Assessment of the prevalence of harmful habits of smoking among high school students

In this issue there are represented the results of monitoring the views of high school students on smoking tobacco cigarettes, hookahs, and electronic cigarettes and vapes that became so popular nowadays. The reason for this research was one case that happened to a ninthgrader from Ekaterinburg. His vape exploded in his mouth while boy was smoking it. It was required comprehensive rehabilitation provided by dentist of the various profiles: surgeon, therapist, orthopedist.В статье рассмотрены результаты мониторинга мнения старшеклассников о вопросах курения табачных сигарет, кальянов и ставших модными в последнее время электронных сигарет и вейпинге. Поводом для проведения данной работы стал случай с девятиклассником средней школы г. Екатеринбурга, у которого во время парения вейп взорвался в полости рта. Потребовалась комплексная реабилитация у стоматологов разного профиля: хирурга (в стационаре), терапевта и ортопеда

Ближайшие и среднесрочные результаты торакоскопической радиочастотной аблации фибрилляции предсердий

Aim. Evaluation of short- and mid-term (up to one year) results of aт atrial fibrillation thoracoscopic radiofrequency ablation (TRFA) combined with left atrial appendage resection.Methods. 10 patients with persistent AF were included in the study. In 5 cases surgical ablation was performed as the primary intervention and in 5 cases surgery were preceded by two unsuccessful catheter procedures. Age of the patients was 54.4 (41; 63) years, duration of arrhythmic anamnesis – 5.6 (4.8; 6.8) years, anteroposterior size of the left atrium – 4.7 (45; 51 mm), LV ejection fraction – 63 (58; 68) %. TRFA included an isolation of right and left pulmonary veins, ablation lines along the roof and base of posterior wall of the left atrium, left atrial appendage resection.Results. In all cases of TRFA exit-block from the pulmonary veins was achieved. Among 10 procedures, a stable sinus rhythm was documented in 6 patients. In the remaining 4 patients AF was observed only in one case, and the other three demonstrated atypical atrial flutter, that given us a reason to repeat catheter procedures. In three cases of left atrial flutter, catheter ablation led to sinus rhythm restoration, and in case of AF and total sclerosis of left atrium a decision to refuse RF ablation was made. Complications were presented by a single case of bilateral phrenic nerve palsy, which required plication of the diaphragm, and two spontaneously resolved pulmonary atelectasis.Conclusion. The efficacy of atrial fibrillation thoracoscopic radiofrequency ablation during the follow-up period of one year was 90% regarding selective hybrid approach (thoracoscopic + catheter procedure). Procedure safety of TRFA was much lower than that of catheter ablation: the total number of small and big complications was 30%.Цель. Изучение ближайших и среднесрочных (до года) результатов торакоскопической радиочастотной аблации (ТРЧА) фибрилляции предсердий (ФП) в сочетании с резекцией ушка левого предсердия.Материалы и методы. В исследование было включено 10 пациентов с персистирующей ФП. В 5 случаях выполнена первичная операция хирургической аблации в 5 – вмешательство в связи с рецидивами после двух катетерных аблаций. Возраст пациентов составил 54,4 (41; 63) года, длительность аритмического анамнеза – 5,6 (4,8; 6,8) лет, переднезадний размер левого предсердия – 4,7 (45; 51) мм, фракция выброса левого желудочка – 63 (58; 68) %. ТРЧА выполнена в объеме изоляции блока правых и левых легочных вен, линейных аблаций по крыше левого предсердия (ЛП) и основания задней стенки ЛП, резекции ушка ЛП.Результаты. Во всех случаях проведенной ТРЧА удалось достичь блокады выхода из легочных вен. Из 10 процедур устойчивый синусовый ритм документирован у 6 пациентов. У остальных четырех ФП наблюдалась только в одном случае, а в трех других регистрировалось атипичное трепетание предсердий, что послужило поводом для повторных катетерных процедур. В трех случаях при выявлении левопредсердного трепетания была проведена радиочастотная аблация с восстановлением синусового ритма, а в четвертом при наличии ФП и тотального склероза ЛП от нанесения радиочастоных аппликаций было решено воздержаться. Осложнения представлены в виде одного случая двустороннего пареза диафрагмального нерва, что потребовало операции пликации диафрагмы, и двух спонтанно разрешившихся ателектазов легких.Заключение. Эффективность торакоскопической радиочастотной аблации фибрилляции предсердий в средние сроки наблюдения (1 год) составила 90% при условии избирательного гибридного подхода (торакоскопическая + катетерная процедуры). Безопасность данной процедуры значительно ниже, чем при катетерной аблации: общее количество малых и больших осложнений составило 30%

Liver growth prediction in ALPPS – A multicenter analysis from the international ALPPS registry

Background: While ALPPS triggers a fast liver hypertrophy, it is still unclear which factors matter most to achieve accelerated hypertrophy within a short period of time. The aim of the study was to identify patient-intrinsic factors related to the growth of the future liver remnant (FLR). Methods: This cohort study is composed of data derived from the International ALPPS Registry from November 2011 and October 2018. We analyse the influence of demographic, tumour type and perioperative data on the growth of the FLR. The volume of the FLR was calculated in millilitre and percentage using computed-tomography (CT) scans before and after stage 1, both according to Vauthey formula. Results: A total of 734 patients were included from 99 centres. The median sFLR at stage 1 and stage 2 was 0.23 (IQR, 0.18–0.28) and 0.39 (IQR: 0.31–0.46), respectively. The variables associated with a lower increase from sFLR1 to sFLR2 were age˃68 years (p =.02), height ˃1.76 m (p ˂.01), weight ˃83 kg (p ˂.01), BMI˃28 (p ˂.01), male gender (p ˂.01), antihypertensive therapy (p ˂.01), operation time ˃370 minutes (p ˂.01) and hospital stay˃14 days (p ˂.01). The time required to reach sufficient volume for stage 2, male gender accounts 40.3% in group ˂7 days, compared with 50% of female, and female present 15.3% in group ˃14 days compared with 20.6% of male. Conclusions: Height, weight, FLR size and gender could be the variables that most constantly influence both daily growths, the interstage increase and the standardized FLR before the second stage

Heterogeneity of management practices surrounding operable gallbladder cancer – results of the OMEGA-S international HPB surgical survey

Background: Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. Methods: A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. Results: Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. Conclusion: Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes