Selection of metal-cutting machines in operational design by means of PLM systems

© 2017, Allerton Press, Inc.A method is proposed for the selection of metal-cutting machines in the design of technological operations using Teamcenter and UNIGRAPHICS NX software

КЛАССИФИКАЦИЯ МЕСТНО-РАСПРОСТРАНЕННЫХ НОВООБРАЗОВАНИЙ МАЛОГО ТАЗА И ВТОРИЧНОГО ОПУХОЛЕВОГО ПОРАЖЕНИЯ МОЧЕВОГО ПУЗЫРЯ

Analyzed the surgical treatment of 154 patients with locally advanced pelvic tumors that required resection of the bladder or its complete removal. 67 (43.5 %) patients had colorectal cancer. In 53 (34.4 %) cases of cervical cancer in 21 (13.7 %) – ovarian cancer, 8 (5.2 %) – uterine cancer, in 5 (3.2 %) – a cancer of the vagina. In 41 (26.6 %) patients operation was accompanied by resection of the bladder, 113 (73.4 %) cases, the volume of surgery was pelvic exenteration.Proposed surgical classification of locally advanced pelvic tumors and secondary destruction of the bladder with locally advanced tumors. Describes the criteria of choosing the optimal amount of intervention at different propagation of the tumor and the degree of involvement of the bladder. The perspective of large interventions to improve the results of treatment of patients with tumors of the pelvic localization. Проведен анализ хирургического лечения 154 больных местно-распространенными злокачественными новообразованиями органов малого таза, реализация лечебной тактики у которых потребовала или резекции мочевого пузыря (МП) или полного его удаления. Из них 67 (43,5 %) пациентов страдали колоректальным раком. В 53 (34,4 %) случаях диагностирован рак шейки матки, в 21 (13,7 %) – рак яичников, в 8 (5,2 %) – рак тела матки, в 5 (3,2 %) – рак влагалища. У 41 (26,6 %) пациента операция сопровождалась резекцией МП, у 113 (73,4 %) хирургическое вмешательствопроведено в объеме эвисцерации малого таза.Предложены хирургические классификации местно-распространенных опухолей малого таза и вторичного поражения МП при местно-распространенных опухолях. Описаны критерии выбора оптимального объема вмешательства при различном масштабе распространения опухоли и степени вовлечения МП в опухолевый процесс. Отмечена перспективность масштабных вмешательств в улучшении результатов лечения больных с опухолями тазовой локализации.

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

Нормотония - новое слово в лапароскопической резекции почки

Background. Minimally invasive partial nephrectomy is the gold standard in the treatment of stage I malignant tumors. To date, there are a large number of techniques for performing partial nephrectomy. The desire to develop a technique that included all the positive characteristics and had no restrictions on use led to the creation of a normotonic zero ischaemia partial nephrectomy.Materials and methods. A retrospective analysis of 45 patients was performed. 1st group included 24 (53.3 %) patients after laparoscopic normotonic zero ischaemia partial nephrectomy. 2ndgroup included 21 (46.7 %) patients who underwent laparoscopic hypotonic zero ischaemia partial nephrectomy. All patients evaluated such surgical parameters as the surgery time, the blood loss, and the duration of hospitalization. To assess pre-operative renal function, the CKD-EPI equation was used to calculate estimate glomerular filtration rate.Results. All patients were demographically comparable. Patients were also evenly distributed in terms of resection complexity according to the RENAL nephrometric scale. Acute kidney injury rate was significantly higher in the hypotension group: relative risk 5.4 (95 % confidence interval 1.59—20.55), odds ratio 11.3 (95 % confidence interval2.04—59.2);p = 0.007. In 1stgroup, the average operation time was 130min (Q1-Q3 110—140), and in 2ndgroup, 150min (Q1—Q3 115—227.5);p = 0.0159. The average volume of blood loss during laparoscopic zero ischaemia partial nephrectomy was significantly less than during hypotonic partial nephrectomy: 125 ml (Q1—Q3 50—200) and 450 ml (Q1— Q3200— 750) respectively, p &lt;0.0001.Coclusion. In our study, laparoscopic normotonic zero ischaemia partial nephrectomy proved to be a possible alternative to existing resection techniques today. But to use this technique in clinical practice, further study and validation is required.Введение. Резекция почки минимально-инвазивным способом является «золотым стандартом» в лечении злокачественных опухолей I стадии. На сегодняшний день существует большое количество методик выполнения резекции почки. Желание разработать технику операции, которая бы включала все положительные характеристики и не имела ограничений в использовании, привело к созданию нормотонической резекции почки без ишемии.Материалы и методы. Проведен ретроспективный анализ данных 45 пациентов. В 1-ю группу были включены 24 (53,3 %) пациента после лапароскопической нормотонической резекции почки без ишемии, во 2-ю — 21 (46,7 %) больной, которому была выполнена лапароскопическая гипотоническая резекция почки без ишемии. У всех пациентов проведена оценка таких хирургических показателей, как продолжительность операции, объем кровопотери, длительность госпитализации. Для оценки почечной функции до операции использовали формулу расчета скорости клубочковой фильтрации CKD-EPI.Результаты. Пациенты обеих групп были сопоставимы по демографическим показателям. Также пациенты были равномерно распределены по сложности выполняемой резекции согласно нефрометрической шкале RENAL. Острое почечное повреждение существенно чаще встречалось среди пациентов, прооперированных в условиях интраоперационной гипотонии: относительный риск 5,4 (95 % доверительный интервал 1,59—20,55), отношение шансов 11,3 (95 % доверительный интервал 2,04—59,2) (р = 0,007). В 1-й группе среднее время операции составило 130мин (интерквартильный размах (ИКР) 110—140мин), во 2-й группе — 150мин (ИКР 115—227,5мин) (р = 0,0159). Средний объем кровопотери при лапароскопической нормотонической резекции почки без ишемии был значимо меньше, чем при гипотонической резекции, и составил 125мл (ИКР 50—200 мл) и 450 мл (ИКР 200— 750 мл) соответственно (р &lt;0,0001).Заключение. В нашем исследовании лапароскопическая нормотоническая резекция почки зарекомендовала себя как возможная альтернатива имеющимся на сегодняшний день техникам резекции. Однако для использования данной методики в клинической практике требуются дальнейшее изучение и валидация

In-Stent CTO Percutaneous Coronary Intervention: Individual Patient Data Pooled Analysis of 4 Multicenter Registries

OBJECTIVES: The authors sought to examine the outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusions (CTOs). BACKGROUND: The outcomes of PCI for ISR CTOs have received limited study. METHODS: The authors examined the clinical and angiographic characteristics and procedural outcomes of 11,961 CTO PCIs performed in 11,728 patients at 107 centers in Europe, North America, Latin America, and Asia between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events (MACE) included death, myocardial infarction, stroke, and tamponade. Long-term MACE were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. RESULTS: ISR represented 15% of the CTOs (n = 1,755). Patients with ISR CTOs had higher prevalence of diabetes (44% vs. 38%; p \u3c 0.0001) and prior coronary artery bypass graft surgery (27% vs. 24%; p = 0.03). Mean J-CTO (Multicenter CTO Registry in Japan) score was 2.32 ± 1.27 in the ISR group and 2.22 ± 1.27 in the de novo group (p = 0.01). Technical (85% vs. 85%; p = 0.75) and procedural (84% vs. 84%; p = 0.82) success was similar for ISR and de novo CTOs, as was the incidence of in-hospital MACE (1.7% vs. 2.2%; p = 0.25). Antegrade wiring was the most common successful strategy, in 70% of ISR and 60% of de novo CTOs, followed by retrograde crossing (16% vs. 23%) and antegrade dissection and re-entry (15% vs. 16%; p \u3c 0.0001). At 12 months, patients with ISR CTOs had a higher incidence of MACE (hazard ratio: 1.31; 95% confidence intervals: 1.01 to 1.70; p = 0.04). CONCLUSIONS: ISR CTOs represent 15% of all CTO PCIs and can be recanalized with similar success and in-hospital MACE as de novo CTOs

Angiographic Features and Clinical Outcomes of Balloon Uncrossable Lesions during Chronic Total Occlusion Percutaneous Coronary Intervention

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p \u3c 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p \u3c 0.001) and diabetes mellitus (50% vs. 42%, p \u3c 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p \u3c 0.001), moderate/severe calcification (68% vs. 40%, p \u3c 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p \u3c 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p \u3c 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p \u3c 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p \u3c 0.001) and procedural (88% vs. 96%, p \u3c 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p \u3c 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions

ТЕХНОЛОГИЯ ЗАВЕРШЕНИЯ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ НА ОРГАНАХ МАЛОГО ТАЗА, СОПРОВОЖДАЮЩИХСЯ ЦИСТЭКТОМИЕЙ

Results of treatment of 143 patients who underwent cystprostatectomy or anterior pelvic exenteration. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 71), and bilateral perineal drainage (n = 72). Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Installation is simple perineal drainage performed and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy.Проанализированы результаты лечения 143 больных, которым выполнена цистпростатэктомия или передняя надлеваторная эвисцерация малого таза по поводу инвазивного рака мочевого пузыря или местно-распространенного рака шейки, тела матки, и рака яичников. Сопоставлены характеристики послеоперационного периода пациентов в 2 группах: в первой операции заканчивались традиционным дренированием через переднюю брюшную стенку (n = 71), во второй — двусторонним промежностным дренированием (n = 72). Полученные результаты свидетельствуют о том, что после операций на органах малого таза, сопровождающихся цистэктомией и расширенной подвздошно-тазовой лимфодиссекцией, двустороннее промежностное дренирование в сочетании с реконструкцией брюшины боковых стенок таза улучшает послеоперационное восстановление кишечной перистальтики, способствует более раннему снижению интенсивности болевого синдрома и уменьшению частоты развития осложнений в раннем послеоперационном периоде. Промежностная установка дренажей проста в исполнении, ее применение после операций на органах малого таза, сопровождающихся цистэктомией с расширенной лимфаденэктомией, повышает безопасность выполнения данных вмешательств

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration