Surgical treatment of complicated duodenal ulcers with different variants of their localization

Purpose: To analyze and highlight the most effective methods of surgical treatment of complicated duodenal ulcer (DU) depending on its location. Material and methods. 86 patients underwent surgery for complicated combined pyloroduodenal ulcers. All patients with signs of gastrointestinal bleeding and perforation were examined according to clinical protocols. Patients were operated on by various surgical techniques depending on the location of DU. Further the analysis of different methods of surgical treatment of the pathology under study at its various localizations was carried out. Results. It has been established that in complicated combined pyloroduodenal ulcers with localization in the pyloric canal antrumectomy is the method of priority. If duodenum ulcer is complicated by bleeding, excision with pyloroplasty is the method of priority. Suture ulceration with pyloroplasty can be considered as an alternative method of treatment. It has been verified that in complicated duodenal ulcers, exteriorization and suturing of the ulcer have the lowest efficiency. The most frequently used method of duodenal ulcers of any localization treatment was excision of the ulcer with pyloroplasty. 6 (41.8 ± 0.053%).patients had been operated on by this method. In the second place in terms of universality was ulcer’s suturing with pyloroplasty - 22 patients or (25.5 ± 0.047%). The third was the method of exteriorization and suturing of ulcers, which accounted for 10 patients (11.6 ± 0.034%)

Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality

The choice of surgical treatment method of perforated pyloroduodenal ulcer

Objective. To develop a method of organ-saving operation aimed at preservation of the physiological function of the pylorus and the normal physiological functioning of the pyloroduodenal area in patients with combined perforated, stenotic pyloroduodenal ulcers. Materials and methods. The study included 60 patients who faced surgery treatment in relation to complicated combined perforated, stenotic pyloroduodenal ulcers. Depending on diagnostic and surgical tactics applied, patients were conditionally divided into two groups. The control group consisted of 30 patients who underwent standard suturing methods. The main group also consisted of 30 patients in whom the developed method was applicated. Results. In the control group at the postoperative period of 30 patients operated in different ways complications occurred in 12 persons or in 40% of cases. In the main group of 30 patients operated according to the proposed method, complication in the form of anastomositis occurred in 1 patient only. Conclusions. The obtained results substantiate recommendation to clinical application the suggested method of organ-saving operation aimed to preserve the physiological function of the pyloroduodenal area, which excludes perforated ulcers suturing without pyloric stenosis elimination and gastrectomy on the background of peritonitis

Prophylaxis of damage of extrahepatic biliary ducts and pancreatic ducts while performance of gastric resection in accordance to Billroth II method for complicated duodenal ulcers

Objective. To elaborate a method of mobilization and a method of closure of “complex handed” duodenal stump while operating for complicated giant penetrating pyloroduodenal ulcers with the aim to prevent iatrogenic damage of extrahepatic biliary ducts and pancreatic ducts and to improve the results of surgical treatment of this pathology. Materials and metods. In the investigation 46 patients were included, who were operated on for complicated giant penetrating pyloroduodenal ulcers. Giant pyloroduodenal ulcers have had more than 2.5 cm size. The method of duodenal mobilization and the method of suturing of a “complex” duodenal stump were proposed. The method of duodenal mobilization consists of duodenotomy in the zone of a cicatricial-ulcerative transformation and intraintestinal digital upper and anterior stretching towards yourself of all duodenal walls from adhesive process, what includes mobilization of upper-horizontal and of part of descending duodenum portiions, using incision of visceral peritoneum along right and left edges of colon on a distance, sufficient to form its stump without tension. The method of suturing of a “complex” duodenal stump consists of duodenotomy in the affected zone of circular ulcer process. This permits to determine a degree of ulcerative stenosis, to exterritorize the ulcer and after duodenal mobilization, using the above mentioned method, to apply the duodenal mobilized walls for formation of a stump. Application of a one-raw interrupted screw-up sutures permits to distribute the pressure load along all sutures what enhances a mechanical strength of the sutures placed. Results. Average duration of the operation have constituted 136.6 min (95% CI: 125.2; 152.0); a stationary stay - from 7 to 26 bed-days, 15.7 days (95% CI: 13.1; 18.2) at average. Among early postoperative morbidity there were: infection in the wound zone - 2 (4.3%), pneumonia (4.3%), stroke - 1 (2.2%), pulmonary thromboembolism - 1 (2.2%), insufficiency of the duodenal stump sutures - 1 (2.2%) observation. Postoperative mortality have constituted 4.3%, 2 patients died, in 1 (2.2%) pulmonary thromboembolism was the cause of the death, and in 1 (2.2%) - hemorrhagic insult. The duodenal stump sutures insufficiency and extensive serous-fibrinous peritonitis were revealed in the patient on the 6th postoperative day in 1 (2,2%) patient. In 1 year 31 patients were examined: while performing of fibrogastroscopy in 1 (3.2%) patient the ulcer of posterior wall of gastrojejunoanastomosis was revealed, in 7 (22.6%) - superficial gastritis, in 1 (3.2%) - erosive gastritis of gastric stump. Conclusion. The proposed procedure for duodenal mobilization and the method of the duodenal stump formation in a complicated giant circular pyloroduodenal ulcer permits to minimize a possibility of the stump sutures insufficiency occurrence as well as the prevention of iatrogenic damage of biliary and pancreatic ducts, involved in the ulcer infiltrate, injury, and may be recommended for application in clinical practice. Special attention must be drawn to duodenal decompression in postoperative period and to intestinal stimulation

The peculiarities of cross-correlation between two secondary precursors - radon and magnetic field variations, induced by stress transfer changes

A model of precursor manifestation mechanisms, stimulated by tectonic activity and some peculiarities of observer strategy, whose main task is the effective measurement of precursors in the spatial area of their occurrence on the Earth's daylight, are considered. In particular, the applicability of Dobrovolsky's approximation is analyzed, when an unperturbed medium (characterized by the simple shear state) and the area of tectonic activity (local inhomogeneity caused by the change only of shear modulus) are linearly elastic, and perturbation, in particular, surface displacement is calculated as a difference of the solutions of two independent static problems of the theory of elasticity with the same boundary condition on the surface. Within the framework of this approximation a formula for the spatial distribution (of first component) of magnetic field variations caused by piezomagnetic effect in the case of perturbed regular medium, which is in simple shear state is derived. Cogent arguments in favor of linear dependence between the radon spatial distribution and conditional deformation are obtained. Changes in magnetic field strength and radon concentrations were measured along a tectonomagnetic profile of the total length of 11 km in the surroundings of the "Academician Vernadsky" Station on the Antarctic Peninsula (W 64{\deg}16', S 65{\deg}15'). Results showed a positive correlation between the annual surface radon concentration and annual changes of magnetic field relative to a base point, and also the good coincidence with theoretical calculation.Comment: 27 pages, 11 figures, 3 tables (a substantially revised and extended edition; v3 -- some analysis of recent publications added

Граматики слов'янської правильности синтагма (переклад із церковнослов'янської)

У виданні перекладено перший розділ «Граматики слов’янської» видатного українського полеміста, мовознавця, випускника Острозької академії Мелетія Смотрицького. До середини XVIII ст. вона була єдиним підручником із граматики в Україні, Московії та Білорусі й мала потужний вплив на мовознавство всіх слов’янських народів

The peculiarities of cross-correlation between two secondary precursors - radon and magnetic field variations, induced by tectonic activity

A model of precursor manifestation mechanisms, stimulated by tectonic activityand some peculiarities of observer strategy, whose main task is the effective measurement of precursors in the spatial area of their occurrence on the Earth\u27s daylight, are considered. In particular, the applicability of Dobrovolsky\u27s approximation is analyzed, when an unperturbed medium (characterized by the simple shear state) and the area of tectonic activity (local inhomogeneity caused by the change only of shear modulus) are linearly elastic, and perturbation, in particular, surface displacement is calculated as a difference of the solutions of two independent static problems of the theory of elasticity with the same boundary condition on the surface. Within the framework of this approximation a formula for the spatial distribution (offirst component) of magnetic field variations caused by piezomagnetic effect in the case of perturbed regular medium, which is in simple shear state is derived. Cogent arguments in favor of linear dependence between the radon spatial distribution and conditional deformation are obtained. Changes in magnetic field strength and radon concentrations were measured along a tectonomagnetic profile of the total length of 11 km in the surroundings of the "Academician Vernadsky" Station on the Antarctic Peninsula (W 64 16\u27, S 6515\u27). Results showed a positive correlation between the annual surface radonconcentration and annual changes of magnetic field relative to a base point, and also the good coincidence with theoretical calculation

GEM tracking system of the BM@N experiment

BM@N (Baryonic Matter at the Nuclotron) is the fixed target experiment aimed to study nuclear matter in the relativistic heavy ion collisions at the Nuclotron accelerator in JINR. Detectors based on Gas Electron multipliers (GEM) have been identified as appropriate for the BM@N tracking system, which is located inside the BM@N analyzing magnet. The structure of the GEM detectors and the results of study of their characteristics are presented. The GEM detectors are integrated into the BM@N experimental setup and data acquisition system. The performance of the GEM tracking system in the first technical run with the deuteron beam is shortly reviewed