Extirpation of distal part of the pacreas in the severe erosive intraperitoneal bleeding caused by postoperative necrotic acute pancreatitis

Institutul de chirurgie „A.V. Vishnevskii”, Moscova, Rusia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Pancreatita acută postoperatorie (PAP) reprezintă o complicație gravă ce apare după o intervenție chirurgicală pe pancreas (P). Incidența ei poate atinge 58,9%, în timp ce formele severe se întîlnesc în 24,2% cazuri (Kubyshkin V.A.). O trăsătură distinctivă este apariția pe fonul acesteia a dehiscenței anastomotice, fistulelor pancreatice (FP) și hemoragiilor erozive (HE). Scopul lucrării: De a aprecia eficacitatea rezecției bontului pancreatic în caz de HE postoperatorie. Material și metode: La 17 pacienți sursa de HE a fost vena lienală și mezenterică superioară, artera hepatică și mezenterică superioară. Toți pacienții au fost distribuiți în 2 grupuri. În primul grup (5 pacienți) intervenția chirurgicală s-a finisat cu suturarea și ligaturarea vaselor, în cel de-al doilea – extirparea bontului pancreatic. HE a apărut în 8-15 zile după operația inițială, în timp ce FP a fost obsevată în toate cazurile. Rezultate: Toți pacienții au suportat intervenție chirurgicală de urgență. Suturarea vasului sîngerînd s-a efectuat în 5 cazuri, dintre care în 3 au fost relevate hemoragii repetate (toți 5 pacienți au decedat). Extirparea bontului distal pancreatic a fost efectuată la 12 pacienți, dintre care 8 au supraviețuit, iar 4 au decedat. În toate cazurile de deces operația a fost efectuată în condiții de anemie posthemoragică severă. Concluzii: Suturarea și ligaturarea vasului sîngerînd în cazul PAP necrotice deseori este neefectivă și se soldează cu decesul pacientului. Profilaxia apariției și tratamentul adecvat al PAP permite prevenirea formării FP și reduce riscul apariției HE. Extirparea bontului distal pancreatic în cazul PAP severe, deși este o intervenție de disperare, poate fi recomandată cu scop curativ.Introduction: Postoperative acute pancreatitis (PAP) is a serious complication that occurs after surgery on the pancreas (P). The incidence can reach 58.9%, while severe forms are encountered in 24.2% cases (Kubyshkin VA). Its distinctive feature is the occurence of anastomotic dehiscence, pancreatic fistulas (PF) and erosive hemorrhage (EH). The aim: To assess the effectiveness of distal pancreatic resection in cases of postoperative EH. Material and methods: In 17 patients the source of EH was superior mesenteric and splenic vein, hepatic and superior mesenteric artery. All patients were divided into 2 groups. In the first group (5 patients) surgery ended with suturing and ligation of vessels in the second group – distal pancreatic resection was performed. EH appeared in 8-15 days after the initial surgery. PF was mentioned in all cases. Results: All patients have undergone emergency surgery. The suture of the bleeding vessel was performed in 5 cases, including 3 cases of repeated bleeding (all 5 patients died). Distal pancreatic resection was performed in 12 patients: 8 pat ients have survived, 4 – died. In all cases of death, the surgery was performed in patients with posthaemorrhagic severe anemia. Conclusions: Suturing and ligation of bleeding vessels in necrotic PAP is inefficient and often leads to death of the patient. The prevention of occurrence and adequate treatment of PAP allows to prevent the PF formation and reduces the risk of EH. Extirpation of distal part of the pancreas cause a severe PAP, though is an desperate operation, but may be recommended for therapeutic purposes

Post-hepatectomy liver failure – achievements and challenges

Institutul de chirurgie ”A.V.Vishnevskii”, Moscova, Rusia, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Problema insuficienţei hepatice postrezecţionale (IHPR) rămîne a fi în prezent una destul de actuală. Frecvenţa IHPR nu este în descreştere, oscilînd în limitele 0,7-0,9%. În acelaşi timp introducerea de noi tehnologii în domeniul diagnosticării IHPR poate îmbunătăţi rezultatele tratamentului chirurgical al pacienţilor cu tumori hepatice. Scopul: Studierea posibilităţilor de diagnostic precoce și tratament a IHPR la pacienţii care au suportat intervenţii chirurgicale majore hepatice. Material şi metode: Timp de 5 ani au fost efectuate 204 rezecţii hepatice majore. Pe motivul afectării hepatice secundare au fost operaţi 101 (49,6%) pacienţi, dintre care 75 (36,8%) pacienţi cu metastaze de cancer colorectal; tumori hepatice primare – 54 (26,4%) pacienţi, dintre care 25 (12,3%) – carcinom hepatocelular, 20 (9,8%) – colangiocarcinom, 49 (24%) – tumori benigne şi afecţiuni non-tumorale hepatice. Structura operaţiilor efectuate: hemihepatectomia stîngă – 42 (20%), hemihepatectomia dreaptă – 68 (33,3%), hemihepatectomia stîngă extinsă – 27 (13,3%), hemihepatectomia dreaptă extinsă – 44 (21,5%), rezecţia ≥3 segmente hepatice – 19 (16,3%). În perioada postoperatorie au fost estimaţi indicatorii insuficienţei hepatice în baza datelor clinice, scăderea nivelului de albumină <28 g/l, creşterea bilirubinei ˃50 μmol/l, scăderea indicelui protrombinei (IP) <50%, creşterea INR peste 2,0 în 1-3-a, 7-9-a şi a 5-a zi postoperatorie (criteriul 50/50). Pentru aprecierea gradului de IHPR s-a utilizat clasificarea ISGLS. Rezultate: Majoritatea pacienţilor operaţi au prezentat la 1-3-a zi postoperatorie scăderea nivelului de albumină şi IP, creşterea bilirubinei şi INR. În acelaşi timp, schimbări simultane semnificative ale acestor parametri au fost observate la 64 (31,4%) pacienţi. Aceste modificări s-au rezolvat în urma tratamentului conservativ în termen de 4-8 zile, astfel încît nu au putut fi considerate IHPR. La ziua a 5-a aceste modificări erau observate la 48 (23,5%) pacienţi. Valorile numerice ale parametrilor estimaţi au fost în limitele: albumina – 17-34 (media 29) g/l, INR – 1,4-3,8 (media 2,5), bilirubina totală – 22-99 (media 49) μmol/l. La 31 (15,2%) pacienţi semnele IHPR au cedat în urma terapiei standard, ce a fost interpretat ca clasa A de insuficienţă hepatică după ISGLS. IHPR clinic semnificativă s-a observat la 17 (8,3%) pacienţi, dintre care 11 (5,4%) – clasa B şi 6 (2,9%) – clasa C după ISGLS. Cu toate acestea criteriul 50/50 a fost pozitiv doar la 12 (5,9%) pacienţi. Pe fundalul progresării IHPR au decedat 8 (4,1%) pacienţi, dintre care 3 (1,5%) cu criteriul 50/50 negativ. Concluzii: În pofida ameliorării rezultatelor tratamentului chirurgical al tumorilor hepatice, o problemă importantă rămîne a fi depistarea precoce şi profilaxia apariţiei IHPR. Perfecţionarea metodelor de diagnostic precoce şi prognostic al dezvoltării IHPR la etapa preoperatorie va permite nu doar scăderea letalităţii, dar va spori deasemenea posibilităţile chirurgiei hepatice.Introduction: The issue of posthepatectomy liver failure (PHLF) continues to be very actual. The frequency of the PHLF does not tend to decrease, and varies between 0.7-9.1%. However, the introduction of new technologies in the field of diagnosis of PHLF can improve the results of surgical treatment of patients with liver tumors. Aim of study: To study the possibilities of early diagnosis and treatment of PHLF after major hepatic resection. Material and methods: During 5 years were performed 204 major hepatic resections. 101 (49.6%) patients had secondary hepatic injury – 75 (36.8%) patients with metastases of colorectal cancer; 54 (26.4%) patients had primary liver tumors, including 25 (12.3%) – hepatocellular carcinoma, 20 (9.8%) – cholangiocarcinoma, 49 (24%) – benign tumors and non-tumoral liver diseases. Surgical interventions: left hepatectomy – 42 (20%), right hepatectomy – 68 (33.3%), extended left hepatectomy – 27 (13.3%), extended right hepatectomy – 44 (21.5%), resection of ≥3 segments of liver – 19 (16.3%). In postoperative period, the signs of PHLF were evaluated on clinical data, reduced albumin below 28 g/L, elevated bilirubin levels higher than 50 μmol/l, lower prothrombin index (PTI) below 50%, increasing of INR above 2 at the 1-3 and 7-9-th and 5-th postoperative day (criterion 50/50). To assess the degree of liver failure the ISGLS classification was used. Results: At 1-3 postoperative days most surgical patients presented the decreased levels of albumin and IP, increased bilirubin and INR levels. At the same time, significant simultaneous changes in these parameters were seen in 64 (31.4%) patients. These changes were solved by conservative treatment within 4-8 days, so they could not be considered as PHLF. At the 5-th day, these changes were seen in 48 (23.5%) patients. The numerical values of the estimated parameters ranged: albumin – 17- 34 (average 29) g/L, INR – 1.4-3.8 (average 2.5), total bilirubin – 22-99 (average 49) μmol/L. In 31 (15.2%) cases the signs of PHLF were solved by standard therapy, which was interpreted as a Class A liver failure (ISGLS). Clinically significant PHLF occurred in 17 (8.3%) patients, including 11 (5.4%) – class B and 6 (2.9%) – class C (ISGLS). However, only 12 (5.9%) patients had positive 50/50 criterion. IHPR progression led to the death in 8 (4.1%) cases, of which 3 (1.5%) with negative 50/50 criterion. Conclusions: Despite the amelioration of the surgical treatment of liver tumors, an important problem remains early detection and prevention of the PHLF occurrence. Improved methods of early diagnosis and prediction of PHLF development in preoperative stage will not only reduce mortality, but will also enhance them opportunities of liver surgery

A model for A=3 antinuclei production in proton-nucleus collisions

A simple coalescence model based on the same diagrammatic approach of antimatter production in hadronic collisions as used previously for antideuterons is used here for the hadroproduction of mass 3 antinuclei. It is shown that the model is able to reproduce the existing experimental data on Tbar and 3hebar production without any additional parameter.Comment: 7 figures. submitted to Eur. Phys. J.

The PHENIX Experiment at RHIC

The physics emphases of the PHENIX collaboration and the design and current status of the PHENIX detector are discussed. The plan of the collaboration for making the most effective use of the available luminosity in the first years of RHIC operation is also presented.Comment: 5 pages, 1 figure. Further details of the PHENIX physics program available at http://www.rhic.bnl.gov/phenix

Controlled mobility in stochastic and dynamic wireless networks

We consider the use of controlled mobility in wireless networks where messages arriving randomly in time and space are collected by mobile receivers (collectors). The collectors are responsible for receiving these messages via wireless transmission by dynamically adjusting their position in the network. Our goal is to utilize a combination of wireless transmission and controlled mobility to improve the throughput and delay performance in such networks. First, we consider a system with a single collector. We show that the necessary and sufficient stability condition for such a system is given by ρ<1 where ρ is the expected system load. We derive lower bounds for the expected message waiting time in the system and develop policies that are stable for all loads ρ<1 and have asymptotically optimal delay scaling. We show that the combination of mobility and wireless transmission results in a delay scaling of Θ([1 over 1−ρ]) with the system load ρ, in contrast to the Θ([1 over (1−ρ)[superscript 2]]) delay scaling in the corresponding system without wireless transmission, where the collector visits each message location. Next, we consider the system with multiple collectors. In the case where simultaneous transmissions to different collectors do not interfere with each other, we show that both the stability condition and the delay scaling extend from the single collector case. In the case where simultaneous transmissions to different collectors interfere with each other, we characterize the stability region of the system and show that a frame-based version of the well-known Max-Weight policy stabilizes the system asymptotically in the frame length.National Science Foundation (U.S.) (Grant CNS-0915988)United States. Army Research Office. Multidisciplinary University Research Initiative (Grant W911NF-08-1-0238

Superconductivity in diamond

We report the discovery of superconductivity in boron-doped diamond synthesized at high pressure (8-9 GPa) and temperature (2,500-2,800 K). Electrical resistivity, magnetic susceptibility, specific heat, and field-dependent resistance measurements show that boron-doped diamond is a bulk, type-II superconductor below the superconducting transition temperature Tc=4 K; superconductivity survives in a magnetic field up to Hc2(0)=3.5 T. The discovery of superconductivity in diamond-structured carbon suggests that Si and Ge, which also form in the diamond structure, may similarly exhibit superconductivity under the appropriate conditions.Comment: 13 pages, 4 figure