Diagnosis and classification of Mirizzi syndrome

Objective. To determine the factors, predisposing to development of Mirizzi syndrome; to improve diagnosis and classification of it, taking into account of these factors and possibilities to apply a definite kind of endoscopic or operative treatment. Materials and methods. Retrospective analysis was done for results of treatment of 21 patients with Mirizzi syndrome: Type I in accordance to classification of McSherry (1982) was present in 7 patients, while a Type II - in 14. Results. There was established, that atypia (the variant anatomy) of the ductus cysticus localization predisposes for contact between hepaticocholedochus and a gallbladder of with ductus cysticus, leading to development of Mirizzi syndrome Types I and II. Squeezing (Type I) or fistula (Type II) are observed on any level of hepaticocholedochus. In syndrome of Mirizzi Type II the duct distal to fistula may be not dilated (Subtype IIA) or dilated (Subtype IIB). Conclusion. Atypia (the variant anatomy) of the ductus cysticus duct constitute a factor, promoting development of Mirizzi syndrome. While diagnostic process for Mirizzi syndrome it is necessary to take into account a localization of squeezing of hepaticocholedochus or of fistula, presence of atypia of the ductus cysticus and its stump localization, character of the gallbladder inflammation, quantity and size of calculi. Proposition to include the Types IIA and IIB II in Mirizzi syndrome, depending on the dilation degree present in hepaticocholedochus distally, to the fistula, constitutes a substantiated principle, because it takes into account a possibility to perform endoscopic lithoextraction and to impact the choice of the surgical treatment method

Diagnostic system of determination of an acute cholangitis

Objecive. To elaborate a diagnostic system, permitting to confirm or exclude the diagnosis of an acute cholangitis in patients, suffering biliary ducts obstruction. Materials and methods. The wok is based on analysis of clinical, laboratory and instrumental indices in 174 patients, suffering the biliary ducts obstruction (in 18 - with an acute cholangitis). Results. The diagnostic system was constructed, taking into account informativity of such indices, as ratio of the segmented and stab neutrophils quantity, quantity of stab neutrophils, bilirubin, a gallbladder wall thickness, quantity of monocytes, leukocytes, the Charcot’s triad presence, the body temperature, level of amylase, the duodenal papilla magna size, quantity of lymphocytes, presence of excluded gallbladder, presence of cholecystectomy in anamnesis, the immobile calculus of duodenal papilla magna, tumor, the eosinophils quantity, as well as the presence of any choledocholithiasis and age. Conclusion. The elaborated diagnostic scheme for determination of an acute cholangitis in patients, suffering biliary ducts obstruction, owes high security (≥ 95%), because the part of failed diagnosis did not exceeded 5% and have constituted 2.8%

Numerical Investigation of a High-Pressure Gas Medium Preionization by Runaway Electrons

A comparative simulation of the generation and acceleration of runaway electrons in the discharge gap during the initiation of the discharge by nanosecond and subnanosecond pulses is carried out. We used a numerical model based on the PIC-MCC method. Calculations were carried out for N2 6 atm pressure. Numerical simulation of a formation process of the electron avalanche initiated by an electron field-emitted from the top of the cathode micro-spike was carried out taking into account the motion of each electron in the avalanche. Characteristic runaway electron trajectories, runaway electron energy gained during the motion through the discharge gap, times required for runaway electrons to reach the anode were calculated. We compared our results with calculations using well-known differential equation of electron acceleration using braking force in Bethe approximation. We solved this equation also for braking force based on real (experimental) ionization cross section. The reasons for the discrepancy in the calculation results are discussed. © 2021 Institute of Physics Publishing. All rights reserved.The work was carried out within the framework of the state tasks of IEP UB RAS and was supported by RFBR, Grant 20-08-00172

Atmospheric Pressure Plasma Generation System Based on Pulsed Volume Discharge for the Biological Decontamination of a Surface

The research introduces a system for pulsed volume discharges ignition at atmospheric pressure within gaps reaching 125 mm. The corona discharge is used for the volume discharge initiation. A damping oscillations pulse generator is used as a high-voltage power supply. The pulse repetition rate reaches 1 kHz, while the rate of damping high-frequency harmonic oscillations can reach megahertz units. The volume discharge electric and spectral characteristics were analyzed. The study revealed that O2+ emission spectrum dominates in the UV region. The potential of using pulsed volume discharge for cleaning biological surfaces was demonstrated in the research. The survival rate for E. coli under the influence of 15 seconds long pulsed volume discharge has decreased by 30 times

Влияние частичной обструкции общего желчного протока без гипербилирубинемии на печень

Цель. Изучение в эксперименте морфологических изменений печени и биохимических показателей крови при частичной обструкции общего желчного протока (ЧООЖП) без гипербилирубинемии. Материалы и методы. На 34 крысах моделировали ЧООЖП. Животных выводили из эксперимента на 3, 7, 14, 21, 28-е и 35-е сутки. Определяли содержание билирубина, альбумина, мочевины сыворотки крови и активность аланинаминотрансферазы (АЛТ), аспартатаминотрансферазы (АСТ), щелочной фосфатазы (ЩФ). Измеряли диаметр общего желчного протока, массу и объем печени, исследовали ее гистологию, выполняли морфометрию. Контролем служили 17 животных. Результаты. У 14 (41,2%) животных наблюдали ЧООЖП без гипербилирубинемии. Максимальные морфологические изменения отмечены на 28 – 35-е сутки: увеличение массы печени на 31% и ее объема на 25,5%; увеличение числа и дилатация желчных протоков, увеличение числа синусоидальных клеток, площади гепатоцитов, наличие фиброза ІІ степени в 4 из 5 наблюдений. Изменения биохимических показателей были достоверными только на 3 – 7-е сутки: содержание альбумина снизилось до (21,6 ± 2,5) г/л, контрольный показатель – (26,7 ± 1,6) г/л. В течение эксперимента активность АЛТ, АСТ, ЩФ, содержание мочевины не отличались от контрольных величин. Выводы. Несмотря на полную функциональную компенсацию, ЧООЖП без гипербилирубинемии приводит к значимым морфологическим изменениям печени

МОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ ПЕЧЕНИ ПРИ ЭКСПЕРИМЕНТАЛЬНОМ ОСТРОМ БИЛИАРНОМ ПАНКРЕАТИТЕ

У крыс линии Вистар моделировали холестаз путем перевязки общего желчного протока (ОЖП), острый билиарный панкреатит (ОБП) - низкой перевязки билиопанкреатического протока. Образцы печени исследовали через 1, 3, 7 сут. По данным морфологических исследований, у крыс обеих групп выявлены очаги некроза гепатоцитов, их гипертрофия с увеличением ядерно-цитоплазматического отношения (ЯЦО), увеличение объемной плотности (Vv) воротных каналов, количества желчных протоков, синусоидных клеток. Морфологические изменения в печени при экспериментальном ОБП обусловлены последствиями холестаза, они возникали раньше и были достоверно более выражены при обструктивном холестазе (ОХ)

The results of treatment of patients with an acute cholecystitis and perivesical complications

Objective. To improve the quality of diagnosis and results of treatment in patients, suffering an acute cholecystitis, complicated by formation of perivesicular infiltrate, abscess and Mirizzi’s syndrome. Materials and methods. Results of diagnosis and surgical treatment of 694 patients, suffering an acute cholecystitis, ageing 38 - 87 yrs old, admitted to the clinic in 2010 - 2019 yrs, were analyzed. The examination have included general clinical investigation, biochemical investigations of the blood, ultrasonographic investigation of a gallbladder and extrahepatic biliary ducts, and in accordance to certain indications – computer tomography, papilloscopy and endoscopic retrograde cholangiopancreaticography. Results. Of 694 patients, suffering an acute cholecystitis in 541 (78.0%) perivesical complications were revealed. In 215 (31.0%) patients perivesical infiltrate was formed, while in 76 (11.0%) – perivesical abscess. In 250 (36.0%) patients an acute cholecystitis have developed on background of obturation jaundice, caused by choledocholithiasis in 138 patients, while in 98 patients Mirizzi’s syndrome Type I was diagnosed, and in 14 - Mirizzi’s syndrome Type II. Of 215 patients with an acute cholecystitis and perivesical infiltrate in 84 laparoscopic cholecystectomy was performed after course of antibacterial therapy, while in 131 patients – open cholecystectomy. In all 76 patients with perivesical abscess open cholecystectomy was performed. Of 138 patients, suffering obturation jaundice on background of choledocholithiasis in 82 endoscopic retrograde cholangiopancreaticography with simultaneous lithoextraction and subsequent laparoscopic cholecystectomy was conducted. In 56 patients naso-biliary drainage was installed and was held in place till calculi from common biliary duct have gone away and subsequent laparoscopic cholecystectomy performed. Of 98 patients with an acute cholecystitis and confirmed Mirizzi’s syndrome Type I in 95 laparoscopic cholecystectomy was performed, while in 3 – the open one. Of 14 patients, suffering Mirizzi’s syndrome Type II, in 10 open operation was done with sanation of biliary ducts and plasty of a common biliary duct defect, while in 4 – laparoscopic cholecystocholedocholithotomy with restoration of the bile physiological passage. Conclusion. In 78.0% patients with an acute cholecystitis perivesical complications were diagnosed. Of 531 patients with perivesical infiltrate, choledocholithiasis and Mirizzi’s syndrome in 321 (60.5%) laparoscopic operations on biliary ducts were accomplished. Open laparotomy was performed in 210 (39.5%) patients. In all the patients, suffering Mirizzi’s syndrome of both Types, physiologic passage of bile was preserved

The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts

Objective. A search for factors, promoting development of an acute biliary pancreatitis, and peculiarities of its signs in patients, suffering obstruction of extrahepatic biliary ducts. Materials and methods. Retrospective analysis of treatment in 283 patients, suffering obstruction of extrahepaic biliary ducts, was conducted, together with various indices analysis in patients, suffering an acute biliary pancreatitis and without acute biliary pancreatitis. Results. An acute biliary pancreatitis was diagnosed in 30 (10.6%) patients. Trustworthy differences (p < 0.05) were revealed, concerning pronounced pain syndrome, hyperthermia, leukocytosis, young neutrophils, general bilirubin, amylase in the blood, the gallbladder volume, choledocholithiasis, the fixed calculus and stenosis of duodenal papilla magna, cholangitis. Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001). Conclusion. Sludge of common biliary duct, stenosis and fixed calculus of duodenal papilla magna, bilirubinemia 70 mcmol/l and higher constitute the risk factors for development of an acute biliary pancreatitis, and the pronounced abdominal pain syndrome, hyperthermia, hyperamylasemia, leucocytosis, increase of the young neutrophils content up to 7% and higher, the volume of  a gallbladder 50 cm3 and more - served as the signs of an acute biliary pancreatitis in obstruction of extrahepatic biliary ducts. In obstruction of extrahepatic biliary ducts with an acute biliary pancreatitis, comparing with obstruction of extrahepatic biliary ducts without an acute biliary pancreatitis, cholangitis is revealed trustworthily: 16.7 and 5.1% accordingly (p < 0.05)

Факторы риска развития и проявления острого холангита у больных с доброкачественной обструкцией внепеченочных желчных путей

Цель. Определение факторов, способствующих развитию острого холангита (ОХ) или являющихся его признаками при доброкачественной обструкции внепеченочных желчных путей (ДОВЖП). Материалы и методы. Ретроспективно проанализированы 144 наблюдения ДОВЖП, ОХ отмечен в 17 наблюдениях. Проведено сравнение встречаемости различных факторов и признаков у больных с ОХ и без ОХ. Результаты. Различия выявлены (p 0,05) между следующими показателями: пол, возраст, индекс массы тела, наличие абдоминального болевого синдрома, холецистэктомия в анамнезе, объем ЖП, причина обструкции, расширение гепатикохоледоха, эндоскопическая папиллосфинктеротомия в анамнезе, наличие околососочкового дивертикула и острого билиарного панкреатита. Выводы. Факторы риска развития ОХ: уровень общего билирубина 70 мкмоль/л и выше, утолщение стенки ЖП до 4 мм и более, отключенный ЖП, фиксированный камень БСДПК, размер БСДПК 15 мм и более. Проявления ОХ: гипертермия, наличие триады Шарко, лейкоцитоз 9 × 109 в 1 л и выше, увеличение содержания палочкоядерных нейтрофилов до 7% и выше, гиперамилаземия