The stromal vascular fraction from fat tissue in the treatment of osteochondral knee defect: Case report

© 2018 Salikhov, Masgutov, Chekunov, Tazetdinova, Masgutova, Teplov, Galimov, Plakseichuk, Yagudin, Pankov and Rizvanov. In this study we applied autologous fat tissue stromal vascular fraction (SVF) cells in combination with microfracturing technique in a 36-year-old man with an osteochondral lesion of the medial femoral condyle 8 months after the injury. Cell material was generated by fat tissue liposuction from the anterior abdominal wall with subsequent extraction of the SVF and injected through a mini-arthrotomy portal with subsequent fibrin sealant fixation. The follow-up period was 2 years. Clinical score improved from 23 to 96 according to IKDC and from 10 to 90 according to EQ-VAS at 24 months follow-up. Magnetic resonance imaging (MRI) before the surgery revealed an osteochondral lesion with development of significant trabecular edema that remained unchanged for 6 months despite conservative treatment. MRI 1 and 2 years after the surgery showed the recovery of the damaged cartilage thickness with somewhat uneven structure and a decrease in the trabecular edema of the femoral condyle. The use of SVF cells with fibrin sealant fixation might be a promising approach in the treatment of osteochondral joint lesions. Further studies are required

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.

Измерение анатомических структур во время лапароскопических вмешательств

Determining the exact sizes of anatomical structures play a very important today in laparoscopic surgery. This makes it possible to make a correct selection of gauges of instruments needed, prosthetic materials, and to make decisions regarding the further strategy of the surgical procedure. The device developed at the clinic has proven itself in everyday clinical practices. It is currently used in laparoscopic operations for hiatal hernias, choledoch measurements in patients with choledocholithiasis, stomach stump size measurements during the resection in patients with morbid obesity. The presented clinical case serves to confirm that obtaining objective data in video endoscopic surgery makes it possible to choose the optimal treatment strategy.На сегодня в лапароскопической хирургии очень важную роль играет определение точных размеров анатомических структур, что позволяет наиболее верно подбирать необходимые размеры инструментов, протезирующих материалов, выбирать дальнейшую тактику оперативного вмешательства. Разработанное в клинике устройство хорошо зарекомендовало себя в повседневной клинической практике и на данный момент применяется при выполнении лапароскопических операций по поводу хиатальных грыж, измерении размеров холедоха у пациентов с холедохолитиазом, измерением размеров культи желудка при резекции его у пациентов с морбидным ожирением. Данный клинический случай доказывает, что получение объективных данных в видеоэндохирургии позволяет выбрать оптимальную тактику лечения заболеваний

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

MODERN TREATMENT MINIMALLY INVASIVE TECHNOLOGIES RENOVASCULAR HYPERTENSION

The purpose of the research was the study of the effectiveness of balloon angioplasty and stenting of renal arteries to improve the microcirculation of the kidneys in patients with renovascular hypertension. During the period from 2010 to 2012 inclusive in the vascular compartment BSMU clinic were examined and treated 32 patients with renal artery stenosis. Inclusion criteria were: presence of verified violations of regional circulation in the kidney, the presence of symptomatic renovascular hypertension. Measures the average systolic and diastolic blood pressure mast. Patients received antihypertensive treatment to endovascular treatment. Treatment with antihypertensive medication was effective only in 9.8 % of cases. Diagnostic angiography of the renal arteries was performed using angiographic complex INNOVA 3131 IQ. After analyzing the data, the question of stenting or balloon angioplasty. After a detailed survey of 32 patients underwent endovascular intervention for renal artery 6 balloon angioplasty and stenting 26. Following the procedure, the hypotensive effect was observed in all cases. Evaluation of the results showed a significant reduction in the maximum rise in systolic blood pressure by 28 %, diastolic - 21 %. After endovascular intervention, the mean systolic blood pressure decreased by 10%, the average diastolic blood pressure - 15 %. Mean arterial pressure decreased by 8 %. In a review of the effectiveness of endovascular procedures with the original length and the degree of hypertension. Thus, roentgenendovascular treatment improves microcirculation in the renal tissue, which leads to the hypotensive effect of a predominantly marked reduction of maximum systolic blood pressure

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

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

Эндопротезирование гастродуоденальной артерии стент-графтом с целью «выключения» ложной аневризмы из кровотока

Introduction. Aneurysms of visceral arteries in the abdominal cavity are very rare. Often aneurysms of branches of the abdominal aorta are an incidental finding as patients seldom present obvious clinical signs or pathological changes in the organ supplied by the artery involved. The incidence of aneurysms of branches connecting the celiac trunk and the upper mesenteric artery amounts to 3.5% of all the cases of aneurysms of abdominal aorta arteries, mostly the gastroduodenal artery. This paper presents a case of minimally invasive treatment of gastroduodenal artery pseudoaneurysm at the BSMU Clinic.Materials and methods. Patient K, a 47-year-old female, was admitted for emergency treatment at the Bashkir State Medical University Clinic in May 2019. The patient’s complaints included feeling weak, black stool for seven days prior, faintness and epigastric pain.Results and discussions. Instrumental examination and angiography data demonstrated that the size of the pseudoaneurysm has increased 2.5 times and reached 65×45 mm; the clinical picture led to the conclusion that the aneurysm was ready to rupture and that there was an immediate need to stop the blood flow to the gastroduodenal artery pseudoaneurysm.Conclusion. The range of currently available image-guided surgical procedures makes it possible to perform adequate embolization of pathological structures such as artery aneurysms.Введение. Аневризмы висцеральных артерий брюшной полости встречаются очень редко в клинической практике врачей. Зачастую аневризмы ветвей брюшной аорты являются диагностической находкой, так как клиническая картина редко когда отображает явные признаки ее наличия и на первый план выходят патологические изменения со стороны органа, который данная артерия кровоснабжает. Частота встречаемости аневризмы ветвей, соединяющих чревный ствол и верхнюю брыжеечную артерию, составляет 3,5 % от всех аневризм артерий брюшной аорты, и основную долю их занимает гастродуоденальная артерия.Цель исследования: демонстрация мини-инвазивного лечения ложной аневризмы гастродуоденальной артерии в Клинике БГМУ.Материалы и методы. В Клинику Башкирского государственного медицинского университета в мае 2019 года в экстренном порядке поступила пациентка К. 47 лет с жалобами на слабость, черный стул в течение 7 дней, головокружение, боли в эпигастральной области.Результаты и обсуждение. По данным инструментальных методов исследования и ангиографии, размер ложной аневризмы увеличился в 2,5 раза и составил 65×45 мм, по клинической картине можно было судить о готовности разрыва аневризмы и прямой необходимости в устранении кровоснабжения ложной аневризмы гастродуоденальной артерии.Заключение. На сегодняшний день инструментарий для проведения рентген-хирургических вмешательств позволяет выполнять полноценную эмболизацию патологических образований, таких как аневризмы артерий

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