Endoscopic and surgical treatment of the Mirizzi syndrome

Academia Medicală de Studii Postuniversitare, Harkov, Ucraina, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Sindromul Mirizzi se caracterizează prin compresia căii biliare de către colecist sau formarea unei fistule între acestea, care corespunde tipului Mirizzi I şi II (McSherry, 1984). Diagnosticul se confirmă prin ERCP. Corecţia chirurgicală este complexă şi adesea în cazurile de Mirizzi II este necesară aplicarea hepaticojejunostomiei. Scop: Evaluarea oportunităţilor tratamentului endoscopic şi chirurgical al sindromului Mirizzi pentru păstrarea pasajului bilei spre duoden. Material şi metode: Dintre 2144 pacienţi cu litiază biliară, obstrucţia căilor biliare a fost evidențiată la 328 (15,3%). Sindromul Mirizzi a fost diagnosticat în 21 (6,4%) cazuri: de tip I – la 6 (28,6%) pacienţi, de tip II – la 15 (71,4%). Rezultate: În două cazuri de Mirizzi I iniţial a fost practicat drenajul biliar transnazal, într-un caz – stentarea ductului biliar comun. Colecistectomia laparoscopică s-a efectuat la 5 pacienţi şi deschisă – la unul. La 2 din 15 (13,3%) pacienţi cu Mirizzi II s-a reuşit litotripsia, la un bolnav a fost realizată stentarea biliară. Pentru a reduce icterul în 12 cazuri a fost aplicat drenajul biliar transnazal. Ulterior, 9 pacienţi au suportat colecistectomie cu plastia defectului ductului biliar comun, la 2 bolnavi s-a efectuat colecistectomie laparoscopică cu extragerea calculilor biliari, şi într-un caz s-a practicat hepaticojejunostomia. Astfel, la 14 din 15 (93,3%) bolnavi cu Mirizzi II pasajul biliar fiziologic a fost restabilit cu succes. Mortalitatea postoperatorie a constituit 0, morbiditatea – 19% (4 pacienţi). Concluzie: Aplicarea tratamentului endoscopic şi chirurgical la pacienţii cu Mirizzi II a permis restabilirea pasajul biliar fiziologic în 93% din cazurile noastre.Introduction: The Mirizzi syndrome is characterized by compression of bile duct by gallbladder or fistula formation between them, that corresponds to the Mirizzi type I and type II (McSherry, 1984). The diagnosis confirms by ERCP. Surgical correction is complex and often needs hepaticojejunostomy in cases of Mirizzi II. Aim: Evaluate opportunities of the endoscopic and surgical treatment of Mirizzi syndrome in the preservation of bile passage to the duodenum. Material and methods: Among 2144 patients with cholelithiasis, biliary tract obstruction occurred in 328 (15.3%). Mirizzi syndrome was diagnosed in 21 (6.4%): type I – in 6 (28.6%) patients, type II – in 15 (71.4%). Results: In two cases of Mirizzi I initially transnasal biliary drainage was performed and in one – the common bile duct stenting. In 5 patients laparoscopic and in one open cholecystectomy was performed. In 2 of 15 (13.3%) patients with Mirizzi II lithotr ipsy was successful; in one bile duct stenting was performed. To reduce jaundice in 12 cases transnasal biliary drainage was introduced. Thereafter, 9 patients underwent cholecystectomy with the common bile duct defect plasty, 2 patients underwent laparoscopic cholecystolitotomy with bile duct stones extraction, and in one case hepaticojejunostomy was formed. Thus, in 14 of 15 (93.3%) of Mirizzi II physiological bile passage was successfully restored. Postoperative mortality was 0, morbidity was 19% (4 patients). Conclusion: The use of endoscopic and surgical treatment in cases of Mirizzi II allowed restoring the physiological bile passage in 93% of cases

MULTIFREQUENCY HIGH POWER MICROWAVE ELECTRIC-VACUUM DEVICES

Abstract A new approach for the development of microwave electric-vacuum devices is proposed. It implies extracting output power at two or more frequencies ω, 2ω, …, nω simultaneously while applying input power at fundamental frequency ω. The characteristic feature of these devices is that microwave oscillations at different frequencies are phased. It is possible to obtain output power at frequencies ω and 2ω simultaneously by using double-gap resonator tuned into two multiple frequencies -in-phase one at frequency ω and anti-phase one at frequency 2ω. It is possible to obtain power on four frequencies ω, 2ω, 3ω, 6ω by using electro-dynamic system of two doublegap resonators placed one inside other. It is possible to get power at many multiple frequencies by using special coaxial resonator. Has been created a microwave device producing power on nine multiple frequencies simultaneously. The output pulse of the device has ultra-short duration and super-high repetition frequency equal to the input frequency ω. Multifrequency high power microwave electric vacuum devices can be used in compact accelerators of charged particles

Plants of the calcifilic flora exposition of the N.V. Tsitsin Main Botanical Garden of the Russian Academy of Sciences, listed in the regional Red Data Books of Central Russia

The results of conservation of plants of the exposition of the calciphilous flora of the Main Botanical Garden of the Russian Academy of Sciences, listed in the regional Red Data Books of Central Russia, are shown. For 12 years, in the culture of GBS RAS, in the conditions of Moscow, 118 calciphilous species listed in the regional Red Books, represented by 77 genera from 34 families, were studied. Among them, in terms of introduction resistance, resistant ones prevail - 46% and highly resistant - 35.5%, weakly resistant - 13.5%, unstable - 5%. The main groups according to ecological confinement are considered: obligate (25%) and facultative (75%) calciphilic species. The experiment proved the importance of using special agricultural techniques for the successful adaptation of representatives of this group. In total, an average of 70% of calciphilous taxa of regional protected lists were tested. The representation of calciphilic species in the regional Red Data Books of Central Russia is different and is due to the natural features of the distribution of their classical habitats. In the regions of the Chernozem region, this figure ranges from 55% in the Belgorod region to 24% in the Tambov region. In the Non-Chernozem region: Bryansk, Ryazan, Tula regions, calciphilic species in relation to the total number of protected species also represent a significant part - 25%. For Vladimir, Ivanovo, Kaluga, Kostroma, Smolensk, Tver, Yaroslavl regions and the federal city of Moscow, calciphilic taxa represent an average of 9% of protected lists. The share of calciphilous species of categories: 0, 1, 2 in the regional Red Data Books of Central Russia averages 58%, which indicates a high vulnerability of this group and the need for ex situ stud

IMMEDIATE RESULTS OF HEPATECTOMY FOR METASTATIC COLORECTAL CANCER

Incorporation of bevacizumab to preoperative regional chemotherapy (CT) failed to increase the volume of intraoperative blood loss and the frequency of postoperative complications. Addition of the drug in the regional CT group significantly enhanced the rate of its effect up to 64 % and that of grade III medical pathomorphism up to 55 %. Regardless of the pattern of surgeries, the rate of complications after extended hepatectomy did not differ significantly in the treatment groups. Irrespective of treatment, the rate of acute liver failure rose when the volume of surgery was increased from conventional hemihepatectomy to extended hemihepatectomy. Acute liver failure was prominent (21%) among the complications in the treatment group. The highest incidence of acute liver failure in the comparable groups was observed in the preoperative regional CT group

The Hydration Structure at Yttria-Stabilized Cubic Zirconia (110)-Water Interface with Sub-Angstrom Resolution

The interfacial hydration structure of yttria-stabilized cubic zirconia (110) surface in contact with water was determined with ~0.5 Å resolution by high-resolution X-ray reflectivity measurement. The terminal layer shows a reduced electron density compared to the following substrate lattice layers, which indicates there are additional defects generated by metal depletion as well as intrinsic oxygen vacancies, both of which are apparently filled by water species. Above this top surface layer, two additional adsorbed layers are observed forming a characteristic interfacial hydration structure. The first adsorbed layer shows abnormally high density as pure water and likely includes metal species, whereas the second layer consists of pure water. The observed interfacial hydration structure seems responsible for local equilibration of the defective surface in water and eventually regulating the long-term degradation processes. The multitude of water interactions with the zirconia surface results in the complex but highly ordered interfacial structure constituting the reaction front.ope

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

Riistaeläinten populaatioiden dynamiikka Pohjois-Euroopassa: tiivistelmä : 7. kansainvälinen symposium. 24. – 28. Syyskuuta

We have studied Black Grouse population abundance and its dynamics in large regions of North-Europe and Urals’ taiga (Finland, Russian Karelia, Murmansk, Arhangel, Kirov and Komi regions and). The data is based on Winter Track Counts (WTC, Priklonski, 1973), where all grouse sightings are recorded. We also studied the longterm Black Grouse abundance changes in Russian and Belarus Natural Reserves (by “Chronical of Natural” Programme, including summer counts of forest grouses): Pinezhsky, Pechoro-Ilychskiy, National Park "Mechera", Nature Reserve "Kivach", "Bryansk Forest", Kostomuksha Nature Reserve Volzhsko-Kamsky National Nature Biosphere Reserve and Visimskiy State Nature Reserves. The highest and most stable abundances of Black Grouse were recorded from East Fennoscandia (Karelia – 3.6 birds per 10 km; Finland – 4.4, coefficient of variation – 12% and 27%, respectively), whereas in the Murmansk and Arkhangelsk Regions and Komi republic, e.g. the species abundance indices were 0.5, 2.5 and 1.1 birds per 10 km, respectively. The “Peak” and minimal abundance years do not concur in different regions of north-European taiga. In Komi in the period from 2001 to 2013, the number of the black grouse declined twice, in Arhangel in the period 30 years – decreased fivefold. In Tatarstan Republic (Volzhsko-Kamsky National Nature Biosphere Reserve) after 1980 abundance decreased rapidly and at last 10 tears – disappeared. In Central Siberia BG are small in numbers and rare. The data suggest Black Grouse abundance varies significantly across Northern Eurasia and among years. One may presume there are some factors acting in different directions: towards convergence and towards divergence of the trends.Peer reviewe

Frustrated spin correlations in diluted spin ice Ho2-xLaxTi2O7

We have studied the evolution of the structural properties as well as the static and dynamic spin correlations of spin ice Ho2Ti2O7, where Ho was partially replaced by non-magnetic La. The crystal structure of diluted samples Ho2-xLaxTi2O7 was characterized by x-ray and neutron diffraction and by Ho L-III-edge and Ti K-edge extended x-ray absorption fine structure (EXAFS) measurements. It is found that the pyrochlore structure remains intact until about x = 0.3, but a systematic increase in local disorder with increasing La concentration is observed in the EXAFS data, especially from the Ti K edge.Quasi-elastic neutron scattering and ac susceptibility measurements show that, in x<= 0.4 samples at temperatures above macroscopic freezing, the spin -spin correlations are short ranged and dynamic in nature. The main difference with pure spin ice in the dynamics is the appearance of a second, faster, relaxation process

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)