Лапароскопические операции при остром аппендиците, осложненном перитонитом

Introduction. Acute appendicitis (AA) is one of the most common acute abdominal surgical diseases. The current incidence, according to various authors, is 22.8 per 10,000 inhabitants. Annually, 50 to 70 thousand people die from AA and its complications around the world. Laparoscopy is generally accepted as the most effective method of differential diagnosis of AA. It is fundamentally significant to move from the diagnostic stage to the therapeutic one, i.e. to perform the elimination of the disease, including cases with other surgery-requiring pathology detected. Aim. To evaluate the role of video-endoscopic surgical methods in the surgical management of acute appendicitis complicated by peritonitis. Materials and methods. The analysis of recent publications and personal clinical experience revealed that diagnostic laparoscopy, unless contraindicated, should be performed as the initial step in suspected acute abdominal pathology. When the surgery is technically performable, laparoscopy also causes curative effect. Results and discussion. The use of laparoscopy in surgical treatment of acute appendicitis complicated by peritonitis has proven advantages for the patient over open surgery. An adequate appendectomy as a reliable method for elimination of the source of peritonitis is the key to successful treatment of patients. Laparoscopic lavage in the early postoperative period against the postoperative peritonitis with developing complications, is considered to be an alternative method to non-surgical treatment or delayed intervention and to have better ultimate results than percutaneous drainage or relaparotomy. Conclusion. The success of video-endoscopic technologies application depends not only on the technical aspects, but also on the correct choice of indications for such an intervention and their appropriate combination with open surgeries.Введение. Острый аппендицит (ОА) — одно из самых широко распространенных острых хирургических заболеваний брюшной полости. В настоящее время, по данным различных авторов, частота встречаемости составляет 22,8 на 10 000 населения. Ежегодно в мире от ОА и его осложнений умирает от 50 до 70 тыс. человек. Общепризнанным является мнение, что лапароскопия — это наиболее эффективный метод дифференциальной диагностики ОА. Принципиальным фактом является возможность перехода от диагностического этапа к лечебному, т. е. выполнению устранения заболевания, в том числе при выявлении другой патологии, требующей хирургической коррекции. Цель исследования: оценить роль эндовидеохирургических методов в хирургическом лечении острого аппендицита, осложненного перитонитом. Материалы и методы. Анализ современной литературы и собственный клинический опыт позволяют утверждать, что в отсутствие противопоказаний диагностическая лапароскопия должна выполняться первичным этапом при подозрении на острую абдоминальную патологию. Она же становится лечебной при наличии технических возможностей выполнения операции. Результаты и обсуждение. Применение лапароскопических методов в хирургическом лечении острого аппендицита, осложненного перитонитом, имеет доказанные преимущества для пациента перед открытой операцией. Залогом успешного лечения пациентов является надежная ликвидация источника перитонита — выполнение адекватной аппендэктомии. Лапароскопическая санация в раннем послеоперационном периоде на фоне послеоперационного перитонита, при развивающихся осложнениях, является альтернативным методом безоперационному лечению и отложенному вмешательству и, в конечном счете, имеет лучшие результаты чем, чрескожное дренирование или релапаротомия. Заключение. Успех применения видеоэндоскопических технологий зависит не только от технических аспектов, но и от верного выбора показаний к такой операции и рациональному использованию их сочетания с открытыми операциями.

Donor-acceptor recombination emission in hydrogen-terminated nanodiamond: Novel single-photon source for room-temperature quantum photonics

In fluorescence spectra of nanodiamonds (NDs) synthesized at high pressure from adamantane and other organic compounds, very narrow (~1 nm) lines of unknown origin are observed in a wide spectroscopic range from ~500 to 800 nm. Here, we propose and experimentally substantiate the hypothesis that these mysterious lines arise from radiative recombination of donor-acceptor pairs (DAPs). To confirm our hypothesis, we study the fluorescence spectra of undoped and nitrogen-doped NDs of different sizes, before and after thermal oxidation of their surface. The results obtained with a high degree of confidence allowed us to conclude that the DAPs are formed through the interaction of donor-like substitutional nitrogen present in the diamond lattice, and a 2D layer of acceptors resulting from the transfer doping effect on the surface of hydrogen-terminated NDs. A specific behavior of the DAP-induced lines was discovered in the temperature range of 100-10 K: their energy increases and most lines are split into 2 or more components with decreasing temperature. It is shown that the majority of the studied DAP emitters are sources of single photons, with an emission rate of up to >1 million counts/s at room temperature, which significantly surpasses that of nitrogen-vacancy and silicon-vacancy centers under the same detection conditions. Despite an observed temporal instability in the emission, the DAP emitters of H-terminated NDs represent a powerful room-temperature single-photon source for quantum optical technologies

Use of Gene-Activated Demineralized Bone Allograft in the Therapy of Ulnar Pseudarthrosis. Case Report

© 2016, Springer Science+Business Media New York.This paper presents a clinical case of successful ulnar pseudarthrosis treatment using a gene-activated bone allograft containing VEGF (vascular endothelial growth factor) and BMP2 (bone morphogenetic protein 2) in the form of a multicystron plasmid. Demineralized bone matrix with applied recombinant plasmid DNA was grafted into the bone defect using the classical open surgical approach. Two months after the surgery, the patient noticed the disappearance of pain including pain during activity. On X-rays of ulna, signs of union in the form of callus formation were found

Clinical Cases of Gallstone Ileus

Background. Gallstone ileus is a rare complication of cholelithiasis accounting for 0.3–2.1% total acute intestinal obstructions. The recent years are witnessing a sharply elevated incidence of cholelithiasis and its entailed complications. The major diagnostic biases are the atypical clinical presentation, instrumental and laboratory evidence, and a relative paucity of surgical cases.Aim. Highlighting to surgeons the feasibility of this rare reluctantly diagnosed form of acute small bowel obstruction.Materials and methods. The article presents the clinical observations of gallstone-induced small intestinal obstruction collected at a surgery unit of the Bashkir State Medical University Clinic. Patients had surgeries for cholecystoduodenal fistula embolisation, gastro/enterotomy and lithoextraction followed by gastro/enterotomy wound suturing.Results and discussion. Patients had a benign postoperative period are were discharged in a satisfactory condition on day 7–10 after surgery for outpatient surveillance.Conclusion. Surgeons need to contemplate this pathology to ensure timely diagnosis and treatment, as well as avoid possible complications. Mostly important still is a timely gallbladder resection upon diagnosing cholelithiasis via laparoscopic cholecystectomy as a “gold standard” in treatment for this disease

Bootstrapping the energy flow in the beginning of life.

This paper suggests that the energy flow on which all living structures depend only started up slowly, the low-energy, initial phase starting up a second, slightly more energetic phase, and so on. In this way, the build up of the energy flow follows a bootstrapping process similar to that found in the development of computers, the first generation making possible the calculations necessary for constructing the second one, etc. In the biogenetic upstart of an energy flow, non-metals in the lower periods of the Periodic Table of Elements would have constituted the most primitive systems, their operation being enhanced and later supplanted by elements in the higher periods that demand more energy. This bootstrapping process would put the development of the metabolisms based on the second period elements carbon, nitrogen and oxygen at the end of the evolutionary process rather than at, or even before, the biogenetic even

Rising atmospheric methane: 2007-2014 growth and isotopic shift

From 2007 to 2013, the globally averaged mole fraction of methane in the atmosphere increased by 5.7±1.2ppb yr$^{-1}$. Simultaneously, $\delta^{13}$C$_\text{CH4}$ (a measure of the $^{13}$C/$^{12}$C isotope ratio in methane) has shifted to significantly more negative values since 2007. Growth was extreme in 2014, at 12.5±0.4ppb, with a further shift to more negative values being observed at most latitudes. The isotopic evidence presented here suggests that the methane rise was dominated by significant increases in biogenic methane emissions, particularly in the tropics, for example, from expansion of tropical wetlands in years with strongly positive rainfall anomalies or emissions from increased agricultural sources such as ruminants and rice paddies. Changes in the removal rate of methane by the OH radical have not been seen in other tracers of atmospheric chemistry and do not appear to explain short-term variations in methane. Fossil fuel emissions may also have grown, but the sustained shift to more $^{13}$C-depleted values and its significant interannual variability, and the tropical and Southern Hemisphere loci of post-2007 growth, both indicate that fossil fuel emissions have not been the dominant factor driving the increase. A major cause of increased tropical wetland and tropical agricultural methane emissions, the likely major contributors to growth, may be their responses to meteorological change.This work was supported by the UK Natural Environment Research Council projects NE/N016211/1 The Global Methane Budget, NE/M005836/1 Methane at the edge, NE/K006045/1 The Southern Methane Anomaly and NE/I028874/1 MAMM. We thank the UK Meteorological Office for flask collection and hosting the continuous measurement at Ascension, the Ascension Island Government for essential support, and Thumeka Mkololo for flask collection in Cape Tow

Triple F - a comet nucleus sample return mission

The Triple F (Fresh From the Fridge) mission, a Comet Nucleus Sample Return, has been proposed to ESA's Cosmic Vision program. A sample return from a comet enables us to reach the ultimate goal of cometary research. Since comets are the least processed bodies in the solar system, the proposal goes far beyond cometary science topics (like the explanation of cometary activity) and delivers invaluable information about the formation of the solar system and the interstellar molecular cloud from which it formed. The proposed mission would extract three sample cores of the upper 50cm from three locations on a cometary nucleus and return them cooled to Earth for analysis in the laboratory. The simple mission concept with a touch-and-go sampling by a single spacecraft was proposed as an M-class mission in collaboration with the Russian space agency ROSCOSMOS. © The Author(s) 2008

Geogenic and atmospheric sources for volatile organic compounds in fumarolic emissions from Mt. Etna and Vulcano Island (Sicily, Italy)

In this paper, fluid source(s) and processes controlling the chemical composition of volatile organic compounds (VOCs) in gas discharges from Mt. Etna and Vulcano Island(Sicily, Italy) were investigated. The main composition of the Etnean and Volcano gas emissions is produced by mixing, to various degrees, of magmatic and hydrothermal components. VOCs are dominated by alkanes, alkenes and aromatics, with minor, though significant, concentrations of O-, S- and Cl(F)-substituted compounds. The main mechanism for the production of alkanes is likely related to pyrolysis of organic-matterbearing sediments that interact with the ascending magmatic fluids. Alkanes are then converted to alkene and aromatic compounds via catalytic reactions (dehydrogenation and dehydroaromatization, respectively). Nevertheless, an abiogenic origin for the light hydrocarbons cannot be ruled out. Oxidative processes of hydrocarbons at relatively high temperatures and oxidizing conditions, typical of these volcanic-hydrothermal fluids, may explain the production of alcohols, esters, aldehydes, as well as O- and S-bearing heterocycles. By comparing the concentrations of hydrochlorofluorocarbons (HCFCs) in the fumarolic discharges with respect to those of background air, it is possible to highlight that they have a geogenic origin likely due to halogenation of both methane and alkenes. Finally, chlorofluorocarbon (CFC) abundances appear to be consistent with background air, although the strong air contamination that affects the Mt. Etna fumaroles may mask a possible geogenic contribution for these compounds. On the other hand, no CFCs were detected in the Vulcano gases, which are characterized by low air contribution. Nevertheless, a geogenic source for these compounds cannot be excluded on the basis of the present data

The Eurasian Modern Pollen Database (EMPD), version 2

The Eurasian (née European) Modern Pollen Database (EMPD) was established in 2013 to provide a public database of high-quality modern pollen surface samples to help support studies of past climate, land cover, and land use using fossil pollen. The EMPD is part of, and complementary to, the European Pollen Database (EPD) which contains data on fossil pollen found in Late Quaternary sedimentary archives throughout the Eurasian region. The EPD is in turn part of the rapidly growing Neotoma database, which is now the primary home for global palaeoecological data. This paper describes version 2 of the EMPD in which the number of samples held in the database has been increased by 60 % from 4826 to 8134. Much of the improvement in data coverage has come from northern Asia, and the database has consequently been renamed the Eurasian Modern Pollen Database to reflect this geographical enlargement. The EMPD can be viewed online using a dedicated map-based viewer at https://empd2.github.io and downloaded in a variety of file formats at https://doi.pangaea.de/10.1594/PANGAEA.909130 (Chevalier et al., 2019)Swiss National Science Foundation | Ref. 200021_16959