Клінічний випадок гострої товстокишкової кровотечі в Ургентній гінекології

This article describes the clinical case of acute colonic bleeding and microperforation of the sigmoid colon in a patient with bilateral pyosalpinx. At primary operative intervention, diverticulosis of the vagmoid colon was not detected through an inflammatory infiltrate, which led to repeated surgical intervention with resection of the sigmoid colon and stoma.В статье описано клинический случай острого толстокишечного кровотечения и микроперфорации сигмовидной кишки у пациентки с двухсторонним пиосальпинксом. При первичном оперативном вмешательстве не было обнаружено дивертикулеза сигмовидной кишки через воспалительный инфильтрат, что привело к повторному оперативному вмешательству с выполнением резекции сигмовидной кишки и стомы.У статті описано клінічний випадок гострої товстокишкової кровотечі та мікроперфорації сигмоподібної кишки у пацієнтки із двостороннім піосальпінксом. При первинному операційному втручанні не виявлено дивертикульозу сигмоподібної кишки через запальний інфільтрат, що призвело до повторного операційного втручання з виконанням резекції сигмоподібної кишки та стоми

Assessment of the condition severity and prediction of postoperative complications in elderly and senile patients with perforated gastric and duodenal ulcer

Aim. To assess the condition severity and predict postoperative complications and mortality in elderly and senile patients with perforated gastric and duodenal ulcer using the P-POSSUM score. Materials and methods. To conduct a scientific study, 80 (100.0 %) cases of treatment for patients aged 60 to 89 years with a diagnosis of gastric or duodenal ulcer perforation were analyzed. At the stage of hospitalization, the general condition was assessed using the variables of the P-POSSUM score. All patients underwent emergency surgery. Results. The obtained sum of points was compared with postoperative complications and mortality. We defined the discrimination point as >43 points for postoperative complications and >48 points for mortality. Based on the result, the patients were divided into group A with a sum of points up to 43 inclusive – 39 patients (48.8 %), and with a greater number of points – 41 patients (51.2 %) – group B. Evaluation of the detected complications in the postoperative period and comparison with the sum of points significantly confirmed an increase in their frequency in group B (sum of points >43) as compared to group A (sum of points ≤43) – p = 0.0018, U = 474.0. To compare the mortality rate, all the patients were divided into group C – 48 (60.0 %) patients with a sum of points ≤48, and group D – 32 patients (40.0 %) with a sum of points ≥49. In the group of patients with a total score >48 (group D), the mortality rate was significantly increased compared to group C with a score ≤48, p = 0.0002, U = 384.0. Conclusions. Our study has led to the following conclusions: the P-POSSUM score use in elderly and senile patients with perforated gastric and duodenal ulcers significantly confirms the increase in the frequency of postoperative complications, in group A – 6 (15.4 %) patients, while in group B – 23 (56.1 %), p = 0.0018, U = 474.0 and increased mortality, in group C – 6.3 %, in group D – 56.3 %, p = 0.0002, U = 384.0; the P-POSSUM score provides reliable prediction an increase in the risk of postoperative complications and mortality. This, in turn, makes it possible to predict and change treatment approaches and improve the quality of emergency surgical care for elderly and senile patients

Dephasing time of disordered two-dimensional electron gas in modulated magnetic fields

The dephasing time of disordered two-dimensional electron gas in a modulated magnetic field is studied. It is shown that in the weak inhomogeneity limit, the dephasing rate is proportional to the field amplitude, while in strong inhomogeneity limit the dependence is quadratic. It is demonstrated that the origin of the dependence of dephasing time on field amplitude lies in the nature of corresponding single-particle motion. A semiclassical Monte Carlo algorithm is developed to study the dephasing time, which is of qualitative nature but efficient in uncovering the dependence of dephasing time on field amplitude for arbitrarily complicated magnetic-field modulation. Computer simulations support analytical results. The crossover from linear to quadratic dependence is then generalized to the situation with magnetic field modulated periodically in one direction with zero mean, and it is argued that this crossover can be expected for a large class of modulated magnetic fields.Comment: 8 pages, 2 figure

Resistance effects due to magnetic guiding orbits

The Hall and magnetoresistance of a two dimensional electron gas subjected to a magnetic field barrier parallel to the current direction is studied as function of the applied perpendicular magnetic field. The recent experimental results of Nogaret {\em et al.} [Phys. Rev. Lett. {\bf 84}, 2231 (2000)] for the magneto- and Hall resistance are explained using a semi-classical theory based on the Landauer-B\"{u}ttiker formula. The observed positive magnetoresistance peak is explained as due to a competition between a decrease of the number of conducting channels as a result of the growing magnetic field, from the fringe field of the ferromagnetic stripe as it becomes magnetized, and the disappearance of snake orbits and the subsequent appearance of cycloidlike orbits.Comment: 7 pages, 7 figure

Визначення показань та протипоказань до симультанних оперативних втручань у пацієнтів з поєднанням ендокринної та іншої хірургічної патології

The aim of the work: to develop indications and contraindications for the implementation of simultaneous surgical interventions on the example of patients with combined pathology of the thyroid gland (TG) and cholelithiasis (CL) / gallbladder polyposis, using the scale of the functional state of P-POSSUM. Materials and Methods. During the period from January 2015 to September 2018, 35 patients with combined pathology of the TG and CL / gallbladder polyposis were examined and operated. At the preoperative stage, as well as on the first day of the postoperative period, all patients evaluated on the P-POSSUM scale. Results and Discussion. In 22 (62.9 %) patients, whose functional state before the intervention was assessed by physiological subscale (FS) ≤ 17 points, there were postoperative changes in health with an average difference of 0.13 points, T (Z) = 1.21, p = 0.225. In all these patients, the complexity of surgical intervention on the surgical sub-scale (SS) on the P-POSSUM scale was estimated ≤ 14 points. In 13 (37.1 %) patients, whose condition was estimated at 17 points by FS, significant changes in functional health before and after surgery were revealed, with a difference of average 1.15 points, T (Z) = 2.67; p = 0.0077. The complexity of their operations ranged from 14 to 16 points for SS.Цель работы: разработать показания и противопоказания к выполнению симультанных оперативных вмешательств на примере пациентов с сочетанной патологией щитовидной железы (ЩЖ) и желчнокаменной болезнью (ЖКБ) / полипозом желчного пузыря, с использованием шкалы функционального состояния P-POSSUM. Материалы и методы. За период с января 2015 по сентябрь 2018 года обследовано и прооперировано 35 пациентов с сочетанной патологией щитовидной железы и ЖКБ / полипозом желчного пузыря. На дооперационном этапе, а также на первые сутки послеоперационного периода, всем пациентам проводили оценку функционального состояния по шкале P-POSSUM. Результаты исследований и их обсуждение. У 22 (62,9 %) пациентов, функциональное состояние которых до вмешательства оценивалось по физиологической субшкале (ФС) ≤ 17 баллов, имели место послеоперационные изменения состояния здоровья с разницей средних 0,13 баллов, Т (Z) = 1,21, р = 0,225. В этих больных сложность оперативного вмешательства по хирургической субшкале (ХС) шкале P-POSSUM была оценена ≤ 14 баллов. У 13 (37,1 %) больных, состояние которых было оценено в 17 баллов по ФС, выявлены значимые изменения функционального состояния здоровья до и после операции, с разницей средних 1,15 балла, Т (Z) = 2,67; р = 0,0077. Сложность операций у них колебалась от 14 до 16 баллов за ХС.Мета роботи: розробити показання та протипоказання до виконання симультанних оперативних втручань на прикладі пацієнтів з поєднаною патологією щитоподібної залози (ЩЗ) та жовчнокам’яною хворобою (ЖКХ) / поліпозом жовчного міхура, з використанням шкали функціонального стану P-POSSUM. Матеріали і методи. За період з січня 2015 до вересня 2018 року обстежено та прооперовано 35 пацієнтів з поєднаною патологією щитоподібної залози та ЖКХ / поліпозом жовчного міхура. На доопераційному етапі, а також на першу добу післяопераційного періоду всім пацієнтам проводили оцінку функціонального стану за шкалою P-POSSUM. Результати досліджень та їх обговорення. У 22 (62,9 %) пацієнтів, функціональний стан яких до втручання оцінювався за фізіологічною субшкалою (ФС) ≤ 17 балів, мали місце післяопераційні зміни стану здоров’я з різницею середніх 0,13 бала, Т (Z) = 1,21, р = 0,225. У всіх цих хворих складність оперативного втручання за хірургічною субшкалою (ХС) шкали P-POSSUM була оцінена ≤ 14 балів. У 13 (37,1 %) хворих, стан яких був оцінений в ˃ 17 балів за ФС, виявлені значущі зміни функціонального стану здоров’я до та після операції з різницею середніх 1,15 бала, Т (Z) = 2,67; р = 0,0077. Складність операцій у них коливалася від 14 до 16 балів за ХС

A clinical case of small intestinal intussusception caused by metastatic melanoma

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient. Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital. Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention. Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures. Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient

Analysis of the surgical treatment results for an acute cholecystitis in the senile and elderly patients, depending on term of the operative intervention performance

Objective. To estimate the results of surgical treatment in the senile and elderly patients for an acute cholecystitis on background of biliary calculous disease in urgent abdominal surgery, depending on term of performance of operative intervention. Materials and methods. In the investigation there were included 89 patients, ageing 60-89 yrs old with diagnosis: an acute cholecystitis on background of biliary calculous disease. Median age of the patients have constituted (69.66 ± 7.30) yrs old. Results. All the patients were operated in urgent order, average duration of preoperative period was 20.00 (7.00; 27.00) h. Laparoscopic cholecystectomy with abdominal drainage was performed in 70 (78.7%) patients; laparotomy, cholecystectomy with abdominal drainage- in 14 (15.7%); laparotomy, cholecystectomy with drainage of common biliary duct - in 5 (5.6%). In 3 (4.3%) patients while performing of laparoscopic cholecystectomy the necessity have emerged for conversion due to hemorrhage from the gallbladder bed. Preoperative preparation in the senile and elderly patients during more than 24 h have led to significant improvement of their general state, comparing with those, who were operated in terms up to 24 h from the moment of admittance to hospital (U-criterion = 749.50; p = 0.0286). As well, in accordance to data, concerning postoperative period analysis, there was noted significant improvement of the patients’ state, preoperative preparation of whom lasted more than 24 h, comparing with the patients, preoperative preparation of whom lasted lesser than 24 h (U-criterion = 491.00; p < 0.0001). Average duration of stationary stay have differed in this two Groups (U-criterion = 919.00; p = 0.3984). Conclusion. The surgery deferred performance for an acute cholecystitis in the senile and elderly patients permits to improve the results of postoperative treatment and to reduce the frequency of postoperative complications significantly

Динамическая модель тепломассообменных процессов в камере форсуночного увлажнения

Розглядається математичне моделювання динамічних процесів тепло- та масообміну для камери форсуночного зволоження, яка використовується в системах штучного мікроклімату для охолодження та адіабатного зволоження повітря. На основі рівнянь матеріального та теплового балансів отримано три рівноцінні моделі: у вигляді системи диференційних рівнянь; у просторі стану; у вигляді передатних функцій, які дозволяють проводити моделювання перехідних процесів у камері форсуночного зволоження за основними каналами впливу. Запропоновані математичні залежності зручно реалізувати у середовищі MatLAB. Приведено приклад моделювання перехідних процесів для форсуночного зволожувача промислового кондиціонера КЦКП-80, який виготовляється компанією ВЕЗА. Динамічна модель форсуночного зволожувача може використовуватися спеціалістами із автоматизації для аналізу та налаштуванню параметрів систем керування промислових кондиціонерів.Mathematical modeling of dynamic processes heat-mass exchange for a chamber of the sprayer moistening which is used in systems of an artificial microclimate for cooling and for the adiabatic moistening of air is observed. On the basis of the equations of material and thermal balance three equivalent models: in the form of systems of differential equations; state space; in the form of transfer functions, which allow to spend modeling of transients in a chamber of the sprayer moistening on the basic channels of influence are gained. Sampling of dynamic model is defined by methods of a control system synthesis of the industrial air conditioner and tastes of researcher. For raise of accuracy of mathematical calculations in paper experimental definition of factors heat-mass exchange which allows adapting dynamic model for concrete operating conditions of a chamber of the sprayer moistening is offered. The offered mathematical dependences are conveniently realized in the environment of Matlab. The instance of modeling of transients for sprayer humectants of air conditioner KCKP-80, which is manufactured by company VEZA is resulted. The gained transients have aperiodic character without delay. The analysis of transients after the possible channels of adjusting confirmed their high inertance, that is why during automation of industrial conditioners it follows to give up regulative influences in the chamber of the moistening after the change of temperature and expense of water on moistening. The dynamic model of sprayer humectants can be used by specialists on automation for the analysis and adjustment of parameters of control systems of industrial air conditioners.Рассматривается математическое моделирование динамических процессов тепло- и массообмена для камеры форсуночного увлажнения, которая используется в системах искусственного микроклимата. На основании уравнений материального и теплового балансов получено три равноценные модели: в виде системы дифференциальных уравнений; в пространстве состояний; в виде передаточных функций, которые позволяют провести моделирование переходных процессов в камере форсуночного увлажнения по основным каналам влияния. Предложенные математические зависимости удобно реализовывать в среде MatLAB. Приведен пример моделирования переходных процессов для форсуночного увлажнителя промышленного кондиционера КЦКП-80, который изготавливается компанией ВЕЗА. Динамическая модель форсуночного увлажнителя может использоваться специалистами по автоматизации для анализа и настройки параметров систем управления промышленными кондиционерами

Diagnostic criteria for cancer cachexia: Reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis

Abstract Background Cancer‐associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C‐reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer‐associated WL (primary endpoint) and overall survival (OS, secondary endpoint). Methods The data set included a total of 12,253 patients at risk for cancer‐associated WL. Patient‐reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively. Results Patients had a mean weight change of −7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5–5.9% (19.7%), 6.0–10.0% (23.2%), 11.0–14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P  100 mg/L: OR 2.30 (95% CI 1.62–3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5–10.3), with median follow‐up of 39.7 months (95% CI 38.8–40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P < 0.0001). Conclusions Modelling WL as the dependent variable is an approach that can help to identify clinical features and biomarkers associated with WL. Here, we identify criterion values for food intake impairment and CRP that may improve the diagnosis and classification of cancer‐associated cachexia

36. A prospective, randomized study to compare the value of two fractionation schemes of palliative radiotherapy for inoperable non-small cell lung cancer

A prospective, randomized study was conducted in eight Polish institutions to compare the value of two fractionation schemes of palliative radiotherapy for inoperable non-small cell lung cancer. Assessed was the impact of either treatment on the degree and duration of relief of tumor-related symptoms and on patient's performance status. Secondary endpoints included treatment side-effects, objective response and overall survival. One hundred patients were randomly assigned to the dose of 20 Gy/5×/5 days (Arm A) or 16 Gy/2×/8 days (Arm B). There were 90 men and 10 women aged between 47 and 79 (mean 66). Eighty four patients had locally advanced tumor and 16 patients had metastatic disease. Squamous cell carcinoma was diagnosed in 65 patients, adenocarcinoma – in 9 patients, large cell carcinoma – in 1 patient and unspecified non-small cell carcinoma – in 25 patients. Fifty five patients were assigned to Arm A and 45 – to Arm B. Ninety eight patients received assigned treatment whereas two patients died before the end of treatment. The final results of the study will be presented at the conference