Осложнение уменьшения аорто-мезентериального угла и дистанции его диагностики и лечения: клинический случай

Introduction. Wilkie syndrome is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery arising from the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of himus in the duodenum, creating a mechanical obstruction.Aim: To draw the surgeons’ attention towards the possibility of developing a rare complication of decreased aorto-mesenteric angle and the distance, highlighting the challenges in diagnosis and treatment.Materials and methods. This article presents a clinical case of WS diagnosed in the surgical department of the BSMU clinic. We hereby discuss the case report of a 28-year-old patient diagnosed at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn’t able to identify the disease, but when he came to the surgical department of BSMU clinic based on the results of abdominal CT-scan with combined contrast of the stomach and duodenum per os with water-soluble contrast and computer angiography of the mesenteric vessels, the diagnosis was confirmed. The patient was treated with the duodenojejunostomy (laparoscopic Strong’s operation).Results and discussion. Absence of timely diagnosis of this disease can lead to life-threatening complications, and early diagnostics is complicated by similarity of initial manifestations with other gastropancreaticoduodenal diseases. One of the most promising approach in the diagnosis of Wilkie syndrome is the use of abdominal CT-scan with combined contrasting of the stomach and duodenum per os with water-soluble contrast and computer angiography of vessels. In the present clinical case due to the given combination of methods we can assess functional state of the stomach and duodenum, clearly visualize not only the organs topography but also estimate the aorto-mesenteric angle and distance, which can further determine the type and tactics of initial stage treatment, which we decided to perform surgery (laparoscopic Strong’s operation). The postoperative period was without complications. The patient noted an improvement in the state and the relief of pain in the epigastrium and was discharged after 9 days of hospitalization in satisfactory condition.Conclusion. For diagnosis and treatment in time as well as prevention of possible complications, it is necessary to improve surgeons’ information about this pathology, which if diagnosed and treated late can lead to severe, life-threatening complications up to death. The diagnosis at the initial stages, specifically with the assistance of computer tomography with contrast, angiography, and treatment in a timely manner, can preserve life and prevent the possible outcomes of fatal complications.Введение. Синдром Уилки — это заболевание, вызванное аномальным расположением верхней брыжеечной артерии, отходящей от брюшной части аорты. В результате дистальная часть двенадцатиперстной кишки сдавливается между брюшной аортой, позвоночником и верхней брыжеечной артерией, что создает препятствие для прохождения химуса в просвет двенадцатиперстной кишки, создавая механическую обструкцию.Цель: обратить внимание хирургов на возможность развития редкого осложнения уменьшения аорто-мезентериального угла и дистанции, подчеркнув сложности в диагностике и лечении.Материалы и методы. В данной статье представлен клинический случай синдрома Уилки у 28-летнего пациента, диагностированный в хирургическом отделении клиники БГМУ. Пациент страдает от симптомов синдрома Уилки с 2018 года. При поступлении в хирургическое отделение клиники БГМУ на основании результатов КТ-сканирования брюшной полости с комбинированным контрастированием желудка и двенадцатиперстной кишки per os с водорастворимым контрастом и компьютерной ангиографией сосудов диагноз был подтвержден. В качестве лечения пациенту была выполнена дуоденоеюностомия (лапароскопическая операция Стронга).Результаты и обсуждение. Отсутствие своевременной диагностики этого заболевания может привести к жизнеугрожающим осложнениям, а постановка диагноза на ранней стадии затруднена сходством начальных проявлений с другими заболеваниями гастропанкреатикодуоденальной зоны. Одним из наиболее информативных подходов в диагностике синдрома Уилки является использование КТ-сканирования брюшной полости с комбинированным контрастированием желудка и двенадцатиперстной кишки per os с водорастворимым контрастом и компьютерной ангиографией сосудов. В данном клиническом случае за счет комбинации методов мы могли оценить функциональное состояние желудка и двенадцатиперстной кишки, четко визуализировать не только топографию органов, но и оценить аорто-мезентериальный угол и расстояние, что в дальнейшем может определить вид и тактику лечения на начальном этапе. Нами было принято решение о хирургическом вмешательстве (лапароскопическая операция Стронга). Послеоперационный период протекал без каких-либо осложнений. Пациент отмечал улучшение состояния и исчезновение болей в эпигастрии и был выписан через 9 дней после госпитализации в удовлетворительном состоянии.Заключение. Для своевременной диагностики и лечения, а также предупреждения возможных осложнений необходимо повысить информированность хирургов об этой патологии, которая при затягивании в диагностике и лечении может привести к тяжелым осложнениям, вплоть до смерти. Однако диагностика на ранних стадиях, особенно с помощью компьютерной томографии с контрастированием, ангиографии, и своевременно проведенное лечение могут сохранить жизнь и предупредить развитие фатальных осложнений

MUSiC : a model-unspecific search for new physics in proton-proton collisions at root s=13TeV

Results of the Model Unspecific Search in CMS (MUSiC), using proton-proton collision data recorded at the LHC at a centre-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 35.9 fb(-1), are presented. The MUSiC analysis searches for anomalies that could be signatures of physics beyond the standard model. The analysis is based on the comparison of observed data with the standard model prediction, as determined from simulation, in several hundred final states and multiple kinematic distributions. Events containing at least one electron or muon are classified based on their final state topology, and an automated search algorithm surveys the observed data for deviations from the prediction. The sensitivity of the search is validated using multiple methods. No significant deviations from the predictions have been observed. For a wide range of final state topologies, agreement is found between the data and the standard model simulation. This analysis complements dedicated search analyses by significantly expanding the range of final states covered using a model independent approach with the largest data set to date to probe phase space regions beyond the reach of previous general searches.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Measurement of prompt open-charm production cross sections in proton-proton collisions at root s=13 TeV

The production cross sections for prompt open-charm mesons in proton-proton collisions at a center-of-mass energy of 13TeV are reported. The measurement is performed using a data sample collected by the CMS experiment corresponding to an integrated luminosity of 29 nb(-1). The differential production cross sections of the D*(+/-), D-+/-, and D-0 ((D) over bar (0)) mesons are presented in ranges of transverse momentum and pseudorapidity 4 < p(T) < 100 GeV and vertical bar eta vertical bar < 2.1, respectively. The results are compared to several theoretical calculations and to previous measurements.Peer reviewe

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

Peer reviewe

Measurement of the W gamma Production Cross Section in Proton-Proton Collisions at root s=13 TeV and Constraints on Effective Field Theory Coefficients

A fiducial cross section for W gamma production in proton-proton collisions is measured at a center-of-mass energy of 13 TeV in 137 fb(-1) of data collected using the CMS detector at the LHC. The W -> e nu and mu nu decay modes are used in a maximum-likelihood fit to the lepton-photon invariant mass distribution to extract the combined cross section. The measured cross section is compared with theoretical expectations at next-to-leading order in quantum chromodynamics. In addition, 95% confidence level intervals are reported for anomalous triple-gauge couplings within the framework of effective field theory.Peer reviewe

Search for long-lived particles decaying to jets with displaced vertices in proton-proton collisions at root s=13 Te V

A search is presented for long-lived particles produced in pairs in proton-proton collisions at the LHC operating at a center-of-mass energy of 13 TeV. The data were collected with the CMS detector during the period from 2015 through 2018, and correspond to a total integrated luminosity of 140 fb(-1). This search targets pairs of long-lived particles with mean proper decay lengths between 0.1 and 100 mm, each of which decays into at least two quarks that hadronize to jets, resulting in a final state with two displaced vertices. No significant excess of events with two displaced vertices is observed. In the context of R-parity violating supersymmetry models, the pair production of long-lived neutralinos, gluinos, and top squarks is excluded at 95% confidence level for cross sections larger than 0.08 fb, masses between 800 and 3000 GeV, and mean proper decay lengths between 1 and 25 mm.Peer reviewe

Search for top squark production in fully hadronic final states in proton-proton collisions at root s=13 TeV

A search for production of the supersymmetric partners of the top quark, top squarks, is presented. The search is based on proton-proton collision events containing multiple jets, no leptons, and large transverse momentum imbalance. The data were collected with the CMS detector at the CERN LHC at a center-of-mass energy of 13 TeV, and correspond to an integrated luminosity of 137 fb(-1). The targeted signal production scenarios are direct and gluino-mediated top squark production, including scenarios in which the top squark and neutralino masses are nearly degenerate. The search utilizes novel algorithms based on deep neural networks that identify hadronically decaying top quarks and W bosons, which are expected in many of the targeted signal models. No statistically significant excess of events is observed relative to the expectation from the standard model, and limits on the top squark production cross section are obtained in the context of simplified supersymmetric models for various production and decay modes. Exclusion limits as high as 1310 GeVare established at the 95% confidence level on the mass of the top squark for direct top squark production models, and as high as 2260 GeV on the mass of the gluino for gluino-mediated top squark production models. These results represent a significant improvement over the results of previous searches for supersymmetry by CMS in the same final state.Peer reviewe

Observation of tW production in the single-lepton channel in pp collisions at root s=13 TeV

A measurement of the cross section of the associated production of a single top quark and a W boson in final states with a muon or electron and jets in proton-proton collisions at root s = 13 TeV is presented. The data correspond to an integrated luminosity of 36 fb(-1) collected with the CMS detector at the CERN LHC in 2016. A boosted decision tree is used to separate the tW signal from the dominant t (t) over bar background, whilst the subleading W+jets and multijet backgrounds are constrained using data-based estimates. This result is the first observation of the tW process in final states containing a muon or electron and jets, with a significance exceeding 5 standard deviations. The cross section is determined to be 89 +/- 4 (stat) +/- 12 (syst) pb, consistent with the standard model.Peer reviewe