Трудности диагностики и лечения при пневмотораксе и гигантских буллах

Spontaneous pneumothorax is the most common acute chest disease. Often, giant bullae give the impression of the presence of air in the pleural cavity. Inadequate differential diagnosis leads to vain drainage of the pleural cavity, damage to the lung with its collapse and pneumothorax.The aim. Analyze diagnostic and tactical mistakes in patients with pulmonary emphysema, which manifests with giant bullae, and outline the ways to prevent complications.Methods. The analysis of the treatment of 1,636 patients with pulmonary emphysema and its complications undergoing treatment in the thoracic surgical department of the Samara Regional Clinical Hospital named after V.D.Seredavin in the period from 2001 to 2018 is presented.Results. Giant bulla were diagnosed in 35 (2.1%) patients, 16 of them were hospitalized ungently. In 6 patients, the diagnosis of a giant bulla of the lung was correct, and the patients were referred to the thoracic surgical department. In 10 patients, a giant bulla of the lung was regarded as pneumothorax, and pleural drainage was performed before referral to the thoracic surgical department.Conclusion. The correct interpretation of the radiological data and comparison with the clinical picture allows avoiding diagnostic errors and the associated danger and complications.Спонтанный пневмоторакс является самым частым острым заболеванием органов грудной клетки. Нередко гигантские буллы создают впечатление о наличии воздуха в плевральной полости. Неадекватная дифференциальная диагностика приводит к напрасному дренированию плевральной полости, повреждению легкого с его спадением и возникновением пневмоторакса.Целью исследования явился анализ диагностических и тактических ошибок у пациентов с буллезной эмфиземой легких, представленной гигантскими буллами, и обозначение путей профилактики осложнений.Материалы и методы. Проведен анализ лечения пациентов (n = 1 636) с эмфиземой легких и ее осложнениями, госпитализированных в хирургическое торакальное отделение Государственного бюджетного учреждения здравоохранения «Самарская областная клиническая больница имени В.Д.Середавина» Министерства здравоохранения Самарской области (2001–2018).Результаты. Гигантские буллы диагностированы у 35 (2,1%) пациентов, 16 из которых госпитализированы в экстренном порядке. Верный диагноз гигантская булла легкого установлен в 6 случаях, больные направлены в хирургическое торакальное отделение. В 10 случаях гигантская булла легкого расценена как пневмоторакс и до поступления в хирургическое торакальное отделение больным проведено дренирование плевральной полости.Заключение. Верная интерпретация рентгенологических данных и сопоставление с клинической картиной позволяет избежать диагностических ошибок и связанных с этим дальнейших опасностей и осложнений

Analysis of the circadian rhythm of intraocular pressure in stable and progressive forms of primary open-angle glaucoma

Purpose. To analyze the daily dynamics and the parameters of intraocular pressure circadian rhythm (IOP CR) in patients with primary open-angle glaucoma (POAG) (stable and progressive forms) and determine chronobiological regularities of glaucoma progression depending on the patterns of restructuring the daily dynamics of IOP CR and body temperature.Material and methods. The study included 75 POAG patients, of which 35 had a stable form (S-POAG) and 40 had a rapidly progressing form (P-POAG). The control group was composed of 80 subjects without POAG. The index of retinal ganglion cell loss measured by optical coherence tomography (OCT) was used as a criterion of POAG progression. IOP was measured by the patients themselves for 72 hours at 7 time points (3 am, 8 am, 11 am, 2 pm, 5 pm, 8 pm, and 11 pm, who used an Icare ONE portable intraocular pressure tonometer for individual use.Results. IOP daily dynamics was distributed differently in the different groups. In S-POAG, the peak values were mainly reached in the morning hours, while the minimum values were observed at night. In P-POAG, the peak values of IOP were contrariwise recorded at night. In both POAG groups, an increase of irregular fluctuation share was noted, which indicated a decrease of the CR contribution to the IOP CR. Moreover, in POAG, a change in the phase ratio between the IOP CR and CR of body temperature was observed. For IOP CR phase violation manifestations, the threshold value of GCS global loss index was determined at 10–15 % according to OCT data.Conclusion. IOP daily dynamics were shown to differ in S-POAG and P-POAG patients. In both groups. Signs of desynchronization were detected. The ganglion retinal cell global loss index can be used to determine phase disturbances of IOP CR

Measurement of pseudorapidity distributions of charged particles in proton-proton collisions at sqrt(s) = 8 TeV by the CMS and TOTEM experiments

Pseudorapidity ( $\eta$ ) distributions of charged particles produced in proton–proton collisions at a centre-of-mass energy of 8 $~\text {TeV}$ are measured in the ranges $|\eta | < 2.2$ and $5.3 < |\eta | < 6.4$ covered by the CMS and TOTEM detectors, respectively. The data correspond to an integrated luminosity of $\mathcal {L} = 45 \mu {\mathrm {b}}^{-1}$ . Measurements are presented for three event categories. The most inclusive category is sensitive to 91–96 % of the total inelastic proton–proton cross section. The other two categories are disjoint subsets of the inclusive sample that are either enhanced or depleted in single diffractive dissociation events. The data are compared to models used to describe high-energy hadronic interactions. None of the models considered provide a consistent description of the measured distributions