Appendicopathies in emergency surgery - a substantian problem

Catedra Chirurgie, FEC MF, USMF „N. Testemițanu”, Chișinău, Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Dacă pînă în prezent au fost atinse succese notabile în chirurgia apendicitei acute, nu ne dă posibilitatea să constatăm faptul că problema este rezolvată definitiv, au rămas probleme neclare şi discutabile: 1) nu este perfectă diagnostica; 2) sunt divergenţe în privinţa tacticii chirurgicale; 3) lipsesc intraoperator criteriile unice a modificărilor macroscopice; 4) sunt divergenţe în diagnosticul clinic şi rezultatele morfohistologice. Studiile din literatura franceză au constatat faptul că la 20% din cei operaţi s-a înlăturat apendicele neafectat. Au fost studiaţi 235 pacienţi cu vîrsta 14-80 ani. Femei-bărbaţi 1,5:1. Durerea manifestată la 100% bolnavi caracterizată prin (spontană, permanentă, intermitentă, difuză, localizată, violentă, transfixiantă, iradiere topografică). Defens muscular, meteorism, pulsmetria, temperatura corpului s-au manifestat în raport variabil. Simptoamele subiective (diaree, constipaţie, vomă, s.Koher, greţuri) prezente la toţi bolnavii. Prevalenţa s. obiective (Blumberg, Rowzing, triada Dieulafoy, Bartomie-Mihelson, Coop) a fost notată la bolnavii cu semne evidente de apendicită acută. La 80% - hiperleucocitoză. Polinucleoza a fost marcată variabil: normal, moderată, notabilă, excesivă şi majorată enorm. USG abdominală : pneumatoză intestinală, apendice vizualizat, mobil, imobil, îngroşat, lichid în cavitatea abdominală notate variabil. Intraoperator s-a înregistrat lichid seros, serohemoragic, seropurulent, purulent cu variaţii. S-a constatat faptul că 22% nu au modificări patomorfologice în apendice. Coeficientul identificării diagnosticului clinic cu cel patomorfologic este în raport 4,5:1. Acestea sunt cazurile apendicopatiilor cu manifestări clinice evidente şi cu lipsă de substrat patomorfologic, mai bine spus, apendice neafectat. Concluzii: 1. Apendicopatiile diferă radical de apendicita acută prin faptul că ele se manifestă clinic printr-un complex simptomatologic evident de apendicită acută şi cu lipsa totală a substratului patomorfologic. 2. Pentru a clarifica aceste probleme definitiv, va fi necesar un studiu clinic mai profund si identificarea mai sigură a modificărilor patologomorfologice. 3. Extirparea apendicelui alterat în apendicopatie, cauză a fenomenelor dureroase sau a crizelor repetate, se impune ca singura măsură de a vindeca răul prezent şi de a evita pericolele viitorului.The fact that until now has been achieved notable success in the surgery of acute appendicitis doesn’t give us the possibility to say that the problem is entirely solved; there still are many confusing and contestable problems: 1) the diagnosis is not perfect. 2) there are many divergences about the surgical tactics. 3) there are no unique criteriafor macroscopical changes during the operation. 4) there are different opinionsamong surgeons as for clinical diagnosis and morphological characteristics. The study of French literature have concluded that in the case of 20% of operations unaffected appendix has been removed. 235 patients aged 14-80 years in rapport of 1,5:1 women and men have been examined. The pain manifested at 100% of patients was characterized as spontaneous, continuous, intermittent, diffuse, localized, violent, topographical radiation. The muscle defense, flatulence, pulsation, high temperature occurred in several cases. Subjective symptoms (diarrhea, constipation, vomiting, Koher’s sign and nausea) have been noticed at all the patients. The prevalence of objective symptoms (Blumberg, Rowzing, Dieulafoy triad, Bartomie-Mihelson, Coop) has been noticed at the patients with obvious signs of acute appendicitis. 80% manifested hyperleukocytosis. The mark of polynucleosys was variable: normal, moderate, noticeable, excessive and increased enormously. The ultrasound check of abdomen showed intestinal pneumatosis, visible, mobile, immobile, thickened, fluid appendix in the abdominal cavity has been detected in several cases. Intraoperative serous, sero-hemorrhagic, seropurulent and purulentliquid was noticed 22% of patients had no pathomorphologicchanges coefficient was 4,5:1. These are the appendicopathy cases with clinicalmanifestations and lack of pathomorphological base, batter said: normal, unaffected appendix. Conclusions: 1. Appendicopathies differ radically from acute appendicitis in that they manifest clinically evident symptomatic complex of acute appendicitis and total lack of pathomorphological substrate. 2. To clarify these issues ultimately a deeper clinical study and a more reliable identification of pathomorphological changes would be necessary. 3. The removal of altered appendix in appendicitis, cause of pain phenomena or repeated crisis imposes itself as the only measure to cure the present disease and to avoid future dangers

Характеристики перинатального периода, связанного с воспалительными процессами в случае преждевременной мертворождаемости

IMSP Institutul Mamei şi CopiluluiMaternal or fetal infections account for 50% of the causal structure of mortality in underdeveloped or developing countries, as opposed to highly developed countries where the same rate is 10-25%. Purpose of the study: evaluation of perinatal period peculiarities associated with inflammatory processes in preterm stillbirth. Materials and methods: to achieve the aim of the proposed study, we analyzed 237 patients who were born during 2015-2017 within the PMSI Institute of Mother and Child. Results: complication of polyhydramnios pregnancy is associated with a 2-fold greater likelihood of complication with stillbirth, a similar trend with complicated pregnancy with intrauterine infection and an increase in chronic infections of the lower genital tract. The relative risk of intrauterine infection on the preterm stillbirth phenomenon increases proportionally with the term of gestation. Preterm pregnancy complicated with uterine death in the fetus is commonly preceded by corioamnonitis, and birth is complicated by partial retention of placenta or amniotic membranes.Инфекции матери или плода составляют 50% причинно-следственной структуры мертворождаемости в слаборазвитых или развивающихся странах, в отличие от высокоразвитых стран, где такой же показатель составляет 10-25%. Цель исследования: оценить перинатальные особенности, связанные с воспалительными процессами в преждевременной мертворождаемости. Материалы и методы: для достижения цели предлагаемого исследования было проанализировано 237 пациенток, родивших в течение 2015-2017 гг. В Институте Матери и Ребенка. Результаты: Выявлена тесная связь между мертворождаемостью при недоношенной беременности с наличием многоводия, внутриутробной инфекцией и обострениями хронических инфекций мочевыводительной системы. Уровень относительного риска влияния внутриутробной инфекции на возникновение мертворождаемости при недоношенной беременности прямопропорционально сроку гестации

Характеристики перинатального периода, связанного с воспалительными процессами в случае преждевременной мертворождаемости

IMSP Institutul Mamei şi CopiluluiMaternal or fetal infections account for 50% of the causal structure of mortality in underdeveloped or developing countries, as opposed to highly developed countries where the same rate is 10-25%. Purpose of the study: evaluation of perinatal period peculiarities associated with inflammatory processes in preterm stillbirth. Materials and methods: to achieve the aim of the proposed study, we analyzed 237 patients who were born during 2015-2017 within the PMSI Institute of Mother and Child. Results: a complication of polyhydramnios pregnancy is associated with a 2-fold greater likelihood of complication with stillbirth, a similar trend with complicated pregnancy with intrauterine infection, and an increase in chronic infections of the lower genital tract. The relative risk of intrauterine infection on the preterm stillbirth phenomenon increases proportionally with the term of gestation. Preterm pregnancy complicated with uterine death in the fetus is commonly preceded by chorioamnionitis, and birth is complicated by partial retention of the placenta or amniotic membranes.Инфекции матери и плода составляют 50% причинно-следственной структуры мертворождаемости в слаборазвитых или развивающихся странах, в отличие от высокоразвитых стран, где такой же показатель составляет 10-25%. Цель исследования: оценить перинатальные особенности, связанные с воспалительными процессами c преждевременной мертворождаемостью. Материалы и методы: для достижения цели исследования было проанализировано 237 пациенток, родившихся в течение 2015-2017 гг. в Институте Матери и Ребенка. Результаты: осложнение беременности многоводием связано с 2-кратно большей вероятностью при преждевременной мертворождаемости, аналогичная тенденция имеется при беременности, осложненной внутриутробной инфекцией и острыми хроническими инфекциями мочевых путей. Относительный риск влияния внутриутробной инфекции на уровень преждевременной смертности увеличивается пропорционально сроку беременности. Хориоамнонит обычно предшествует преждевременную беременность, с внутриутробной гибелью плода, а роды осложняются частичной задержкой отделения плаценты или амниотических мембран

Transport properties of copper phthalocyanine based organic electronic devices

Ambipolar charge carrier transport in Copper phthalocyanine (CuPc) is studied experimentally in field-effect transistors and metal-insulator-semiconductor diodes at various temperatures. The electronic structure and the transport properties of CuPc attached to leads are calculated using density functional theory and scattering theory at the non-equilibrium Green's function level. We discuss, in particular, the electronic structure of CuPc molecules attached to gold chains in different geometries to mimic the different experimental setups. The combined experimental and theoretical analysis explains the dependence of the mobilityand the transmission coefficient on the charge carrier type (electrons or holes) and on the contact geometry. We demonstrate the correspondence between our experimental results on thick films and our theoretical studies of single molecule contacts. Preliminary results for fluorinated CuPc are discussed.Comment: 18 pages, 16 figures; to be published in Eur. Phys. J. Special Topic

The incommensurate charge-density-wave instability in the extended three-band Hubbard model

The infinite-U three-band Hubbard model is considered in order to describe the CuO_2 planes of the high temperature superconducting cuprates. The charge instabilities are investigated when the model is extended with a nearest-neighbor repulsion between holes on copper d and oxygen p orbitals and in the presence of a long-range Coulombic repulsion. It is found that a first-order valence instability line ending with a critical point is present like in the previously investigated model without long-range forces. However, the dominant critical instability is the formation of incommensurate charge-density-waves, which always occur before the valence-instability critical point is reached. An effective singular attraction arises in the proximity of the charge-density wave instability, accounting for both a strong pairing mechanism and for the anomalous normal state properties.Comment: 15 pages in RevteX. Figures available from M. Grill

Measurement of the CKM angle γ from a combination of B±→Dh± analyses

A combination of three LHCb measurements of the CKM angle γ is presented. The decays B±→D K± and B±→Dπ± are used, where D denotes an admixture of D0 and D0 mesons, decaying into K+K−, π+π−, K±π∓, K±π∓π±π∓, K0Sπ+π−, or K0S K+K− final states. All measurements use a dataset corresponding to 1.0 fb−1 of integrated luminosity. Combining results from B±→D K± decays alone a best-fit value of γ =72.0◦ is found, and confidence intervals are set γ ∈ [56.4,86.7]◦ at 68% CL, γ ∈ [42.6,99.6]◦ at 95% CL. The best-fit value of γ found from a combination of results from B±→Dπ± decays alone, is γ =18.9◦, and the confidence intervals γ ∈ [7.4,99.2]◦ ∪ [167.9,176.4]◦ at 68% CL are set, without constraint at 95% CL. The combination of results from B± → D K± and B± → Dπ± decays gives a best-fit value of γ =72.6◦ and the confidence intervals γ ∈ [55.4,82.3]◦ at 68% CL, γ ∈ [40.2,92.7]◦ at 95% CL are set. All values are expressed modulo 180◦, and are obtained taking into account the effect of D0–D0 mixing

Measurement of the ratio of branching fractions BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma)

The ratio of branching fractions of the radiative B decays B0 -> K*0 gamma and Bs0 -> phi gamma has been measured using 0.37 fb-1 of pp collisions at a centre of mass energy of sqrt(s) = 7 TeV, collected by the LHCb experiment. The value obtained is BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma) = 1.12 +/- 0.08 ^{+0.06}_{-0.04} ^{+0.09}_{-0.08}, where the first uncertainty is statistical, the second systematic and the third is associated to the ratio of fragmentation fractions fs/fd. Using the world average for BR(B0 -> K*0 gamma) = (4.33 +/- 0.15) x 10^{-5}, the branching fraction BR(Bs0 -> phi gamma) is measured to be (3.9 +/- 0.5) x 10^{-5}, which is the most precise measurement to date.Comment: 15 pages, 1 figure, 2 table

Differential branching fraction and angular analysis of the decay B0→K∗0μ+μ−

The angular distribution and differential branching fraction of the decay B 0→ K ∗0 μ + μ − are studied using a data sample, collected by the LHCb experiment in pp collisions at s√=7 TeV, corresponding to an integrated luminosity of 1.0 fb−1. Several angular observables are measured in bins of the dimuon invariant mass squared, q 2. A first measurement of the zero-crossing point of the forward-backward asymmetry of the dimuon system is also presented. The zero-crossing point is measured to be q20=4.9±0.9GeV2/c4 , where the uncertainty is the sum of statistical and systematic uncertainties. The results are consistent with the Standard Model predictions

Measurement of the relative rate of prompt χc0, χc1 and χc2 production at √s=7TeV

Prompt production of charmonium χc0, χc1 and χc2 mesons is studied using proton-proton collisions at the LHC at a centre-of-mass energy of √s=7TeV. The χc mesons are identified through their decay to J/ψγ, with J/ψ→μ+mu− using photons that converted in the detector. A data sample, corresponding to an integrated luminosity of 1.0fb−1 collected by the LHCb detector, is used to measure the relative prompt production rate of χc1 and χc2 in the rapidity range 2.0<y<4.5 as a function of the J/ψ transverse momentum from 3 to 20 GeV/c. First evidence for χc0 meson production at a hadron collider is also presented

Measurements of the branching fractions of B+→ppK+ decays

The branching fractions of the decay B+ → pp̄K+ for different intermediate states are measured using data, corresponding to an integrated luminosity of 1.0 fb-1, collected by the LHCb experiment. The total branching fraction, its charmless component Mpp̄ < 2.85 GeV/c2 and the branching fractions via the resonant cc̄ states η c(1S) and ψ(2S) relative to the decay via a J/ψ intermediate state are [Equation not available: see fulltext.] Upper limits on the B + branching fractions into the η c(2S) meson and into the charmonium-like states X(3872) and X(3915) are also obtained