К вопросу о современном подходе к диагностике и лечению травм селезенки у детей

 Today, the problem of spleen injury in children still appears relevant. The choice of diagnostics and treatment tactics at the present stage is far from being unified. The priority direction is the organ-preserving approach, which  is possible and justified in children, which significantly reduces surgical  aggression and prevents the likelihood of negative consequences of splenectomy. The choice of the optimal diagnostic method and  determination of safe treatment tactics was the purpose of our study. Thirty-nine injured children were treated in 2007–2019. The predominant cause of spleen injury was fall from height (64.1%). Echography was the main diagnostic method, which was performed around the clock. Splenectomy  was performed in 7 patients (17.9%), in 32 children (82.1%) the organ was preserved. One case (2.6%) was fatal. The analysis of our own results showed that the widespread use of echography, particularly by surgeons, is necessary in the emergency service and greatly simplifies the work. The developed local protocol for diagnosis and treatment is simple and accessible, since it is based on the interpretation of the main criteria, such as systemic hemodynamics and hemoperitoneum. Continued bleeding reasons diagnostic laparoscopy. With unstable hemodynamics, large hemoperitoneum, laparotomy is indicated.Проблема травмы селезенки у детей не теряет своей актуальности и в настоящее время. Выбор диагностики и лечебной тактики на современном этапе далек от унификации. Приоритетным направлением является органосохраняющий подход, который возможен и обоснован у детей, что значительно снижает хирургическую агрессию и предупреждает вероятность отрицательных последствий спленэктомии. Выбор оптимального метода  диагностики и определение безопасной тактики лечения послужили целью нашего исследования. Пролечены 39 пострадавших детей за период с 2007 по 2019 г. Преобладающей причиной повреждения селезенки была кататравма (64,1%). Эхография являлась основным методом диагностики, которую выполняли в круглосуточном режиме.  Спленэктомия проведена 7 пациентам (17,9%), у 32 детей (82,1%) орган сохранен. В одном случае (2,6%) отмечен летальный исход. Анализ собственных результатов показал, что широкое использование эхографии, в том числе и хирургами, необходимо в ургентной службе и значительно упрощает работу. Разработанный локальный протокол диагностики и лечения прост и доступен, так как основывается на интерпретации главных критериев, таких  как системная гемодинамика и гемоперитонеум.  Продолжающееся кровотечение служит основанием для  проведения диагностической лапароскопии. При  нестабильной гемодинамике, большом гемоперитонеуме  показана лапаротомия.

УСПЕШНОЕ ЛЕЧЕНИЕ ОБШИРНОГО ГЛУБОКОГО ОЖОГА У РЕБЕНКА С ЕДИНСТВЕННОЙ ЛЕВОЙ ПОЧКОЙ И ОТСУТСТВИЕМ СЕЛЕЗЕНКИ

We report a case of successful treatment in a child with extensive deep burns of the trunk and lower limbs with a flame in the absence of the right kidney and spleen.Представлен случай успешного лечения ребенка с обширным глубоким ожогом пламенем туловища и нижних конечностей при отсутствии у пациента правой почки и селезенки

ВНУТРЕННЕЕ ДРЕНИРОВАНИЕ ВЕРХНИХ МОЧЕВЫХ ПУТЕЙ В ЛЕЧЕНИИ ВРОЖДЕННОГО ГИДРОНЕФРОЗА У ДЕТЕЙ

The work analyzes the results obtained during the treatment of 285 children with congenital hydronephrosis aged 3 months to 17 years. Hynes-Andersen caliceal plasty was performed in 200 patients, nephrectomy – in 56 patients and internal renal drainage (as the main method of treatment) – in 17 patients. 192 resected caliceal segments underwent a histological examination.In 26 preparations (13.5%) of young children only inflammatory changes were discovered. This led to surveillance review of patients with hydronephrosis of all grades in young patients using small invasive endoscopic interventions aimed at the restoration of caliceal urodynamics. We used endoscopic appliances, urethral catheters and stents for preliminary bougienage and drainage of an affected organ with the examination of preliminary results.В работе представлен анализ результатов лечения 285 детей с врожденным гидронефрозом в возрасте от 3 месяцев до 17 лет. Пластика прилоханочного сегмента по методике Хайнес-Андерсена-Кучеры проведена 200 больным, нефрэктомия – 56, внутреннее дренирование почки (как основной метод лечения) – 17. Гистологическому исследованию подвергнуто 192 резецированных прилоханочных сегмента. Обнаружение только воспалительных изменений в 26 препаратах (13,5%) у детей младшей возрастной группы позволило пересмотреть тактику ведения больных с гидронефрозом всех степеней у пациентов раннего возраста с применением малоинвазивных эндоскопических вмешательств, направленных на восстановление уродинамики прилоханочных сегментов. Нами использовалась эндоскопическая аппаратура, мочеточниковые катетеры и стенты для проведения предварительного бужирования и дренирования больного органа с изучением предварительных результатов

Цимолы. 4. Получение крезолов и их применение

Methods of cresols obtaining and the main directions of their applications were analysed. It was concluded that the synthesis of cresols on the basis of cymenes is most perspective nowadays.Проанализированы методы получения крезолов и основные направления их применения. Сделан вывод о том, что наиболее перспективным способом получения крезолов на сегодняшний день является синтез на основе цимолов

2νββ2\nu\beta\beta decay of 76^{76}Ge into excited states with GERDA Phase I

Two neutrino double beta decay of $^{76}$Ge to excited states of $^{76}$Se has been studied using data from Phase I of the GERDA experiment. An array composed of up to 14 germanium detectors including detectors that have been isotopically enriched in $^{76}$Ge was deployed in liquid argon. The analysis of various possible transitions to excited final states is based on coincidence events between pairs of detectors where a de-excitation $\gamma$ ray is detected in one detector and the two electrons in the other. No signal has been observed and an event counting profile likelihood analysis has been used to determine Frequentist 90\,\% C.L. bounds for three transitions: ${0^+_{\rm g.s.}-2^+_1}$: $T^{2\nu}_{1/2}>$1.6$\cdot10^{23}$ yr, ${0^+_{\rm g.s.}-0^+_1}$: $T^{2\nu}_{1/2}>$3.7$\cdot10^{23}$ yr and ${0^+_{\rm g.s.}-2^+_2}$: $T^{2\nu}_{1/2}>$2.3$\cdot10^{23}$ yr. These bounds are more than two orders of magnitude larger than those reported previously. Bayesian 90\,\% credibility bounds were extracted and used to exclude several models for the ${0^+_{\rm g.s.}-0^+_1}$ transition

Results on ββ\beta\beta decay with emission of two neutrinos or Majorons in 76^{76}Ge from GERDA Phase I

A search for neutrinoless $\beta\beta$ decay processes accompanied with Majoron emission has been performed using data collected during Phase I of the GERmanium Detector Array (GERDA) experiment at the Laboratori Nazionali del Gran Sasso of INFN (Italy). Processes with spectral indices n = 1, 2, 3, 7 were searched for. No signals were found and lower limits of the order of 10$^{23}$ yr on their half-lives were derived, yielding substantially improved results compared to previous experiments with $^{76}$Ge. A new result for the half-life of the neutrino-accompanied $\beta\beta$ decay of $^{76}$Ge with significantly reduced uncertainties is also given, resulting in $T^{2\nu}_{1/2} = (1.926 \pm 0.095)\cdot10^{21}$ yr.Comment: 3 Figure

Flux Modulations seen by the Muon Veto of the GERDA Experiment

The GERDA experiment at LNGS of INFN is equipped with an active muon veto. The main part of the system is a water Cherenkov veto with 66~PMTs in the water tank surrounding the GERDA cryostat. The muon flux recorded by this veto shows a seasonal modulation. Two effects have been identified which are caused by secondary muons from the CNGS neutrino beam (2.2 %) and a temperature modulation of the atmosphere (1.4 %). A mean cosmic muon rate of $I^0_{\mu} = (3.477 \pm 0.002_{\textrm{stat}} \pm 0.067_{\textrm{sys}}) \times 10^{-4}$/(s$\cdot$m$^2$) was found in good agreement with other experiments at LNGS at a depth of 3500~meter water equivalent.Comment: 7 pages, 6 figure

Characterization of 30 76^{76}Ge enriched Broad Energy Ge detectors for GERDA Phase II

The GERmanium Detector Array (GERDA) is a low background experiment located at the Laboratori Nazionali del Gran Sasso in Italy, which searches for neutrinoless double beta decay of $^{76}$Ge into $^{76}$Se+2e$^-$. GERDA has been conceived in two phases. Phase II, which started in December 2015, features several novelties including 30 new Ge detectors. These were manufactured according to the Broad Energy Germanium (BEGe) detector design that has a better background discrimination capability and energy resolution compared to formerly widely-used types. Prior to their installation, the new BEGe detectors were mounted in vacuum cryostats and characterized in detail in the HADES underground laboratory in Belgium. This paper describes the properties and the overall performance of these detectors during operation in vacuum. The characterization campaign provided not only direct input for GERDA Phase II data collection and analyses, but also allowed to study detector phenomena, detector correlations as well as to test the strength of pulse shape simulation codes.Comment: 29 pages, 18 figure

Background free search for neutrinoless double beta decay with GERDA Phase II

The Standard Model of particle physics cannot explain the dominance of matter over anti-matter in our Universe. In many model extensions this is a very natural consequence of neutrinos being their own anti-particles (Majorana particles) which implies that a lepton number violating radioactive decay named neutrinoless double beta ($0\nu\beta\beta$) decay should exist. The detection of this extremely rare hypothetical process requires utmost suppression of any kind of backgrounds. The GERDA collaboration searches for $0\nu\beta\beta$ decay of $^{76}$Ge (^{76}\rm{Ge} \rightarrow\,^{76}\rm{Se} + 2e^-) by operating bare detectors made from germanium with enriched $^{76}$Ge fraction in liquid argon. Here, we report on first data of GERDA Phase II. A background level of $\approx10^{-3}$ cts/(keV$\cdot$kg$\cdot$yr) has been achieved which is the world-best if weighted by the narrow energy-signal region of germanium detectors. Combining Phase I and II data we find no signal and deduce a new lower limit for the half-life of $5.3\cdot10^{25}$ yr at 90 % C.L. Our sensitivity of $4.0\cdot10^{25}$ yr is competitive with the one of experiments with significantly larger isotope mass. GERDA is the first $0\nu\beta\beta$ experiment that will be background-free up to its design exposure. This progress relies on a novel active veto system, the superior germanium detector energy resolution and the improved background recognition of our new detectors. The unique discovery potential of an essentially background-free search for $0\nu\beta\beta$ decay motivates a larger germanium experiment with higher sensitivity.Comment: 14 pages, 9 figures, 1 table; ; data, figures and images available at http://www.mpi-hd.mpg/gerda/publi