Досвід неоад’ювантної селективної внутрішньоартеріальної хіміотерапії за схемою FOLFIRINOX, проведеної пацієнту з умовно резектабельним раком правого анатомо-хірургічного сегмента підшлункової залози

Досвід неоад’ювантної селективної внутрішньоартеріальної хіміотерапії за схемою FOLFIRINOX, проведеної пацієнту з умовно резектабельним раком правого анатомо-хірургічного сегмента підшлункової залоз

Dynamical lymphadenectomy as a component of multidisciplinary approach while doing operative interventions for pancreatic cancer

Objective. To improve the results of treatment of pancreatic cancer, using modification of volumes of lymphadenectomy and application of multidisciplinary approach. Materials and methods. Into the investigation 16 patients, suffering a moderately differentiated (G2) adenocarcinoma of the pancreatic gland head (II stage of the disease) were included. There were 10 men and 6 women. The average age of the patients have constituted 62.4 yrs old. The patients were divided into two groups – the main and the comparative one, equally - by 8 of every group. In all the patients pancreaticoduodenal resection was done. All the patients in postoperative period have obtained gemcitabine in combination with 5-fluorouracyl. In patients of the main group a dynamical personalized intraoperative lymphadenectomy in accordance to our elaborated scheme, was performed. In patients of the comparison group lymphadenectomy was performed in accordance to the volumes adjusted, and it is called a standard one. Results. Average duration of the operation have constituted (347 ± 48) min, lymphadenectomy – (42 ± 12) min in the main group, and (31 ± 9) in the comparison group. Average volume of the blood loss have constituted (342 ± 272) ml. Average duration of hospitalization have constituted (8.2 ± 4.3) days, general rate of postoperative complications – 24.3% in both groups. After the operation the mortality was absent. Clinically significant lymphorrhea was observed in 3 patients in the main group, and in 5 – from the comparison group. In patients of the main group 9 ± 2 lymph nodes were excised, and in a comparative one – 13 ± 2, there were revealed 7 ± 1 (77.7%) and 9 ± 2 (60%) lymph nodes affected, accordingly. Postoperative diarrhea have occurred in 4 patients: in 3 – from comparative group, and in 1 – from the main group. Duration of the recurrence-free period in the main group have constituted (18 ± 2.3) mo, and in a comparative one – (13 ± 1.5) mo. Two years have survived 12/16 (75%) patients. In the main group one patient died, and in a comparative one - 3. The two-year survival in the main group have constituted 87.5%, and in a comparative one – 62.5%. Conclusion. Dynamical lymphadenectomy as a component of multidisciplinary approach gives possibility to reduce the quantity of the lymph nodes excised, unaffected by the tumor, to enhance the quantity of the excised lymph nodes trustworthily affected by the tumor, to lower the morbidity rate and to prolong the duration of the recurrence free period

Local Activity in the Contemporary Educational-Educational Process: Theoretical Concepts

У статті зроблено спробу з’ясувати роль краєзнавчої роботи у сучасному освітньо-виховному процесі в навчальних закладах усіх рівнів. Розглянуто зміст понять теоретичного блоку: краєзнавчий світогляд, краєзнавча свідомість, краєзнавче чуття, краєзнавчі знання, краєзнавчий смак, краєзнавчі здібності. Обґрунтовано доцільність їх формування у молодого покоління.The article testifies the attempt to clarify the role of local history work in the modern educational process in educational institutions of all levels. The content of the concepts of the theoretical block is examined: a local history outlook, a local lore consciousness, a local lore, local history knowledge, a local lore taste, and local lore abilities. The expediency of their formation in the younger generation is justified

Gas Accretion via Condensation and Fountains

For most of their lives, galaxies are surrounded by large and massive coronae of hot gas, which constitute vast reservoirs for gas accretion. This chapter describes a mechanism that allows star-forming disc galaxies to extract gas from their coronae. Stellar feedback powers a continuous circulation (galactic fountain) of gas from the disc into the halo, producing mixing between metal-rich disc material and metal-poor coronal gas. This mixing causes a dramatic reduction of the cooling time of the corona making it condense and accrete onto the disc. This fountain-driven accretion model makes clear predictions for the kinematics of the extraplanar cold/warm gas in disc galaxies, which are in good agreement with a number of independent observations. The amount of gas accretion predicted by the model is of the order of what is needed to sustain star formation. Accretion is expected to occur preferentially in the outer parts of discs and its efficiency drops for higher coronal temperatures. Thus galaxies are able to gather new gas as long as they do not become too massive nor fall into large halos and they maintain their star-forming gaseous discs