Ability to diagnose chronic external biliary fistula calculous origin

Introduction: Chronic external biliary fistulas occur in 0.4-2.4% of patients with diseases of the biliary tract and are likely to be one of the complications of surgical treatment of diseases of the biliary tract. Aim: Choose the most appropriate methods of diagnosis of chronic external biliary fistula calculous etiology by improving the diagnostic algorithm. Materials and methods: Analyzed the results of diagnosis 86 patients with chronic external biliary fistula. 79 were operated previously in other hospitals. Fistula after they have formed the following operations: cholecystostomy - 23, cholecystectomy, holedohostomii on Wisniewski - 37, cholecystectomy, choledochostomy through the cystic duct stump - 24, holedohostomii - 2. Of the 86 patients 72 were operated in urgent procedure. To clarify the diagnosis chronic external biliary fistula used the following methods: fistulocholangiography - 76, ultrasound - 71 CT - 32, fistulocholangioscopy - 9, endoscopic retrograde cholangiopancreatography - 9, the definition of sterkobilina in feces and urine urobilin - 30, determination of bilirubin in the fistulous the discharge - 17, test with methylene blue - 16. Results: One of the most informative methods for studying bile fistula is fistulocholangiography. With it identified: bile duct stones - for 74 people, cystic duct stone - 12, stenosis of the sphincter of Oddi - 48 people. Endoscopic retrograde pancreatography performed in 9 patients with follow-up and removal of stone papillosfinkterotomiey of choledochal - in 5. The accuracy of ultrasound in detecting choledocholithiasis was 86%, computed tomography - 92.3%. Fistulocholagioscopy with lithotomy was effective in 9 patients. Conclusions: None of the methods of preoperative diagnosis of chronic external biliary fistula is universal. The most valuable diagnostic information about the state of the bile ducts give fistulocholangiography, endoscopic retrograde pancreatography in some cases supplemented by ultrasound or computed tomography

On the Absorption of X-rays in the Interstellar Medium

We present an improved model for the absorption of X-rays in the ISM intended for use with data from future X-ray missions with larger effective areas and increased energy resolution such as Chandra and XMM, in the energy range above 100eV. Compared to previous work, our formalism includes recent updates to the photoionization cross section and revised abundances of the interstellar medium, as well as a treatment of interstellar grains and the H2molecule. We review the theoretical and observational motivations behind these updates and provide a subroutine for the X-ray spectral analysis program XSPEC that incorporates our model.Comment: ApJ, in press, for associated software see http://astro.uni-tuebingen.de/nh

Surface temperature and synthetic spectral energy distributions for rotationally deformed stars

The spectral energy distribution (SED) of a non-spherical star could differ significantly from the SED of a spherical star with the same average temperature and luminosity. Calculation of the SED of a deformed star is often approximated as a composite of several spectra, each produced by a plane parallel model of given effective temperature and gravity. The weighting of these spectra over the stellar surface, and hence the inferred effective temperature and luminosity, will be dependent on the inclination of the rotation axis of the star with respect to the observer, as well as the temperature and gravity distribution on the stellar surface. Here we calculate the surface conditions of rapidly rotating stars with a 2D stellar structure and evolution code and compare the effective temperature distribution to that predicted by von Zeipel's law. We calculate the composite spectrum for a deformed star by interpolating within a grid of intensity spectra of plane parallel model atmospheres and integrating over the surface of the star. Using this method, we find that the deduced variation of effective temperature with inclination can be as much as 3000 K for an early B star, depending on the details of the underlying model.Comment: 38 pages, 9 figures (AAStex preprint format). Accepted for publication in the Ap

A NLTE line blanketed model of a solar type star

We present LTE and NLTE atmospheric models of a star with solar parameters, and study the effect of treating many thousands of Iron group lines out of LTE on the computed atmospheric structure, overall absolute flux distribution, and the moderately high resolution spectrum in the visible and near UV bands. Our NLTE modeling includes the first two or three ionization stages of 20 chemical elements, up to and including much of the Fe-group, and includes about 20000 Fe I and II lines. We investigate separately the effects of treating the light metals and the Fe-group elements in NLTE. Our main conclusions are that 1) NLTE line blanketed models with direct multi-level NLTE for many actual transitions gives qualitatively similar results as the more approximate treatment of Anderson (1989) for both the Fe statistical equilibrium and the atmospheric temperature structure, 2) models with many Fe lines in NLTE have a temperature structure that agrees more closely with LTE semi-empirical models based on center-to-limb variation and a wide variety of spectra lines, whereas LTE models agree more with semi-empirical models based only on an LTE calculation of the Fe I excitation equilibrium, 3) the NLTE effects of Fe-group elements on the model structure and flux distribution are much more important than the NLTE effects of all the light metals combined, and serve to substantially increases the violet and near UV flux level as a result of NLTE Fe over-ionization. These results suggest that there may still be important UV opacity missing from the models.Comment: Accepted for publication in The Astrophysical Journa

Numerical Simulations of Magnetoacoustic-Gravity Waves in the Solar Atmosphere

We investigate the excitation of magnetoacoustic-gravity waves generated from localized pulses in the gas pressure as well as in vertical component of velocity. These pulses are initially launched at the top of the solar photosphere that is permeated by a weak magnetic field. We investigate three different configurations of the background magnetic field lines: horizontal, vertical and oblique to the gravitational force. We numerically model magnetoacoustic-gravity waves by implementing a realistic (VAL-C) model of solar temperature. We solve two-dimensional ideal magnetohydrodynamic equations numerically with the use of the FLASH code to simulate the dynamics of the lower solar atmosphere. The initial pulses result in shocks at higher altitudes. Our numerical simulations reveal that a small-amplitude initial pulse can produce magnetoacoustic-gravity waves, which are later reflected from the transition region due to the large temperature gradient. The atmospheric cavities in the lower solar atmosphere are found to be the ideal places that may act as a resonator for various oscillations, including their trapping and leakage into the higher atmosphere. Our numerical simulations successfully model the excitation of such wave modes, their reflection and trapping, as well as the associated plasma dynamics

The impact of non-LTE effects and granulation inhomogeneities on the derived iron and oxygen abundances in metal-poor halo stars

This paper presents the results of a detailed theoretical investigation of the impact of non-LTE effects and of granulation inhomogeneities on the derived iron and oxygen abundances in the metal-poor halo subgiant HD140283. Our analysis is based on both the `classical' one-dimensional (1D) stellar atmosphere models and on the new generation of three-dimensional (3D) hydrodynamical models. We find that the non-LTE effects on the iron abundance derived from Fe {\sc i} lines are very important, amounting to ${\sim}0.9$ dex and to ${\sim}0.6$ dex in the 3D and 1D cases, respectively. On the other hand, we find that non-LTE and 3D effects have to be taken into account for a reliable determination of the iron abundance from weak Fe {\sc ii} lines, because the significant overexcitation of their upper levels in the granular regions tend to produce emission features. As a result such Fe {\sc ii} lines are weaker than in LTE and the abundance correction amounts to ${\sim}0.4$ dex for the 3D case. We derive also the oxygen-to-iron abundance ratio in the metal-poor star HD140283 by using the O {\sc i} triplet at 7772--5 \AA and the forbidden [O {\sc i}] line at 6300 \AA. Interestingly, when both non-LTE and 3D effects are taken into account there still remains significant discrepancies in the iron abundances derived from Fe {\sc i} and Fe {\sc ii} lines, as well as in the oxygen abundances inferred from the O {\sc i} and [O {\sc i}] lines. We conclude that the metalicity of this type of metal-poor stars could be significantly larger than previously thought, which may have far-reaching implications in stellar astrophysics.Comment: The Astrophysical Journal (in press). (35 pages, 5 figures and 4 tables

Permitted Oxygen Abundances and the Temperature Scale of Metal-Poor Turn-Off Stars

We use high quality VLT/UVES published data of the permitted OI triplet and FeII lines to determine oxygen and iron abundances in unevolved (dwarfs, turn-off, subgiants) metal-poor halo stars. The calculations have been performed both in LTE and NLTE, employing effective temperatures obtained with the new infrared flux method (IRFM) temperature scale by Ramirez & Melendez, and surface gravities from Hipparcos parallaxes and theoretical isochrones. A new list of accurate transition probabilities for FeII lines, tied to the absolute scale defined by laboratory measurements, has been used. We find a plateau in the oxygen-to-iron ratio over more than two orders of magnitude in iron abundance (-3.2 < [Fe/H] < -0.7), with a mean [O/Fe] = 0.5 dex (sigma = 0.1 dex), independent of metallicity, temperature and surface gravity. According to the new IRFM Teff scale, the temperatures of turn-off halo stars strongly depend on metallicity, a result that is in excellent qualitative and quantitative agreement with stellar evolution calculations, which predict that the Teff of the turn-off at [Fe/H] = -3 is about 600-700 K higher than that at [Fe/H] = -1.Comment: In press, Ap

Differences sustained between diffuse and limited forms of juvenile systemic sclerosis in expanded international cohort. www.juvenile-scleroderma.com

OBJECTIVES: To evaluate the baseline clinical characteristics of juvenile systemic sclerosis (jSSc) patients in the international Juvenile SSc Inception Cohort (jSScC), compare these characteristics between the classically defined diffuse (dcjSSc) and limited cutaneous (lcjSSc) subtypes, and among those with overlap features. METHODS: A cross-sectional study was performed using baseline visit data. Demographic, organ system evaluation, treatment, and patient and physician reported outcomes were extracted and summary statistics applied. Comparisons between dcjSSc and lcSSc subtypes and patients with and without overlap features were performed using Chi-square and Mann Whitney U-tests. RESULTS: At data extraction 150 jSSc patients were enrolled across 42 centers, 83% were Caucasian, 80% female, dcjSSc predominated (72%), and 17% of the cohort had overlap features. Significant differences were found between dcjSSc and lcjSSc regarding the modified Rodnan Skin Score, presence of Gottron's papules, digital tip ulceration, 6 Minute walk test, composite pulmonary and cardiac involvement. All more frequent in dcSSc except for cardiac involvement. DcjSSc patients had significantly worse scores for physician rated disease activity and damage. A significantly higher occurrence of Gottron's papules, musculoskeletal involvement and composite pulmonary involvement, and significantly lower frequency of Raynaud's phenomenon, were seen in those with overlap features. CONCLUSION: Results from a large international jSSc cohort demonstrate significant differences between dcjSSc and lcjSSc patients including more globally severe disease and increased frequency of ILD in dcjSSc patients, while those with lcSSc have more frequent cardiac involvement. Those with overlap features had an unexpected higher frequency of interstitial lung disease

Oxygen in the Very Early Galaxy

Oxygen abundances in a sample of ultra-metal-poor subdwarfs have been derived from measurements of the oxygen triplet at 7771--5 A and OH lines in the near UV performed in high-resolution and high signal-to-noise spectra obtained with WHT/UES, KeckI/HIRES, and VLT/UVES. Our Fe abundances were derived in LTE and then corrected for NLTE effects following Thevenin and Idiart (1999). The new oxygen abundances confirm previous findings for a progressive linear rise in the oxygen-to-iron ratio with a slope -0.33+-0.02 from solar metallicity to [Fe/H] -3. A slightly higher slope would be obtained if the Fe NLTE corrections were not considered. Below [Fe/H]= -2.5 our stars show [O/Fe] ratios as high as ~ 1.17 (G64-12), which can be interpreted as evidence for oxygen overproduction in the very early epoch of the formation of the halo, possibly associated with supernova events with very massive progenitor stars. We show that the arguments against this linear trend given by Fulbright and Kraft (1999), based on the LTE Fe analysis of two metal-poor stars cannot be sustained when an NLTE analysis is performed. Using 1-D models our analysis of three oxygen indicators available for BD +23 3130 gives consistent abundances within 0.16 dex and average [O/Fe] ratio of 0.91.Comment: 45 pages, 11 figures, accepted for publication in The Astrophysical Journa

Опыт диагностики и лечения болезни Кавасаки в клинике Санкт-Петербургского государственного педиатрического медицинского университета и Д етской городской больнице №1 Санкт-Петербурга

Kawasaki disease (KD) is acute systemic vasculitis of unknown etiology. Approximately 20–25% of untreated patients develop coronary artery changes with a range of severity from asymptomatic coronary artery dilatation to giant coronary artery aneurysms with thrombosis, myocardial infarction, and sudden death. To date there is no official data on the incidence of KD in Russia. In Russia, the disease is not enough known now to a wide circle of physicians and often masks other more common diseases. Since 2010, the detection rate of KD has dramatically increased in Saint-Petersburg.Objective: to analyze the experience in diagnosing and treating KD in two largest hospitals of Saint Petersburg.Patients and methods. The retrospective study included data on 30 children (18 boys, 12 girls) who were hospitalized with a diagnosis of KD in the Saint-Petersburg State Pediatric Medical University Clinic and Children’s Hospital One (Saint Petersburg) between January 2011 and September 2016. Data are represented by median and extreme values. The age of the children was 2.8 (0.2; 4.6) years; of them 5 (16.7%) patients were under the age of 1 year. The children were hospitalized on 5 (1; 14) days of disease onset; KD was diagnosed on 9 (3; 52) day of the disease.Results. Immediately after diagnosis, 27 (90%) children received aspirin. In early stages (before 10 days of the disease), intravenous immunoglobulin (IVIG) therapy was performed in 15 (50%) children, one of them received IVIG before disease day 5 (on day 3), but without effect. On disease days 11-20 (immediately after diagnosis), 10 (33.3%) children were prescribed with IVIG; thereafter fever was abolished in all the patients. Their body temperature became normal on day 11 (6; 23). Ultrasonography revealed coronary artery lesions in 13 (43.3%) patients. Out of the 30 children followed up, one baby who fell ill at the age of 3 months and received IVIG died on day 30 of the disease.Conclusion. Currently, there continues to be a delayed diagnosis of KD. IVIG therapy was effective, especially in cases of timely diagnosis. It is necessary to increase awareness of KD among clinicians and ultrasound diagnosticians.Болезнь Кавасаки (БК) – остро протекающий системный васкулит неизвестной этиологии. Примерно у 20–25% не получивших лечения больных развиваются изменения коронарных артерий различной степени тяжести – от бессимптомной дилатации до гигантских аневризм, тромбоза, инфаркта миокарда и внезапной смерти. До настоящего времени официальных данных о заболеваемости БК в России нет. В нашей стране БК недостаточно известна широкому кругу врачей и часто проходит под маской других более распространенных заболеваний. В Санкт-Петербурге после 2010 г. резко возросла выявляемость БК.Цель исследования – проанализировать опыт диагностики и лечения БК в двух крупных стационарах Санкт-Петербурга.Пациенты и методы. В ретроспективное исследование были включены данные о 30 детях (18 мальчиков, 12 девочек), находившихся на стационарном лечении с диагнозом БК в клинике Санкт-Петербургского государственного педиатрического медицинского университета и Детской городской больнице №1 Санкт-Петербурга с января 2011 г. по сентябрь 2016 г. Данные представлены медианой и крайними значениями. Возраст детей составил 2,8 [0,2; 4,6] года, из них 5 (16,7%) пациентов были в возрасте до 1 года. Дети были госпитализированы на 5-е [1; 14] сутки болезни, диагноз БК установлен на 9-й [3; 52] день болезни.Результаты. Сразу после установления диагноза получили аспирин 27 детей (90%). В ранние сроки (до 10-го дня болезни) терапия внутривенным иммуноглобулином (ВВИГ) проводилась у 15 (50%) пациентов, из них 1 получил ВВИГ ранее 5-го дня болезни (на 3-й день), однако без эффекта. На 11–20-й день болезни (сразу после установления диагноза) ВВИГ назначен 10 (33,3%) детям, после чего лихорадка была купирована у всех пациентов. Температура тела нормализовалась на 11-й [6; 23] день. Поражение коронарных артерий при УЗИ выявлено у 13 (43,3%) пациентов. Из 30 находившихся под наблюдением детей у 1 ребенка, заболевшего в возрасте 3 мес и получившего ВВИГ на 30-й день болезни, зафиксирован летальный исход.Выводы. В настоящее время БК продолжает диагностироваться с опозданием. Терапия ВВИГ была эффективной, особенно в случаях своевременного установления диагноза. Необходимо повышение осведомленности клиницистов и врачей ультразвуковой диагностики о БК