Rectal cancer (lecture)

The lecture deals with the issues of classification, etiology, diagnostics and treatment of rectal cancer

ЛАПАРОСКОПИЧЕСКАЯ ГАСТРЭКТОМИЯ С ЕЮНОГАСТРОПЛАСТИКОЙ

The arm of the research. To develop a way to perform the laparoscopic total gastrectomy with jejunal interposition (Longmire’s procedure).Material and methods. The study presents the technology of laparoscopic total gastrectomy with a lymph node dissection D1α and jejunal interposition. After removal of the gaster with the tumor through a mini-laparotomy (2 inch), the jejunum was cut approximately45 cm distally to the ligament of Treitz. A circular stapler was used to perform an esophago-jejunostomy with Roux-en-Y reconstruction using a standard technology. The second stage is forming a segment of the small intestine for jejunal interposition. The third stage is entering the head of the circular stapling apparatus into the stump of the duodenum on a probe retrogradely through the afferent loop of the small intestine. The fourth stage is stapled anastomosis between a free segment of the jejunum and the duodenum with the circular stapler. The procedure is finalized with hand-sewn anastomosis between the afferent and efferent loops of the small intestine.Results. The presented technology was used to perform surgery on one patient. The increase in operative time did not lead to increased intraoperative blood loss and longer post-operative bed-days. After 1 year the patient shows no evidence of a tumor progression, manifestations of reflux esophagitis, and dumping syndrome. Conclusion. The proposed technology allows laparoscopic total gastrectomy with jejunal interposition via a mini-invasive technology. Цель исследования – разработать способ выполнения лапароскопической гастрэктомии с сохранением пассажа по ДПК путём пластики сегментом тонкой кишки без формирования резервуара.Материал и методы. Представлена технология лапароскопической гастрэктомии с лимфодиссекцией Д1α и пластикой желудка сегментом тонкой кишки с включением в пассаж двенадцатиперстной кишки без формирования резервуара. Производится лапароскопическая гастрэктомия. После удаления препарата через минидоступ первым этапом накладывается циркулярным аппаратом эзофагоэнтероанастомоз на Ру-петле по стандартной технологии. Вторым этапом формируется интерпонируемый сегмент тонкой кишки из Рупетли. Третьим этапом в культю двенадцатиперстной кишки вводится головка циркулярного сшивающего аппарата ретроградно на зонде через приводящую петлю тонкой кишки. Четвёртым этапом накладывается аппаратный еюнодуоденоанастомоз между сегментом тонкой кишки и двенадцатиперстной кишкой. Операция завершается наложением анастомоза между приводящей и отводящей петлями тонкой кишки.Результаты. По описанной технологии прооперирован один пациент. Увеличение времени операции не привело к увеличению интраоперационной кровопотери и удлинению послеоперационного койко-дня. Через 1 год у больного нет признаков опухолевого прогрессирования, проявлений рефлюкс-эзофагита и демпинг-синдрома.Заключение. Предлагаемая схема лапароскопической гастрэктомии позволяет выполнить операцию с еюногастропластикой по мини-инвазивной технологии.

Brown bear attacks on humans : a worldwide perspective

The increasing trend of large carnivore attacks on humans not only raises human safety concerns but may also undermine large carnivore conservation efforts. Although rare, attacks by brown bears Ursus arctos are also on the rise and, although several studies have addressed this issue at local scales, information is lacking on a worldwide scale. Here, we investigated brown bear attacks (n = 664) on humans between 2000 and 2015 across most of the range inhabited by the species: North America (n = 183), Europe (n = 291), and East (n = 190). When the attacks occurred, half of the people were engaged in leisure activities and the main scenario was an encounter with a female with cubs. Attacks have increased significantly over time and were more frequent at high bear and low human population densities. There was no significant difference in the number of attacks between continents or between countries with different hunting practices. Understanding global patterns of bear attacks can help reduce dangerous encounters and, consequently, is crucial for informing wildlife managers and the public about appropriate measures to reduce this kind of conflicts in bear country.Peer reviewe

LAPAROSCOPIC GASTRECTOMY WITH LONGMIRE’S PROCEDURE

The arm of the research. To develop a way to perform the laparoscopic total gastrectomy with jejunal interposition (Longmire’s procedure).Material and methods. The study presents the technology of laparoscopic total gastrectomy with a lymph node dissection D1α and jejunal interposition. After removal of the gaster with the tumor through a mini-laparotomy (2 inch), the jejunum was cut approximately45 cm distally to the ligament of Treitz. A circular stapler was used to perform an esophago-jejunostomy with Roux-en-Y reconstruction using a standard technology. The second stage is forming a segment of the small intestine for jejunal interposition. The third stage is entering the head of the circular stapling apparatus into the stump of the duodenum on a probe retrogradely through the afferent loop of the small intestine. The fourth stage is stapled anastomosis between a free segment of the jejunum and the duodenum with the circular stapler. The procedure is finalized with hand-sewn anastomosis between the afferent and efferent loops of the small intestine.Results. The presented technology was used to perform surgery on one patient. The increase in operative time did not lead to increased intraoperative blood loss and longer post-operative bed-days. After 1 year the patient shows no evidence of a tumor progression, manifestations of reflux esophagitis, and dumping syndrome. Conclusion. The proposed technology allows laparoscopic total gastrectomy with jejunal interposition via a mini-invasive technology

The evolution of crystalline precursors during the formation of Al-Cu-Fe quasicrystalline intermetallics in mechanically alloyed powders

Mechanical alloying (MA) of elemental powders in the Al-Cu-Fe system was carried out using two types of laboratory equipment (vibratory and planetary mills) to produce single phase, stable icosahedral quasicrystals. The sequence and nature of the solid state reactions during milling and subsequent annealing were studied in detail using qualitative and quantitative laboratory X-ray analysis and differential scanning calorimetry. The effect of milling parameters (energy intensity, temperature, milling time) on the course of transformations was elucidated. Specific reactions were identified which took place during annealing in different temperature ranges. The evolution of crystalline precursors of the quasicrystalline phase was established

Crystallochemical aspects of solid state reactions in mechanically alloyed Al-Cu-Fe quasicrystalline powders

A number of elemental mixtures have initial compositions close to Al₆₅Cu₂₃Fe₁₂ were mechanically alloyed at different energy intensities using a planetary mill. Laboratory X-ray diffraction analysis, differential scanning calorimetry and Mössbauer spectroscopy were used for characterization of the phase and structural state of mechanically alloyed powders after different periods of milling and annealing. Several exothermic effects were found, and these were ascribed to specific solid-state reactions. Quantitative phase analysis was applied in order to identify the mechanism of solid-state reactions taking place in the vicinity of the quasicrystalline phase domain in the Al-Cu-Fe system as a result of mechanical and thermal excitation and homogenization. Metastable intermetallics were identified which possess certain structural and topological elements identical to those found in quasicrystals

Nanoquasicrystalline Phase in Mechanically Alloyed and Heat-Treated Al73Cu11Cr16Al_{73}Cu_{11}Cr_{16}

X-ray diffraction analysis, scanning and transmission electron microscopy, thermal analysis and measurement of chemical composition were implemented to determine structure, thermal stability and chemical composition of the decagonal quasicrystal in $Al_{73}Cu_{11}Cr_{16}$ alloy produced by long-term mechanical alloying of elemental powders followed by annealing at 700°C. According to the TEM investigation such a technique permits to produce a single-phase nanostructural quasicrystal with grain size about 60 nm. Differential thermal analysis revealed that the decagonal phase does not exist above 923°C and undergoes incongruent two-stage melting coming to the end at 1100°C