Choice of minimally invasive method of treatment of pancreatic pseudocysts: a single center, retrospective study

Aim of the study is to evaluate efficacy of different methods of minimally invasive treatment of pancreatic pseudocysts (PPC). Methods. A single center retrospective study of patients with pancreatic pseudocysts (n = 17): 90 males (76.9 %), 27 females (23.1 %) aged 25 to 72 years. The patients underwent external percutaneous drainage (group 1, n = 96) or internal drainage (group 2, n = 21). The diagnosis of pseudocysts included clinical, laboratory (biochemical and bacteriological) and special investigation methods: radiological, endoscopic, ultrasound examination of hepatobiliary zone, computer tomography. Results. Complications in the early postoperative period were observed in patients from both groups 1 and 2. They were related to inefficacy of cystodigestive anastomosis, which required percutaneous drainage in 2 cases (9.5 %), or to formation of pancreatic fistula. Lethal outcomes were not observed. Readmission to surgical department for removal of the drainage was required in 28 (23.9 %) patients from group 1. Internal drainage is considered more advantageous for PPC decompression compared to external one due to persistence of pancreatic fluid passage through gastrointestinal tract. External drainage is associated with frequent external pancreatic fistulae formation as well as prolonged hospital stay and treatment in an outpatient setting worsening the quality of life, but it is an intervention of choice in somatically severely ill patients, in fast growing cyst, imperfectly formed wall and threatening cyst rupture into abdominal cavity or abscess. These aspects prevent from refusal from external drainage for PPC treatment. Conclusion. When choosing the optimal time and type of surgical intervention in PPC, the surgeon should evaluate localization, sizes, maturation of PC wall and its relation to pancreatic duct, somatic state and patient’s individual features

The politics of in/visibility: carving out queer space in Ul'yanovsk

<p>In spite of a growing interest within sexualities studies in the concept of queer space (Oswin 2008), existing literature focuses almost exclusively on its most visible and territorialised forms, such as the gay scene, thus privileging Western metropolitan areas as hubs of queer consumer culture (Binnie 2004). While the literature has emphasised the political significance of queer space as a site of resistance to hegemonic gender and sexual norms, it has again predominantly focused on overt claims to public space embodied in Pride events, neglecting other less open forms of resistance.</p><p> This article contributes new insights to current debates about the construction and meaning of queer space by considering how city space is appropriated by an informal queer network in Ul’ianovsk. The group routinely occupied very public locations meeting and socialising on the street or in mainstream cafés in central Ul’ianovsk, although claims to these spaces as queer were mostly contingent, precarious or invisible to outsiders. The article considers how provincial location affects tactics used to carve out communal space, foregrounding the importance of local context and collective agency in shaping specific forms of resistance, and questioning ethnocentric assumptions about the empowering potential of visibility.</p&gt

ПРОТЕКТИВНАЯ ВЕНТИЛЯЦИЯ И ПОСЛЕОПЕРАЦИОННЫЕ ДЫХАТЕЛЬНЫЕ ОСЛОЖНЕНИЯ ПРИ ОБШИРНЫХ ПАНКРЕАТОДУОДЕНАЛЬНЫХ ВМЕШАТЕЛЬСТВАХ

Protective peri-operative ventilation can improve post-surgery outcomes and reduce the frequency of respiratory complications. The goal of the study was to evaluate the impact of ventilation with low respiratory volume solely or in combination with permissible hypercapnia (HC) on the outcomes of major pancreaticoduodenal surgery. Materials and methods. 60 patients were enrolled into prospective study who had planned pancreaticoduodenal operations lasting for more than 2 hours. All patients were randomly divided into 3 groups: mechanical ventilation with high respiratory volume (10 ml/kg of predicted body mass (PBM), HRV group, n = 20), low respiratory volume (6 ml/kg of PBM, LRV group, n = 20), and low respiratory volume with moderate HC (РаСО2 45–60 mm Hg., LRV+HC group, n = 20). Hemodynamic and respiratory parameters and frequency of complications were recorded in the peri-operative period. Results. Ratio of РаО2 /FiO in 24 hours upon surgery completion was 15% higher in LRV group compared to HRV group. Higher frequency of atelectasis and prolonged hospital stay were typical of patients from HRV group. Lower concentration of arterial blood lactate was observed in the patients from LRV+HC group. Conclusion. Preventive reduction of respiratory volume in pancreaticoduodenal surgery improves the post-operative oxygenation, decreases the frequency of atelectasis and duration of hospital stay. Протективная периоперационная вентиляция может улучшать послеоперационные исходы и снижать частоту дыхательных осложнений. Цель исследования состояла в оценке влияния вентиляции с низким дыхательным объемом (ДО) либо изолированно, либо в сочетании с допустимой гиперкапнией (ГК) на исходы обширных операций в панкреатодуоденальной зоне. Материалы и методы. В проспективное исследование включено 60 взрослых пациентов, которым выполняли плановое панкреатодуо- денальное вмешательство продолжительностью более 2 ч. Все пациенты были рандомизированы в 3 группы: искусственная вентиляция легких с высоким ДО (10 мл/кг предсказанной массы тела (ПМТ), группа ВДО, n = 20), низким ДО (6 мл/кг ПМТ, группа НДО, n = 20) и низким ДО в сочетании с умеренной ГК (РаСО2 45–60 мм рт. ст., группа НДО + ГК, n = 20). В периоперационном периоде регистрировали гемодинамические и дыхательные параметры, а также частоту осложнений. Результаты. По сравнению с группой ВДО соотношение РаО2 /FiO2 через 24 ч после окончания операции было на 15% выше в группе НДО. Пациенты группы ВДО характеризовались более высокой частотой ателектазирования и увеличением продолжительности госпитализации. У пациентов группы НДО + ГК к концу операции отмечали более низкую концентрацию лактата артериальной крови. Вывод. При панкреатодуоденальных вмешательствах превентивное снижение дыхательного объема улучшает послеоперационную оксигенацию, снижает частоту ателектазов, а также сокращает продолжительность пребывания в стационаре.

Hemorrhagic complications of pancreatitis in surgical practice

The objective of the study was to detect the frequency and sources of hemorrhagic complications in patients with pancreatitis, evaluate the tactics and effectiveness of methods of hemostasis. Material and methods. A retrospective analysis of hemorrhagic complications of pancreatitis was carried out in 40 patients. Results. Bleeding developed mainly on the background of infected acute necrotic collections (77.8 %), the main source of bleeding was the splenic artery (37.0 %). Emergency laparotomy for bleeding was performed in 9 (22.5 %) patients, selective angiography was performed in 10 patients, it was effective only in 5 (50 %) cases. 12 (44.4 %) deaths were recorded in cases of arrosive bleeding. Conclusion. The preferred tactics in case of bleeding from the retroperitoneal space during minimally invasive treatment is crossclamping of drains and endovascular hemostasis

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

The goal of curing children and adults with sickle cell disease (SCD) is to maximize benefits and minimize intermediate and long-term adverse outcomes so that individuals can live an average life span with a high quality of life. While greater than 2000 individuals with SCD have been treated with curative therapy, systematic studies have not been performed to evaluate the long-term health effects of hematopoietic stem cell transplant (HSCT) in this population. Individuals with SCD suffer progressive heart, lung, and kidney disease prior to curative therapy. In adults, these sequalae are associated with earlier death. In comparison, individuals who undergo HSCT for cancer are heavily pretreated with chemotherapy, resulting in potential acute and chronic heart, lung, and kidney disease. The long-term health effects on the heart, lung, and kidney for children and adults undergoing HSCT for cancer have been extensively investigated. These studies provide the best available data to extrapolate the possible late health effects after curative therapy for SCD. Future research is needed to evaluate whether HSCT abates, stabilizes, or exacerbates heart, lung, kidney, and other diseases in children and adults with SCD receiving myeloablative and non-myeloablative conditioning regimens for curative therapy

Toxicity of Organic Fluorophores Used in Molecular Imaging: Literature Review

Fluorophores are potentially useful for in vivo cancer diagnosis. Using relatively inexpensive and portable equipment, optical imaging with fluorophores permits real-time detection of cancer. However, fluorophores can be toxic and must be investigated before they can be administered safely to patients. A review of published literature on the toxicity of 19 widely used fluorophores was conducted by searching 26 comprehensive biomedical and chemical literature databases and analyzing the retrieved material. These fluorophores included Alexa Fluor 488 and 514, BODIPY FL, BODIPY R6G, Cy 5.5, Cy 7, cypate, fluorescein, indocyanine green, Oregon green, 8-phenyl BODIPY, rhodamine 110, rhodamine 6G, rhodamine X, rhodol, TAMRA, Texas red, and Tokyo green. Information regarding cytotoxicity, tissue toxicity, in vivo toxicity, and mutagenicity was included. Considerable toxicity-related information was available for the Food and Drug Administration (FDA)-approved compounds indocyanine green and fluorescein, but published information on many of the non-FDA-approved fluorophores was limited. The information located was encouraging because the amounts of fluorophore used in molecular imaging probes are typically much lower than the toxic doses described in the literature. Ultimately, the most effective and appropriate probes for use in patients will be determined by their fluorescent characteristics and the safety of the conjugates