ХОНДРОСАРКОМА ЛОННОЙ КОСТИ С ПРОРАСТАНИЕМ В МОЧЕВОЙ ПУЗЫРЬ (СЛУЧАЙ ИЗ ПРАКТИКИ)

The paper describes a clinical case of pubic chondrosarcoma invading the bladder. Radical cystectomy has been performed with resection of the pubic symphysis and a part of the left ischium.Представлено клиническое наблюдение хондросаркомы лонной кости, прорастающей в мочевой пузырь. Проведена радикальная цистэктомия с резекцией лонного сочленения и части левой седалищной кости

Функция ортотопического мочевого резервуара, сформированного из илеоцекального угла, в отдаленные сроки после радикальной цистэктомии у женщин

Objective: to study the long-term functional results of creating an orthotopic urinary reservoir from the ileocecal angle in comparison with the Studer technique of creating a urinary reservoir after radical cystectomy in women.Materials and methods. From 2004 to 2018 radical cystectomy for bladder cancer was performed in 120 women. In 71 (59.2 %) patients, an orthotopic urinary reservoir was formed: 48 (67.6 %) from the ileum, 23 (32.4 %) from segments of the colon. This study included 11 patients who had a reservoir formed from the ileocecal angle, including by their own modification, and 13 patients who had a reservoir forme by Studer. The average age of the patients was 62.6 ± 2.6 (29—82) years. The average follow-up time was 77.1 ± 10.5 (19—184) months. The presence and degree of urinary incontinence was assessed using a questionnaire and a Pad test. 12 months or more after the operation, a complex urodynamic study was performed.Results. The overall 5-year survival rate was 92.3 %: in the Studergroup it was 90.9 %, in the ileocecal angle group it was 100 % (p = 0.317). In the general population of patients, 37.5 % were completely continent. Women after plastic surgery by Studer retained urine better than after plastic surgery by ileocecal angle (46.2 % vs 27.3 %), the difference was only for mild urinary incontinence, which was more common in the ileocecal angle group. The frequency of severe urinary incontinence in both groups was the same. Nocturnal urinary incontinence was more common in patients in the Studer group (46.2 %). In the group of patients with ileocecal angle plastic surgery, there was no chronic urinary retention requiring intermittent catheterization, and in the group of Studer plastic surgery — in 1 (7.7 %) case. Analysis of urodynamic parameters revealed the presence of a greater physiological capacity of the urinary reservoir in the group of patients after plastic surgery according to Studer (p = 0.043). In the group of patients with ileocecal angle plastic surgery, higher values of the maximum pressure of the reservoir wall, “leakage pressure” and maximum expulsion pressure are observed, possibly associated with a more pronounced muscle layer of the intestinal segment used.Conclusion. The functional results of the orthotopic reservoir formedfrom the ileocecal angle are comparable to the results of urine derivation using the classical Studer method. Complex urodynamic study showed a direct influence of various characteristics of the reservoir on the nature and degree of urination disorders in patients.Цель исследования — изучение отдаленных функциональных результатов создания ортотопического мочевого резервуара из илеоцекального угла в сравнении с техникой создания мочевого резервуара по Studer после радикальной цистэктомии у женщин.Материалы и методы. С 2004 по 2018 г. радикальная цистэктомия по поводу рака мочевого пузыря выполнена 120 женщинам. У 71 (59,2 %) пациентки сформирован ортотопический мочевой резервуар: из подвздошной кишки — у 48 (67,6 %), из сегментов толстой кишки — у 23 (32,4 %). В исследование включены 11 пациенток, которым был сформирован резервуар из илеоцекального угла, в том числе по собственной модификации, и 13 пациенток, которым был сформирован резервуар по Studer. Средний возраст пациенток составил 62,6 ± 2,6 (29—82) года. Среднее время наблюдения — 77,1 ± 10,5 (19—184) мес. Наличие и степень недержания мочи оценивали с помощью анкетирования и Pad-теста. Спустя 12 мес и более после операции выполняли комплексное уро-динамическое исследование.Результаты. Общая 5-летняя выживаемость составила 92,3 %: в группе Studer — 90,9 %, в группе илеоцекального угла — 100 % (p = 0,317). В общей популяции больных 37,5 % пациенток оказались полностью континентными. Женщины после пластики по Studer лучше удерживали мочу, чем после пластики илеоцекальным углом (46,2 % против 27,3 %), разница была только по недержанию мочи легкой степени, которое чаще встречалось в группе илеоцекального угла. Частота недержания мочи тяжелой степени в обеих группах оказалась одинаковой. Ночное недержание мочи чаще встречалось у пациенток в группе Studer (46,2 %). В группе илеоцекального угла не было хронической задержки мочи, требующей интермиттирующей катетеризации, в группе Studer она отмечена в 1 (7,7 %) случае. При анализе уродинамических показателей наблюдается наличие большей физиологической емкости мочевого резервуара в группе пациенток после пластики по Studer (p = 0,043). В группе илеоцекального угла отмечаются более высокие показатели максимального давления стенки резервуара, «давления утечки» и максимального давления изгнания, возможно связанные с более выраженным мышечным слоем используемого сегмента кишечника.Заключение. Функциональные результаты ортотопического резервуара, сформированного из илеоцекального угла, сопоставимы с результатами деривации мочи по классической методике Studer. Данные комплексного уродинамического исследования показали прямое влияние различных характеристик резервуара на характер и степень нарушений мочеиспускания пациенток

Тридцатидневные осложнения радикальной цистэктомии и факторы, влияющие на их развитие

Objective: to identify the most important factors influencing the development of complications after radical cystectomy (RCE).Materials and methods. The results of 182 RCEs performed in September 2014 and December 2016 were analyzed. The patients included 152 (83.5 %) men and 30 (16.5 %) women. The patients’ age ranged from 31 to 84 years (mean age 62.3 years). An orthotopic urinary reservoir was formed in 138 (75.8 %) patients. Postoperative complications were evaluated according to the Clavien–Dindo classification. The calculations were made with a computer program for SPSS Statistics 16.Results. No complications were recorded in 84 (46.2 %) patients within 30 days after RCE. The development of various postoperative adverse reactions was observed in 98 (53.8 %) patients. The most common complications were gastrointestinal (26.9 %) and infectious (25.8 %). Sixteen (8.8 %) patients developed grade I complications; grades II, III, IV, and V complications were seen in 53 (29.1 %), 21 (11.5 %), 5 (2.7 %), in 3 patients, respectively. Thirty-day mortality was 1.64 %. Univariate regression analysis has established that overweight (p = 0.031), T status (p = 0.021), preoperative hemoglobin levels (p = 0.001), intraoperative blood loss (p = 0.009), and intraoperative abdominal cavity infection (p <0.001) play a significant role in the development of complications following RCE. Multivariate regression analysis has revealed that the frequency of complications after RCE is influenced by body mass index (p = 0.008), preoperative anemia (p = 0.034), blood loss (p = 0.003), and intraoperative abdominal cavity infection (p <0.001).Conclusion. RCE is often accompanied by the development of different categories and severity of complications. Identification of risk factors for their complications will be able to elaborate effective ways for their prevention.Цель исследования – выявление наиболее значимых факторов, влияющих на развитие осложнений после проведения радикальной цистэктомии (РЦЭ).Материалы и методы. Проанализированы результаты 182 РЦЭ, произведенных с сентября 2014 г. по декабрь 2016 г. Среди пациентов были 152 (83,5 %) мужчин и 30 (16,5 %) женщин. Возраст больных варьировал от 31 до 84 лет (средний возраст 62,3 года). У 138 (75,8 %) пациентов сформирован ортотопический мочевой резервуар. Послеоперационные осложнения оценивали по классификации Clavien–Dindo. Расчеты выполняли в компьютерной программе для статистической обработки данных SPSS Statistics 16.Результаты. У 84 (46,2 %) пациентов в 30-дневные сроки после РЦЭ осложнений не зарегистрировано. У 98 (53,8 %) больных было зафиксировано развитие различных нежелательных отклонений после операции. Наиболее частыми осложнениями явились желудочно-кишечные (26,9 %) и инфекционные (25,8 %). У 16 (8,8 %) пациентов развились осложнения I степени, у 53 (29,1 %) – II, у 21 (11,5 %) – III, у 5 (2,7 %) – IV, у 3 пациентов – V. Тридцатидневная летальность составила 1,64 %. Однофакторный регрессионный анализ установил значимую роль избыточной массы тела больных (p = 0,031), T-статуса опухоли (p = 0,021), уровня гемоглобина до операции (p = 0,001), объема интраоперационной кровопотери (р = 0,009) и интраоперационного инфицирования брюшной полости (р <0,001) в развитии осложнений после РЦЭ. Многофакторный регрессионный анализ выявил, что на частоту развития осложнений после РЦЭ влияют индекс массы тела (р = 0,008), анемия до операции (р = 0,034), кровопотеря (р = 0,003) и интраоперационное инфицирование брюшной полости (р <0,001).Заключение. РЦЭ часто сопровождается развитием осложнений различных категорий и степени тяжести. Выявление факторов риска их развития позволит разработать эффективные пути их профилактики

Структура 90-дневных осложнений после резекции единственной почки при опухолях ее паренхимы

Objective. Study of 90 day complications after solitary kidney resection and determination of their dependence on resection complexity level in accordance with the RENAL nephrometry scoring system.Materials and methods. Seventy (70) resections due to solitary kidney tumors were performed in 65 patients (34 males and 31 females). Mean age was 59.1 years (40–75 years). Fifty-five (55) patients had renal cell carcinoma, 10 patients had benign tumors. According to the RENAL scoring system, in 17 (24 %) cases resection complexity was 4–6 points, in 21 (30 %) cases it was 7–9 points, in 32 (45 %) cases it was 10–12 points. Mean tumor diameter was 4.4 (1.5–10.0) cm. Kidney resection without ischemia was performed in 3 patients, with segmental ischemia – in 39 cases. In 28 (40 %) cases general ischemia was used, its mean duration was 18 (6–48) minutes. Local hypothermia was used in 5 patients. Statistical analysis was performed using SPSS Statistics 16.Results. Analysis of 90 day complications revealed no complications in 41 (58.6 %) cases, severity grade I complications were observed in 2 (2.9 %) cases, grade II – in 20 (28.6 %), grade III – in 6 (8.6 %); there were no grade IV and V complications. Hemodialysis wasn’t performed. Complications were significantly more frequent when total RENAL points were higher (Mann–Whitney U-test, р = 0.001); a positive correlation between RENAL score and presence of complications was observed (Spearman’s rho 0.411; p <0.001). A dependence between complications severity and RENAL score (Mann–Whitney U-test, р = 0.004) and a positive correlation between complications severity and RENAL score (Spearman’s rho 0.432; p <0,001) were revealed.Conclusion. Forty-five percent (45 %) of kidney resections were of maximum complexity according to the RENAL scoring system. In 60 % of cases resection was performed without general ischemia. Analysis of the results of solitary kidney resection demonstrated high efficacy and safety of the procedure and dependence of the frequency and severity of complications on complexity level per the RENAL scoring system.Цель исследования: изучить структуру 90-дневных осложнений после резекции единственной почки и определить зависимость их возникновения от степени сложности резекции по нефрометрической системе R.E.N.A.L.Материал и методика. 65 пациентам с опухолями единственной почки произведено 70 резекций  почки. Мужчин было 34, женщин – 31 в возрасте 59,1 (40 – 75) лет. У 55 больных был ПКР, у 10 – доброкачественные опухоли. Степень сложности резекции почки по системе R.E.N.A.L. определена: 4-6 баллов - в 17 (24%) случаях, 7–9 – в 21 (30%), 10–12 - в  32 (45%). Средний диаметр опухолей составил 4,4 см (1,5–10 см).  Резекция почки без ишемии осуществлена у 3 больных, в 39 случаях - с сегментарной ишемией. В 28 случаях (40%) применяли общую ишемию, среднее время ишемии составило 18,0 мин (6–48 мин). У 5 больных применяли местную гипотермию. Статистический анализ проведен с использованием SPSS statistics 16.Результаты. При анализе 90-дневных осложнений установлено: не было осложнений – 41 (58,6%) случаев; I степени –2 (2,9%); II –20 (28,6%); III – 6 (8,6%); IV – 0; V степени – 0. Гемодиализа не было. Осложнения статистически значимо чаще встречались при увеличении балла RENAL (U-test р=0,001), выявлена положительная корреляция между величиной балла RENAL и наличием осложнений (R=0,411, p<0,001). Выявлена зависимость тяжести осложнений от величины RENAL (U-test р=0,004) и положительная корреляция между тяжестью осложнений и баллом RENAL (R=0,432, p<0,001).Заключение. 45% случаев резекции почки относилось к максимальной степени сложности по системе R.E.N.A.L. В 60% случаев резекцию почки выполняли без общей ишемии. Анализ результатов резекции единственной почки показал их высокую эффективность и безопасность и зависимость частоты и тяжести осложнений от степени сложности резекции по системе RENAL

A Remark On Robust Stabilization Of General Asymptotically Controllable Systems

It was shown recently by Clarke, Ledyaev, Sontag and Subbotin that any asymptotically controllable system can be stabilized by means of a certain type of discontinuous feedback. The feedback laws constructed in that work are robust with respect to actuator errors as well as to perturbations of the system dynamics. A drawback, however, is that they may be highly sensitive to errors in the measurement of the state vector. This paper addresses this shortcoming, and shows how to design a dynamic hybrid stabilizing controller which, while preserving robustness to external perturbations and actuator error, is also robust with respect to measurement error. This new design relies upon a controller which incorporates an internal model of the system driven by the previously constructed feedback

Asymptotic Controllability Implies Feedback Stabilization

It is shown that every asymptotically controllable system can be globally stabilized by means of some (discontinuous) feedback law. The stabilizing strategy is based on pointwise optimization of a smoothed version of a control-Lyapunov function, iteratively sending trajectories into smaller and smaller neighborgoods of a desired equilibrium. A major technical problem, and one of contributions of the present paper, concerns the precise meaning of "solution" when using a discontinuous controller. I. Introduction A longstanding open question in nonlinear control theory concerns the relationship between asymptotic controllability to the origin in R n of a nonlinear system x = f(x; u) (1) by an "open loop" control u : [0; +1) ! U and the existence of a feedback control k : R n ! U which stabilizes trajectories of the system x = f(x; k(x)) (2) with respect to the origin. For the special case of linear control systems x = Ax + Bu, this relationship is well understood: asymptotic cont..

Long-term functional results of orthotopic urinary derivation by Studer and VIP after radical cystectomy in women

Introduction. The feasibility of reconstructing an orthotopic urinary reservoir after radical cystectomy (RCE) in women is still debatable. This is due to the peculiarities of the physiology and anatomy of the female lower urinary tract and an increased risk of developing urinary incontinence or urinary retention after surgery.Purpose of the study. Studying long-term functional results of creating an orthotopic urinary reservoir by VIP in comparison with the technique of creating a urinary reservoir by Studer after RCE in women.Materials and methods. The study included 32 women who underwent RCE with the formation of an orthotopic urinary reservoir by to Studer — 13 patients and a «spherical» reservoir in the VIP — 19 modification. At the time of surgery, the age of patients was 61.1±1.9 years (29 ‒ 82). The average follow-up time was 77.5±7.8 months (17 ‒ 157, median 82). The patients who underwent a more complex type of plastic were younger than the patients operated on by the Studer method (p = 0.014). The groups did not differ statistically in other parameters.Results. The overall five-year survival rate in the Studer group was 90.9%, and in the VIP group — 94.7% (p = 0.596). 59.4% of patients were completely continent. Women after plastic surgery by VIP held urine better (68.4% vs 46.2%). The incidence of mild urinary incontinence was higher after Studer surgery. The incidence of severe urinary incontinence was the same in both groups. Nighttime urinary incontinence was the same in both groups. Intermittent catheterization was used more often by patients after VIP plastic surgery than after Studer surgery (21% vs 7.7%). In urodynamic studies, it was shown that the lower physiological capacity of the reservoir according to Studer due to more intense peristalsis of the reservoir wall, which causes involuntary leaking of urine, hyperperistalsis of the reservoir and a higher frequency of urinary incontinence causes more complete emptying in patients less residual urine, less need for self-catheterization. In the group of patients with plastic surgery according to VIP, a high physiological capacity of the reservoir with a lower pressure of the walls of the reservoir during the filling phase was recorded. This is manifested by a lower incidence of urinary incontinence, and, at the same time, a more significant amount of residual urine and a higher need for patients for self-catheterization.Conclusion. The formation of an orthotopic urinary reservoir with favourable long-term results is possible in women after RCE. The most beneficial in terms of the quality of daily held urine is the VIP modification, which is characterized by sufficiently high capacity and low intraluminal pressure. However, with this method of surgery, the risk of hypercontinence increases, which requires periodic catheterization. A complex urodynamic study made it possible to show the direct effect of various characteristics of the reservoir on the nature and degree of impaired urination of patients

PUBIC CHONDROSARCOMA INVADING THE BLADDER (A CLINICAL NOTE)

The paper describes a clinical case of pubic chondrosarcoma invading the bladder. Radical cystectomy has been performed with resection of the pubic symphysis and a part of the left ischium