

Abstract Objectives. The aim of this study is to evaluate the efficacy of immediate weight-bearing versus two weeks delayed weight-bearing following anterior cruciate reconstruction. Methods. We conducted a prospective observational study on the efficiency of immediate or delayed weight-bearing following anterior cruciate reconstruction. 30 patients undergoing anterior cruciate ligament reconstruction were included in the study. The patients in the first group were allowed the maximum endurance level of weight-bearing on the operated leg from the first postoperative day, resuming normal walking as soon as possible. Patients in group II were barely allowed the loading of the affected limb after 2 weeks postoperatively. Patient assessment was performed preoperatively, immediately after the procedure and postoperatively at 6 weeks, 3 and 6 months. Results. The average pre- and postoperative values of the arthometric assessment show a statistically significant improvement of joint stability in both groups of patients. There were no significant differences in the development of joint mobility averages between the two groups. Following the evolution of functional test average values, there is a gradual function improvement in both groups of patients. The assessment results at 6 weeks and three months postoperatively shows that patients in the first group are significantly better in comparison with the results of patients in group II. The final evaluation showed no significant differences between the two groups of patients. Conclusions. The final assessment revealed no statistically significant difference in reported or objectively measured function. We believe that the weight-bearing exercises and the non–weight-bearing exercises are equally effective and safe in the post-ligamentoplasty recovery.

Some Biochemical Parameters as a Simple Tool for the Prediction of Severity of Scorpion Envenomation among Some Egyptian Children

BACKGROUND: Scorpion sting envenomation is a common public health problem in Egypt and life-threatening emergency, particularly in children. They are at greater risk of developing severe cardiac, respiratory, and neurological complications. Early evaluation of the severity of the envenomation is essential to institute adequate treatments and prevent mortality. AIM: The aim of this study was to assess the value of some routine biochemical parameters in the prediction of severity of scorpion envenomation among some Egyptian children. METHODS: A prospective observational study was conducted on all scorpion envenomated children, admitted to the poison control centre , Ain shams university hospitals from January to December 2015. On admission, all the children with envenomation were subjected to complete medical history, physical examination and routine biochemical laboratory tests. The patients were classified in to three main groups, according to the degree of severity; Group II (mild grade); Group III (moderate grade) and Group IV (severe grade). In addition, ten apparently healthy children were included as a control group (Group I). RESULTS: there were 25 patients (41.6%) in group II, 20 patients (33.4%) in group III and 15 patients (25%) in group IV. The mean age and body weight were significantly decreased in groups III and IV, being lower in group IV. The mean delay time between sting and hospital admission was significantly longer for group IV compared with group III followed by group II. The frequency of stings in lower limb (68%) was significantly higher than those on the upper limb (32%) in group II. It was significantly higher in upper limb than lower limb in groups III and IV. Clinically,the most common finding was severe pain at sting site in all studied groups. Furthermore, the results of patients in group IV were significantly higher when compared with group III as regards: the general manifestations (sweating, fever and cold extremities); respiratory manifestations (tachypnea, cyanosis and pulmonary edema); cardiac manifestations (hypertension, tachycardia and heart failure); neurological manifestations (agitation and coma) and gastrointestinal manifestations (vomiting and abdominal pain). The mean values of random glucose level, total WBC and platelet counts were significantly higher in groups III and IV when compared with control group, being higher in group IV when compared with group III. The mean values of CK-MB level were significantly higher in group IV when compared with control group. In severe cases (group IV), Platelet counts showed a significant positive correlation with WBC count, and CK-MB level values, In addition WBC count showed a significant positive correlation with CK-MB level. While glucose level showed insignificant correlation with CK-MB level, WBC and platelet counts. The mean duration of hospital stay was significantly longer in group IV compared with groups II and III. All the patients discharged with complete recovery with no morbidity or mortality. CONCLUSION: Increased levels of on admission glucose, CK-MB, total WBC and platelets count were more obvious in severely envenomated cases. Increased platelet, total WBC count and CK-MB level were found to be predictors of severe envenomation.

Sensory heterotropia: Which eye should be the main site of surgery, sound or amblyopic eye?

Introduction The altered tonic vergence movement in sensory heterotropia may make the preoperative measured angle of deviation inconstant, and the surgical results are less predictable than when visual acuity is normal in each eye. Maintaining the postoperatively corrected position of the amblyopic eyes is considered difficult because the brain has lost interest in those eyes' position. Objective The aim of this study was to compare the postoperative results and their stability in patients undergoing surgery mainly on the sound eyes with those undergoing surgery mainly in the amblyopic eyes in case of sensory heterotropia. Design This prospective nonrandomized comparative study was carried out in the Ophthalmology Department, Minia University Hospital during the period from March 2011 to October 2012. Patients and methods Sixty patients were included in this study and were divided into two equal groups according to the type of horizontal deviations. In each group, half of the patients underwent surgery mainly on the sound eyes and the others underwent surgery mainly on the amblyopic eyes, and the results were compared. Results In patients of group 1 (esotropia) who underwent surgery mainly on the sound eyes, there were significantly higher and stable results than those who underwent surgery mainly on the amblyopic eyes after 1 and 6 months. Patients of group 2 (exotropia) who underwent surgery on the sound eyes had significantly higher and stable results than those who underwent surgery on the amblyopic eyes after 6 months only. Conclusion Surgery on the sound eyes mainly in horizontal sensory heterotropia had better and more stable results than surgery on the amblyopic eyes.

Effect of artificial tears on automated visual field testing in patients with glaucoma and dry eye

ObjectiveTo evaluate the effects of artificial tears on automated visual field (VF) testing in patients with glaucoma with dry eye syndrome. DesignProspective study. ParticipantsFifty eyes of 50 patients with medically treated primary open-angle glaucoma (POAG) were recruited for this study. The patients were subdivided into 2 subgroups: those with dry eye syndrome (group I) and those without dry eye syndrome (group II). MethodsTear break-up time, Lissamine green staining, and Schirmer I test with topical anesthesia were performed in the same order in all patients. Ocular Surface Disease Index questionnaire was completed by the patients. All participants underwent automated perimetry using the 24-2 SITA (Swedish interactive threshold algorithm) standard strategy before and after 1-week treatment with a lubricating eye drop 4 times daily. VF results were compared before and after the treatment using Wilcoxon signed rank test, and Mann–Whitney test was performed to compare the results of patients in groups I and II. ResultsOf the 50 patients, 25 (50%) were diagnosed with dry eye syndrome. No significant differences between both groups were found with respect to age (P = 0.779) and glaucoma duration (P = 0.722). In patients with glaucoma with dry eye syndrome, there was a significant improvement in test duration, mean deviation, and the number of depressed points at probability level less than 0.5% and less than 1% in pattern deviation plots after the treatment (P< 0.05). ConclusionsThe use of artificial tears in patients with glaucoma with dry eye syndrome decreased VF testing time and improved test results.

Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study.

BackgroundSingle embryo transfer (SET) remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH) to provide this advantage and improve pregnancy rate from SET.MethodsFirst-time IVF patients with a good prognosis (age <35, no prior miscarriage) and normal karyotype seeking elective SET were prospectively randomized into two groups: In Group A, embryos were selected on the basis of morphology and comprehensive chromosomal screening via aCGH (from d5 trophectoderm biopsy) while Group B embryos were assessed by morphology only. All patients had a single fresh blastocyst transferred on d6. Laboratory parameters and clinical pregnancy rates were compared between the two groups.ResultsFor patients in Group A (n = 55), 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient). Aneuploidy was detected in 191/425 (44.9%) of blastocysts in this group. For patients in Group B (n = 48), 389 blastocysts were microscopically examined (8.1 blastocysts/patient). Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017); ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009). There were no twin pregnancies.ConclusionAlthough aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss), this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9%) among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

Combined resection and recession of a single rectus muscle for the treatment of incomitant strabismus

Background: The treatment of incomitant strabismus is challenging. Traditional approaches include the use of asymmetric bilateral surgery and the fadenoperation (posterior fixation suture). We report our experience with a different approach: combined resection and recession of a single rectus muscle. Methods: The charts of 12 patients who underwent resection of a single rectus muscle with an equal or greater amount of recession of the same muscle were identified. In 5 patients, the procedure was performed using the adjustable suture technique, and the adjustment was performed later the same day (Group 1). In the remaining 7 patients, permanent sutures were placed at the time of surgery (Group 2). The procedure was performed for horizontal and vertical gaze incomitance, dissociated horizontal deviation, and distance-near disparity. Results: Four of the 5 patients in Group 1 showed stable, long-term correction of their incomitance, both in primary gaze and in gaze in the direction of the muscle operated on. The results for patients in Group 2 showed stable, long-term correction of incomitance in 3 patients; however, these patients also had slight overcorrections in the direction of gaze opposite to the muscle operated on. An additional patient in Group 2 had a shift of her distance-near disparity, shifting from relatively exotropic to relatively esotropic disparity postoperatively. All patients in Group 2 showed at least some decrease in the amount of measured incomitance. We did not encounter complications such as muscle slippage or loss, scleral perforation, or late overcorrection in the field of gaze of the operated muscle. Conclusions: The technique of combined resection and recession of a single rectus muscle shows promise in the treatment of incomitant strabismus. It offers the advantages of posterior fixation combined with the greater technical ease of a standard hangback recession. The muscle may also be placed on an adjustable suture, allowing for postoperative adjustment in selected patients. (J AAPOS 1999;3:263-8)

Hepatic resection for bilobar multicentric hepatocellular carcinoma: Is it justified?

<h2>Abstract</h2> <b>Background:</b> Hepatic resection for multiple hepatocellular carcinomas (HCCs) involving both lobes of the liver is rarely recommended because of high operative risks and low radicality. Thus the justification of hepatic resection for bilobar multicentric HCC remains undefined. <b>Methods:</b> Two hundred eleven patients with HCC, who underwent curative hepatic resection, were studied retrospectively. The patients were divided into two groups. Group A consisted of 39 patients with bilobar (both sides of Cantlie's line) multicentric HCCs. Group B consisted of 172 patients with HCC with solitary or unilobar lesions. The backgrounds and resectional results of patients in groups A and B were compared. <b>Results;</b> Patients in group A usually required multiple separate liver resections and a longer operative time. However, the operative blood loss, amount of blood transfused, and operative morbidity and mortality rates were not significantly different. Patients in group A showed higher incidences of associated satellite nodules, microscopic vascular invasion, and a lack of capsules. The 6-year disease-free and actuarial survival rates of patients in groups A and B were 30.5% and 41.8% (<i>p</i> = 0.17) and 42.9% and 51.4% (<i>p</i> = 0.12), respectively. For patients in group A the presence of satellite nodules in any resected tumor was the only independent unfavorable feature that influenced the actuarial survival rate after multivariate analysis. <b>Conclusions:</b> Liver resection is justified for bilobar multicentric HCCs in selected patients, if the tumors can be totally resected. Postoperative adjuvant therapies should be considered when satellite nodules are present in any resected tumor. (Surgery 1998;123:270-7.)

Hepatic resection for bilobar multicentric hepatocellular carcinoma: Is it justified?

Background: Hepatic resection for multiple hepatocellular carcinomas (HCCs) involving both lobes of the liver is rarely recommended because of high operative risks and low radicality. Thus the justification of hepatic resection for bilobar multicentric HCC remains undefined. Methods: Two hundred eleven patients with HCC, who underwent curative hepatic resection, were studied retrospectively. The patients were divided into two groups. Group A consisted of 39 patients with bilobar (both sides of Cantlie's line) multicentric HCCs. Group B consisted of 172 patients with HCC with solitary or unilobar lesions. The backgrounds and resectional results of patients in groups A and B were compared. Results; Patients in group A usually required multiple separate liver resections and a longer operative time. However, the operative blood loss, amount of blood transfused, and operative morbidity and mortality rates were not significantly different. Patients in group A showed higher incidences of associated satellite nodules, microscopic vascular invasion, and a lack of capsules. The 6-year disease-free and actuarial survival rates of patients in groups A and B were 30.5% and 41.8% ( p = 0.17) and 42.9% and 51.4% ( p = 0.12), respectively. For patients in group A the presence of satellite nodules in any resected tumor was the only independent unfavorable feature that influenced the actuarial survival rate after multivariate analysis. Conclusions: Liver resection is justified for bilobar multicentric HCCs in selected patients, if the tumors can be totally resected. Postoperative adjuvant therapies should be considered when satellite nodules are present in any resected tumor. (Surgery 1998;123:270-7.)

Urethral Valves During the First Year of Life - A Retrospective, Multicenter Study

The diagnoses, treatment, and clinical courses of 178 children with urethral valves were analyzed in a retrospective, multicenter study. In group I the diagnosis had been made during the first 4 weeks of life, in group II between the 2nd and 12th months of life, after which treatment was begun. Statistical analysis of the patient data and results revealed clearly poorer results for patients in group I, who had the most severe congenital abnormalities: 10% of the infants in group I died within the 1st year of life as compared to 1% in group II. Among the survivors, 25% of children in group I had renal insufficiency as opposed to 8.2% in group II. The following parameters proved to be statistically significant risk factors with regard to prognosis: 1. Birth weight 2. Age at diagnosis 3. Renal function, particularly when initial creatinine levels exceed 200 mumol/l and fail to decrease below 100 mumol/l after successful therapy 4. Bilateral grade IV or V vesicoureteral reflux 5. Late incontinence (after conclusion of the 5th year of life). Statistical significance could be demonstrated for parameters 1-4, but due to the small number of patients not for parameter 5. The study showed that numerous neoimplantations associated with high complication rates were carried out in both groups, however, no statistically significant effect on long-term prognosis could be established. Our results did not confirm those of the Toronto group, who proposed that broadening the indications for supravesical urinary diversion would provide demonstrable parenchymal protection. No statistically significant relationship between therapeutic procedure and long-term clinical course could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)