The development of management and strategic management accounting in agriculture

© Medwell Journals, 2017. The study reviews the development of strategic management accounting in the system of strategic management of agriculture. The following aspects are being presented: models of management and strategic management accounting, accounting matrix of interactions between subsystems and functional tools of management accounting and the conceptual model of the strategic subsystem development. The model of differentiation of management accounting into subsystems of operational and strategic management accounting is proposed. Conceptual solutions for the development of strategic management accounting in agriculture are developed. It is hereby concluded that strategic management accounting is a modified form of management accounting which focuses on study of both internal and external environment, data collection, its processing, design and transfer of strategic managerial decisions to the management system as well as monitoring and evaluation of their execution efficiency. The importance of the developed methodological aspects and conceptual solutions in development of strategic management accounting is defined for the theory and practice of management accounting in agriculture

Резекция единственной функционирующей почки при опухолях почечной паренхимы

Aim: to evaluate results of partial nephrectomy for patients with a solitary kidney performed at the N.N. Blokhin Cancer Center.Materials and methods: medical data of 131 patients with solitary kidney tumors underwent partial nephrectomy at the Department of Urology of the N.N. Blokhin Russian Cancer Research Center from 1980 to 2015 were collected. Median age was 57 (26–75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 ± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III – 30 (22.9 %), stage IV–V – 0 (0 %)). Median follow-up for all patients was 55 (6–386) months.Results. The rate of intraoperative complications was 9.2 % (12/131), the rate of postoperative complications was 26.9 % (35/131) (severity grade II – 23 (17.6 %), III – 10 (7.7 %), IV – 1 (0.8 %), V – 1 (0.8 %)). Acute renal failure was observed in 69 (52.7 %) cases, acute dialysis was necessary in 6 (4.6 %) patients. Progression of chronic kidney disease was observed in 58 (44.6 %) patients, hemodialysis was demanded for 2 (1.5 %) patients. Histological study revealed renal cell carcinoma in 124 (94.6 %) samples, positive surgical margins were in 2 (1.5 %) samples. No local recurrences in the resection area were observed. Overall 5- and 10-year survival for all patients with renal cell carcinoma was 89.6 and 72.0 %, specific survival was 93.5 and 81.3 %, recurrence-free survival was 85.3 and 62.2 % respectively.Conclusion. Partial nephrectomy is an effective method of treatment in of solitary kidney tumors associated with satisfactory functional and oncological outcomeЦель: изучение непосредственных и отдаленных результатов серии резекций единственной функционирующей почки, выполненной в РОНЦ им. Н.Н. Блохина. Материал: отобраны данные 131 пациента с опухолью почечной паренхимы единственной функционирующей почки, подвергнутого резекции в отделении урологии РОНЦ им. Н.Н. Блохина с 1980 по 2015 гг. Медиана возраста - 57,0 (26-75) лет, соотношение мужчин и женщин – 1:1,2. Медиана суммы баллов по нефрометрической шкале RENAL составила 7±2,4. Во всех случаях исходно установлен диагноз хронической болезни почек (ХБП) (ХБП ≥3 стадии - 30 (22,9%), ХБП 4-5 стадий – 0 (0,0%)). Медиана наблюдения за всеми пациентами составила 55 (6-386) месяцев. Результаты: частота интраоперационных осложнений – 9,2% (12/131), послеоперационных осложнений – 26,9% (35/131) (степень тяжести II - 23 (17,6%), III – 10 (7,7%), IV – 1 (0,8%), V – 1 (0,8%)). Острое снижение почечной функции зарегистрировано в 69 (52,7%) случаев и потребовало проведения острого диализа у 6 (4,6%) больных. Прогрессирование ХБП зарегистрировано у 58 (44,6%) больных, программный гемодиализ проводится 2 (1,5%) пациентам. Гистологическое исследование выявило рак почки в 124 (94,6%) образца, клетки опухоли по краю разреза имелись в 2 (1,5%) образцах. Местных рецидивов в зоне резекции не было. Пяти- и десятилетняя общая выживаемость всех больных раком почки составила 89,6% и 72,0%, специфическая – 93,5% и 81,3%, безрецидивная – 85,3% и 62,2% соответственно. Заключение: резекция единственной почки – эффективный метод лечения опухолей почечной паренхимы, обеспечивающий хорошие функциональные и онкологические результаты

The development of management and strategic management accounting in agriculture

© Medwell Journals, 2017. The study reviews the development of strategic management accounting in the system of strategic management of agriculture. The following aspects are being presented: models of management and strategic management accounting, accounting matrix of interactions between subsystems and functional tools of management accounting and the conceptual model of the strategic subsystem development. The model of differentiation of management accounting into subsystems of operational and strategic management accounting is proposed. Conceptual solutions for the development of strategic management accounting in agriculture are developed. It is hereby concluded that strategic management accounting is a modified form of management accounting which focuses on study of both internal and external environment, data collection, its processing, design and transfer of strategic managerial decisions to the management system as well as monitoring and evaluation of their execution efficiency. The importance of the developed methodological aspects and conceptual solutions in development of strategic management accounting is defined for the theory and practice of management accounting in agriculture

Pathogenetic and substitution correction of anemia in patients with malignant neoplasms

Anemia in patients with malignant neoplasms affects the quality of life of the patient and sometimes limits the timely implementation of antitumor treatment. In the pathogenesis of anemia of the malignant neoplasms the largest role play infiltration of the bone marrow by tumor cells, suppression of hematopoiesis by inflammation cytokines, development of functional iron deficiency, reduction of sensitivity of receptors to erythropoietin or its synthesis. The doctor can prescribe effective pathogenetic therapy after evaluating the mechanisms of anemia development in this category of patients. In the article are described in detail the methods of pathogenetic correction of anemic syndrome using parenteral iron preparations, recombinant erythropoietin, indications for their appointment, effectiveness in patients with cancer, as well as possible side effects and complications of therapy. The mechanisms of action, pharmacokinetics, and features of the use of different erythropoietin adents are described. It is shown the effectiveness of erythropoietin preparations in patients with lymphoproliferative disorders based on the results of our own study. A positive response was observed in 77.3 % of patients with non-Hodgkin’s lymphomas, in 61.8 % – with multiple myeloma and 60.9 % with chronic lymphocytic leukemia. It is presented the prognostic factors for the response to erythropoietin therapy and showed own datum in patients with myelodysplastic syndrome (in case of the serum erythropoietin <500 mMU / ml a positive response was found in 35.6 %, with higher level – no response) and with lymphoproliferative disorders (in case of erythropoietin was <130 mMU / ml, the positive response was 80 %, at 130–499 mMU / ml – 63.6 %, and at ≥500 mMU / ml – 25 %). In the article are described the principles of anemia correction using red blood cells transfusions and features of their use in patients with cancer. Special attention is paid to the study of blood saturation as one of the indicators that allow us to assess the adequacy of the gas transport function of blood during red blood cells transfusions. The algorithm for correcting anemia in malignant neoplasms using red blood cells transfusions and erythropoietin agents are presented. It is shown low blood saturation (<60 %) in 32 % hematological malignancie’s patients with a hemoglobin 8.0 g / dL. This datum suggests presence of tissue hypoxia and gives approval to expand the threshold for red blood cells transfusion

DIAGNOSTICS AND SURGICAL TREATMENT OF DEEP VENOUS THROMBOSIS LOWER LIMBS AND PELVIS

OBJECTIVE. Based on our own experience and analysis of the literature, we want to demonstrate the features of diagnosis and treatment of ascending deep phlebothrombosis of the lower limbs and pelvis.MATERIAL AND METHODS. During the period from October 2008 to September 2016, in the First Clinic of Surgery (postgraduate medical education) of ”Military Medical Academy named after S. M. Kirov” we analyzed the results of treatment of 44 patients with this pathology. Selective surgical tactics was based on the evaluating of general status, activity of the patient, the presence of concomitant pathology, complications of the disease. Implantation of the cava-filter was performed in 23 patients. In active patients, without significant concomitant pathology, open thrombectomy operations were performed from the deep veins of the lower limbs or from the inferior vena cava and iliac veins (21 patients). In some of these patients, a removable cava-filter was implanted before thrombectomy (8 patients). Thrombectomy from the deep veins of the lower limbs was supplemented in 12 patients by the plication of the main vein.RESULTS. This tactic made it possible to achieve favorable results in the majority of patients (27 patients, 87 %) – there were no signs of recurrence of venous thromboembolic complications, there was complete or almost complete (more than 90 %) recanalization of thrombosed veins, venous insufficiency was limited by the presence of transient edema. Small hemorrhagic complications were noted in 2 patients. Relapses of venous thromboembolic complications occurred in a distant period in 3 patients. In order to prevent fatal pulmonary embolism, patients with ascending deep phlebothrombosis need surgical treatment.CONCLUSION. The choice of surgical treatment (cava filter implantation, deep vein thrombectomy) should be determined depending on the general status, patient activity, the presence of concomitant pathology, complications of the disease, and also individually in each specific clinical situation

Partial nephrectomy for patients with a solitary kidney

Aim: to evaluate results of partial nephrectomy for patients with a solitary kidney performed at the N.N. Blokhin Cancer Center.Materials and methods: medical data of 131 patients with solitary kidney tumors underwent partial nephrectomy at the Department of Urology of the N.N. Blokhin Russian Cancer Research Center from 1980 to 2015 were collected. Median age was 57 (26–75) years, a maleto-female ratio was 1:1.2. Median RENAL score was 7.0 ± 2.4. In all cases, chronic kidney disease was initially diagnosed (stage III – 30 (22.9 %), stage IV–V – 0 (0 %)). Median follow-up for all patients was 55 (6–386) months.Results. The rate of intraoperative complications was 9.2 % (12/131), the rate of postoperative complications was 26.9 % (35/131) (severity grade II – 23 (17.6 %), III – 10 (7.7 %), IV – 1 (0.8 %), V – 1 (0.8 %)). Acute renal failure was observed in 69 (52.7 %) cases, acute dialysis was necessary in 6 (4.6 %) patients. Progression of chronic kidney disease was observed in 58 (44.6 %) patients, hemodialysis was demanded for 2 (1.5 %) patients. Histological study revealed renal cell carcinoma in 124 (94.6 %) samples, positive surgical margins were in 2 (1.5 %) samples. No local recurrences in the resection area were observed. Overall 5- and 10-year survival for all patients with renal cell carcinoma was 89.6 and 72.0 %, specific survival was 93.5 and 81.3 %, recurrence-free survival was 85.3 and 62.2 % respectively.Conclusion. Partial nephrectomy is an effective method of treatment in of solitary kidney tumors associated with satisfactory functional and oncological outcom

Electric Muscle Stimulation for Prevention of Venous Thromboembolism in Patients with Multiple Lower Extremity Trauma

Relevance. Patients with multiple lower extremity trauma are the group of a very high risk for the development of venous thromboembolism. Therefore, they need a set of measures to prevent this complication. The risk of developing hemorrhagic complications in the I–III periods of traumatic disease prevents many physicians from prescribing anticoagulants. In addition, the application of the external fixation apparatus makes the use of mechanical blood flow acceleration (elastic bandages, compression knitwear, intermittent pneumatic compression) impossible. The purpose of the study is to evaluate the effectiveness and safety of electric muscle stimulation (EMS) for venous thromboembolism prevention in the patients with multiple trauma and the use of external fixation for the lower limb fractures. Material and Methods. The analysis of treatment results of 31 patients with multiple lower limb trauma with the use of external fixation was carried. All the patients were men with average age of 29.3±5.1 years. The patients were divided into two groups by stratified randomization. The groups were comparable by sex, age, body weight, and injury severity. The patients of main group received EMS, in control group — the authors did not use the mentioned treatment. The EMS was carried out using a Veinoplus DVT according to the scheme: 60 min morning, afternoon and evening. Vascular ultrasonography of the lower extremities was performed for all patients before EMS and then every 7 days, as well as before each surgery. All patients underwent venous thromboembolism prevention with low molecular weight heparins, followed by switching to oral anticoagulants. Results. Side effects associated with the use of the EMS, as well as hemorrhagic complications were not detected. The velocity of blood flow in the popliteal vein in the patients, received EMS, was 9.7 ± 0.7 cm/s before the session and 17.0±1.1 cm/s during the session (p<0.001). According to the vascular ultrasound, no venous thromboembolism was detected in the patients underwent the EMS. Deep vein thrombosis was diagnosed in the control group in 2 (13.3%) patients, and pulmonary embolism in 1 (6.7%). Conclusion. The use of EMS showed the absence of side effects and the development of hemorrhagic complications. The effectiveness of the EMS in the patients with external fixation was achieved due to a statistically significant (p <0.001) increase in the volumetric blood flow through the deep lower limb veins. The further study of the EMS in patients with multiple trauma, the development of optimal schemes for its use, depending on the severity of the injuries, will minimize the likelihood of developing venous thromboembolism in this category of patients

Functional results of partial nephrectomy in solitary functioning kidney tumors

Objective: to assess the early and late functional results of partial nephrectomy in patients with solitary functioning kidney tumors.Materials and methods. Medical data of 131 consecutive patients with solitary kidney parenchymal tumor, who had undergone partial nephrectomy at the N. N. Blokhin Russian Cancer Research Center, were analyzed. The median age was 57 (26–75) years. All the patients were diagnosed with solitary kidney tumor (median RENAL score was 7.0 ± 2.4 and median PADUA score was 9.0 ± 2.2). The median baseline glomerular filtration rate (GFR) was 74 (33–159) ml/min/1.73 m2 (30 (22.9 %) – stage III chronic kidney disease (CKD) and 0 (0 %) – stages IV–V CKD). All the patients underwent partial nephrectomy (with ischemia in 98 (74.8 %) patients, including cold ischemia in 59 (45.1 %)). The median time of ischemia was 24 (7–80) min. The median blood loss was 800 (20–4500) ml.Results. Acute renal injury was recorded in 69 (52.7 %) cases; 6 patients (4.6 %) had indications for acute dialysis. The independent risk factors of acute renal injury were sinus invasion (hazard ratio (HR) 0.08; 95 % confidence interval (CI) 0.03–0.22; p = 0.051), baseline GFR <80 ml/min/1.73 m2 (HR 0.45; 95 % CI 0.22–0.92; p = 0.021), parenchymal ischemia (HR 0.13; 95 % CI 0.05–0.33; p = 0.032), and >500-ml blood loss (HR 0.24; 95 % CI 0.12–0.51; p = 0.005). Progression of previously diagnosed CKD was recorded in 58 (44.6 %) patients; chronical dialysis was required in 2 (1.5 %) patients. The independent risk factors of CKD progression were sinus invasion (HR 0.38; 95 % CI 0.18–0.81; p = 0.002), medial location of the tumor (HR 0.19; 95 % CI 0.09–0.41; p = 0.001), baseline GFR, <60 ml/min/1.73 m2 (HR 0.24; 95 % CI 0.10–0.56; p <0.0001), warm ischemia (HR 0.41; 95 % CI 0.17–1.00; p = 0.052).Conclusion. Solitary kidney resection is associated with a low risk for renal function loss. To achieve optimal functional results, it is desirable to follow the balance between the indications for renal vessel ligation and the need to avoid >500-ml blood loss and cold ischemia