Laparoscopic herniorrhaphy in children with acute inflammatory diseases of the abdominal cavity

Institutul de Cercetări științifice în Chirurgia Pediatrică, Universitatea Națională de Cercetări Medicale „N.Pirogov”, Moscova, Rusia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Prezența unui proces inflamator-distructiv acut în cavitatea abdominală este pe larg considerată ca o contraindicație pentru herniorafia laparoscopică simultană. Material și metode: În perioada 2010-2012, 240 de copii cu vîrsta 5-14 ani, au fost spitalizați cu manifestările clinice ale abdomenului acut și au fost supuși intervențiilor chirurgicale urgente. În timpul laparoscopiei la 29 pacienți (18 băieți și 11 fete) a fost depistat processus vaginalis persistent (PVP): în 25 de cazuri unilateral și în 4 cazuri - bilateral. Nouăsprezece copii din acest lot au fost diagnosticați cu formele distructive ale apendicitei acute (în 6 cazuri complicate cu peritonită locală), 5 – cu pelvioperitonită, 4 – cu limfadenită mezenterică acută și 1 copil – cu apoplexie ovariană. La toți pacienții au fost efectuate intervenții simultane – asanarea focarului inflamator și ligaturarea subcutanată endo-asistată (SEAL) a PVP. Rezultate: Nu a fost înregistrat nici un caz de conversie. După intervenția de asanare a focarului inflamator (apendicectomie, rezecție de ovar, etc.) a fost efectuată SEAL conform metodei modificate de autori. Durata SEAL nu a depășit 6 minute pentru hernia unilaterală și 9 minute în cazuri bilaterale. Postoperator toți copii au primit un tratament standard. În toate cazurile evoluția postoperatorie a fost favorabilă. Complicații abdominale sau la nivelul canalului inghinal nu au fost înregistrate. Examenul ultrasonor și testele de laborator au confirmat rezolvarea completă a procesului inflamator. Toți pacienții au fost externați complet recuperați. Concluzii: Herniorafia laparoscopică simultană la copiii cu procese acute inflamatorii în cavitatea abdominală nu este urmată de elevarea riscului complicațiilor postoperatorii.Introduction: The presence of an acute inflammatory and destructive process in the abdominal cavity is commonly a contraindication to the one-stage laparoscopic herniorrhaphy. Material and methods: From 2010 to 2012, 240 children, 5-14 years of age, were admitted to hospital with a clinical picture of acute abdomen and all of them were urgently operated on. During laparoscopy in 29 patients (18 boys and 11 girls) a persisted processus vaginalis (PPV) was found: unilateral in 25 cases and bilateral in 4 cases. In 19 children from this group destructive forms of acute appendicitis (in 6 cases complicated by local peritonitis) were diagnosed as well as 5 – pelvioperitonitis, 4 – acute mesenteric lymphadenitis, and 1 – ovarian apoplexy. All patients underwent simultaneous procedures – both inflammatory focus treatment and subcutaneous endo-assisted ligation (SEAL) of PPV. Results: There was no conversion in any case. After the intervention for treatment of inflammatory focus (appendectomy, ovarian resection, etc.) the SEAL was performed according to our modification. SEAL duration was not more than 6 minutes for unilateral hernia and 9 minutes for bilateral. Postoperatively, all children received a standard therapy. In all cases the postoperative period was favorable. Complications in abdominal cavity or inguinal canals were not registered. Ultrasound examination and blood tests confirmed a complete relief of the inflammatory process. All patients were discharged with full recovery. Conclusions: Simultaneous laparoscopic herniorrhaphy in children with acute inflammation in the abdominal cavity does not increase the risk of postoperative complications

Laparoscopic herniorrhaphy in children with acute abdomen

Background. The presence of an acute inflammatory and destructive process in the abdominal cavity is commonly a contraindication to the one-stage laparoscopic herniorrhaphy. Material and methods. From 2010 to 2017 986 children, 5-14 years of age, were admitted to hospital with a clinical picture of acute abdomen for surgical treatment. During laparoscopy in 53 patients (33 boys and 20 girls) a persisted processus vaginalis (PPV) was found: unilateral in 48 cases and bilateral in 5 cases. In 37 children from this group various destructive forms of acute appendicitis (in 10 cases complicated by local peritonitis with or without intraabdominal abscess and in 7 – by general peritonitis ) were diagnosed as well as 10 - pelvioperitonitis, 4 - acute mesenteric lymphadenitis, 1 - ovarian apoplexy, 1- torsion of omentum. All patients underwent simultaneous procedures - both inflammatory focus sanation and subcutaneous endo-assisted ligation (SEAL) of PPV. Results. There was no conversion in any case. When the inflammatory focus was reorganized (appendectomy, ovarian resection, etc.) SEAL was performed according to our modification. SEAL duration was not more than 8 minutes for unilateral hernia and 10 minutes for bilateral one. Postoperatively, all children received a standard therapy. In all cases the postoperative period was favorable. Complications in abdominal cavity or inguinal canals were not observed. Ultrasound examination and blood tests confirmed a complete relief of the inflammatory process. All patients were discharged with full recovery. Conclusion. Simultaneous laparoscopic herniorrhaphy in children with acute inflammation in the abdominal cavity does not increase the risk of postoperative complications

Deuteron frozen spin polarized target for nd experiements at the VdG accelerator of Charles University

A frozen spin polarized deuteron target cooled by the 3He/4He dilution refrigerator is described. Fully deuterated 1,2-propanediol was used as a target material. Deuteron vector polarization about 40% was obtained for the target in the shape of a cylinder of 2 cm diameter and 6 cm length. The target is intended for a study of 3N interactions at the polarized neutron beam generated by the Van de Graaff accelerator at the Charles University in Prague

Solar-Wind Bulk Velocity Throughout the Inner Heliosphere from Multi-Spacecraft Measurements

We extrapolate solar-wind bulk velocity measurements for different in-ecliptic heliospheric positions by calculating the theoretical time lag between the locations. The solar-wind bulk velocity dataset is obtained from in-situ plasma measurements by STEREO A and B, SOHO, Venus Express, and Mars Express. During their simultaneous measurements between 2007 and 2009 we find typical solar activity minimum conditions. In order to validate our extrapolations of the STEREO A and B data, we compare them with simultaneous in-situ observations from the other spacecraft. This way of cross-calibration we obtain a measure for the goodness of our extrapolations over different heliospheric distances. We find that a reliable solar-wind dataset can be provided in case of a longitudinal separation less than 65 degrees. Moreover, we find that the time lag method assuming constant velocity is a good basis to extrapolate from measurements in Earth orbit to Venus or to Mars. These extrapolations might serve as a good solar-wind input information for planetary studies of magnetospheric and ionospheric processes. We additionally show how the stream-stream interactions in the ecliptic alter the bulk velocity during radial propagation

Application of the hydrosurgery system and plasmajet for thoracoscopic debridement of pleural cavity in children with fibrinothorax

Introduction. Thoracoscopy became a favored modality in pediatric pleural empyema treatment. However, the factors affecting on outcome of thoracoscopic management remain unclear. Purpose of the study Demonstration of hydrosurgery system “Versajet” and the plasma unit “Plasmajet” during thoracoscopic treatment of children with pleural complications destructive pneumonia. Materials and methods. 377 patients with a pneumonia was treated at the Speransky Children’s Hospital in Moscow for the last 1 year. 62 patients (16.45%) from 377 required drainage of the pleural cavity. 14 patients from 1.6 to 15 years of age (mean, 3.2 ± 3.8) with pleural empyema were operated -Thoracoscopic pleural cavity sanitation with hydrosurgery system (Versajet-2) Hydrosurgery system is a surgical instrument based on the impact of high-speed jet of water on necrotic and inflamed tissues, combining the advantages of acute cleansing tissue and processing them by pulsating water jet. The design of the evacuation tube and its close proximity to the liquid jet creates a local vacuum, which effectively removes fibrin and liquid contents by Bernulli effect. Informed consent was obtained from parents, and the procedure received approval from the local ethics committee. Results. Recovery and rehabilitation was uneventful in 13 cases. 1 patient with empyema of the right pleural cavity and severe organic lesion of the central nervous system was treated in our hospital by thoracoscopic adhesiolysis. However, postoperative period was complicated by recurrence of pleural empyema and cortication of right lung. Rethoracoscopy was performed six days later after initial operation - thoracoscopic debridement of pleural cavity, decortications of the right lung by hydrosurgery system with good results after surgery. Mean operative time was 90 minutes (± 15 minutes). Drainage of the pleural cavity was removed 3-4 days after surgery. The childrens were discharged from the hospital on day 10 (± 1.2 days). After application of argon plasma coagulation has been achieved complete aerostasis in 2 patients, hemostasis - in 1 patient. Ultrasound and X-rays examination 4 months after surgery confirmed the absence of inflammation in the lung parenchyma and full lung reexpantion in all patients. Conclusions. Application Hydrosurgycal system during thoracoscopy, provide effective debridement of pleural cavity, decortications of the lung without damaging the lung parenchyma and create conditions for early rehabilitation of the compromised lung

Observation of a Complex Solar Wind Reconnection Exhaust from Spacecraft Separated by over 1800 R E

We analyze Wind, ACE, and STEREO (ST-A and ST-B) plasma and magnetic field data in the vicinity of the heliospheric current sheet (HCS) crossed by all spacecraft between 22:15 UT on 31 March and 01:25 UT on 1 April 2007 corresponding to its observation at ST-A and ST-B, which were separated by over 1800 R E (or over 1200 R E across the Sun – Earth line). Although only Wind and ACE provided good ion flow data in accord with a solar wind magnetic reconnection exhaust at the HCS, the magnetic field bifurcation typical of such exhausts was clearly observed at all spacecraft. They also all observed unambiguous strahl mixing within the exhaust, consistent with the sunward flow deflection observed at Wind and ACE and thus with the formation of closed magnetic field lines within the exhaust with both ends attached to the Sun. The strong dawnward flow deflection in the exhaust is consistent with the exhaust and X-line orientations obtained from minimum variance analysis at each spacecraft so that the X-line is almost along the GSE Z-axis and duskward of all the spacecraft. The observation of strahl mixing in extended and intermittent layers outside the exhaust by ST-A and ST-B is consistent with the formation of electron separatrix layers surrounding the exhaust. This event also provides further evidence that balanced parallel and antiparallel suprathermal electron fluxes are not a necessary condition for identification of closed field lines in the solar wind. In the present case the origin of the imbalance simply is the mixing of strahls of substantially different strengths from a different solar source each side of the HCS. The inferred exhaust orientations and distances of each spacecraft relative to the X-line show that the exhaust was likely nonplanar, following the Parker spiral orientation. Finally, the separatrix layers and exhausts properties at each spacecraft suggest that the magnetic reconnection X-line location and/or reconnection rate were variable in both space and time at such large scales

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p