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The objective: to show the possibility of anesthesia during liver retransplantation in a child in the absence of adequate vascular access.A clinical case of liver retransplantation in a 10-year-old patient with liver transplant dysfunction and acquired thrombophilia is considered. In 2011, the child underwent Kasai portoenterostomy, and in 2012, living-related transplantation of the left lateral liver bisegment from a related donor was performed due to liver cirrhosis as an outcome of biliary atresia. Also, the child had multiple surgical interventions due to perforations of the small intestine with underlying segmental venous mesenteric thrombosis. In the long term after the transplantation, irreversible transplant dysfunction developed with manifestations and worsening of hepatocellular insufficiency, encephalopathy, as well as recurrent bleeding from varicose veins of the esophagus and cardiac orifice. The clinical situation was complicated by the lack of adequate vascular access due to total thrombosis of the venous system, thrombosis of the superior and inferior vena cava. The only possible option for ensuring adequate venous access was the implantation of a tunneled catheter into the right atrium of the right atrium for prolonged standing in conditions of single-lung ventilation through right-sided thoracotomy.

Purpose. To develop a system for assessing liver function in patients with liver cirrhosis according to magnetic resonance imaging (MRI) with gadoxetic acid.Material and Methods. Data from studies of 74 patients who underwent abdominal MRI with intravenous gadoxetic acid (GA) enhancement were analyzed. For statistical analysis of the data, two groups were formed: group 1 (n = 22) comprised patients with unchanged liver parenchyma, normal liver function, and benign tumors; group 2 (n = 52) comprised patients with liver cirrhosis, with the presence of regenerative and/or dysplastic nodes, and hepatocellular carcinoma (HCC). The following quantitative parameters were studied to assess liver function in patients of two groups: relative enhancement (RE), contrast enhancement index (CEI), liver/skeletal muscle (SM) index, liver/spleen index, liver/kidney index, analysis of histograms (AH), and liver function imaging scale (FLIS).Results. The criteria for a functional deficiency of liver function based on calculated data of contrast agent transport and accumulation were a decrease in FLIS total score to 4 and below, RE values below 0.85, and CEI values below 1.38 with sensitivity and specificity of 100 and 75%, the values of liver/SM and liver/kidney indices below 0.350, liver/spleen index below 0.750 with sensitivity and specificity of 100 and 81%, respectively, in patients with cirrhosis.Conclusion. The developed system for assessing liver function using FLIS, intensity matching analysis (IMA), and AH according to MRI with GC in comparison with METAVIR allowed for liver function assessment in patients with cirrhosis with a sensitivity and specificity of 100% and 80%, respectively.

Anesthesiological provision of pediatric liver surgery is associated with problems related to perioperative analgesia. Standard methods of anesthesia can have contraindications and complications.The objective: To evaluate the safety and efficacy of the posterior TAP block for postoperative analgesia in pediatric liver surgery.Subjects and Methods. A prospective, single, blind, placebo-controlled pilot study was conducted. The participants were children aged 2 to 7 who underwent liver resection. The patients were divided into groups. In Control Group, combined anesthesia was performed. In Study Group, it was combined with a bilateral posterior TAP block. Pain in the postoperative period was assessed by the FLACC scale.Results. The intensity of pain in the postoperative period was higher in Control Group. More patients required tramadol administration in Control Group. There was no difference in the occurrence of the PONV syndrome. No complications associated with the block were noted.Conclusion. The posterior TAP block has a clinically significant analgesic effect and can be used for perioperative pain relief during pediatric liver surgery. This method is relatively safe. Impaired hemostasis system is not an absolute contraindication to a TAP block.

The objective: to assess changes of clinical and laboratory hemostasic parameters in children at the stages of orthotopic liver transplantation.Subjects and Methods. A single-centre, prospective, pilot study of coagulation test scores was performed in 20 children aged 0 to 11 years with hepatoblastoma after a course of PRETEX IV chemotherapy who underwent liver transplantation from a related donor.Results. Children from 0 to 11 years old with hepatoblastoma, after chemotherapy, retain the normal functional activity of the hemostasis system at the pre-hepatic stage of transplantation: APTT 34.6 (34.45; 38.65) s; prothrombin index (PI) 83.53 (74.09; 87.87) %; INR 1.22 (1.16; 1.42) in the 0‒2 year group, APTT 40.45 (34.9; 41, 68), PI 75.57 (64.41; 80.45) %, and INR 1.39 (1.36; 1.87) in the group aged 3‒11 years. Severe hypocoagulation develops by the end of the hepatic stage and in the first 15 minutes after the start of arterial blood flow through the graft: CT and CFT from 195.0 (189.0; 228.5) s and 163.0 (129.5; 171.5) s to 537.0 (456.0; 1,651.5) s and 468.0 (324.5; 611.5) s (p < 0.05), respectively, in the INTEM test. Hypocoagulation at this time develops due to deficiency of coagulation factors and the release of endogenous glycosaminoglycans from the endothelium transplant, as indicated by an increase in CT and CFT to 666.0 (468.5; 2,209.5) s and 254.5 (203.25; 305.75) s in INTEM, CT to 525.0 (389.0; 2028.0) s with p < 0.05 in HEPTEM in children under the age group of up to 2. Within 1 hour after the start of arterial blood flow, the effects of systemic heparinoid effects persist, which is confirmed by the dynamics of CT 360.0 (219.5; 2,116.5) s with up to 960.0 (560.5; 1,440.5) s with p < 0.05 in the EXTEM test.Conclusion. Changes in hemostasis system parameters during surgery make it possible to judge about rapidly developing coagulation and anticoagulation disorders in children of the presented age groups. Specific changes in the coagulation profile at the stages of liver transplantation in children under the age of 11 inclusive, make it possible to do without routine correction of changes in the hemostasis system.

Abernethy malformation is a congenital disease characterized by complete or partial underdevelopment of the portal vein, leading to the occurrence of congenital extrahepatic portosystemic shunts. The anomaly with the absence of the portal vein is detected in 80% of cases in childhood. Patients with this pathology are very frequently examined when detecting space-occupying liver lesions and assuming the presence of a vascular abnormality. The paper describes clinical cases of benign focal liver lesions and Abernethy malformation in children.

Linear equations in Banach spaces with a distributed fractional derivative given by the Stieltjes integral and with a closed operator A in the right-hand side are considered. Unlike the previously studied classes of equations with distributed derivatives, such kinds of equations may contain a continuous and a discrete part of the integral, i.e., a standard integral of the fractional derivative with respect to its order and a linear combination of fractional derivatives with different orders. Resolving families of operators for such equations are introduced into consideration, and their properties are studied. In terms of the resolvent of the operator A, necessary and sufficient conditions are obtained for the existence of analytic resolving families of the equation under consideration. A perturbation theorem for such a class of operators is proved, and the Cauchy problem for the inhomogeneous equation with a distributed fractional derivative is studied. Abstract results are applied for the research of the unique solvability of initial boundary value problems for partial differential equations with a distributed derivative with respect to time.

Chronic liver disease is a serious worldwide problem because its progression is accompanied by liver fibrosis and cirrhosis at the terminal stages. Primary diagnosis and dynamic assessment of liver fibrosis are essential to determine the prognosis of disease and optimal treatment strategy. Long-term world experience in the use of gadoxetic acid (primovist, eovist) for diagnosis of liver diseases confirms its hepatotropic properties. Thus, magnetic resonance imaging (MRI) in hepatobiliary phase of contrast enhancement is valuable for differential diagnosis of focal liver lesions and assessment of liver structure and fibrotic changes. This review is devoted to the most common methods of contrast-enhanced MRI for assessment of liver function and correlation between severity of diffuse structural liver changes and gadoxetic acid accumulation in liver parenchyma. There is no a single method for MRI-based analysis of liver function that is confirmed by active researches in this direction. It was found that liver biopsy can by unnecessary in some cases if contrast-enhanced MRI with gadoxetic acid is available. The advantage of gadoxetic acid is also elimination properties. Indeed, biliary excretion ensures T1-weighted MR-cholangiography for additional assessment of patency, function and anatomy of the bile ducts. However, there are still several questions in this area that necessitates further research.Хронические заболевания печени являются актуальной проблемой во всем мире, так как их прогрессия сопровождается развитием фиброза с формированием цирроза печени в терминальной стадии. Первичная инструментальная диагностика и динамическая оценка скорости и степени прогрессии фиброза имеют большое клиническое значение в определении прогноза заболевания и выборе оптимальной тактики лечения. Многолетний мировой опыт применения гадоксетовой кислоты (ГК) (примовист, эовист) в диагностике заболеваний печени доказывает ее гепатотропные свойства, поэтому именно оценка магнитно-резонансных томограмм (МРТ) в гепатобилиарной (ГБ) фазе исследования после введения гадоксетовой кислоты позволяет с высокой точностью провести дифференциальную диагностику образований печени, а также оценить структуру печени и степень развития в ней фиброзных изменений. В данном обзоре отражены наиболее распространенные методы определения функции печени по данным МРТ с ГК и дана характеристика корреляции между степенью диффузных изменений структуры печени и накоплением в паренхиме печени ГК. В настоящее время не выработан единый метод определения функции печени с помощью МРТ, о чем свидетельствуют активные исследования в указанном направлении. Данные, полученные с помощью магнитно-резонансных исследований с ГК, позволяют выявлять различные формы хронических заболеваний печени, не прибегая к инвазивным исследованиям, таким как биопсия печени. Преимуществом ГК также являются особенности ее выведения. Именно с возможностью выделения ГК с желчью связано получение диагностически значимой Т1-контрастной МР-холангиографии, а значит, дополнительной оценки проходимости, функции и анатомии желчных протоков. Однако остается достаточное количество вопросов в этой области, что делает дальнейшие исследования актуальными и востребованными.

The use of video technologies in the criminal proceedings should hardly be considered as a fundamentally new legal phenomenon. In one way or another, video technologies have been used for quite a long time. However, video technologies are used in different ways and to a different extent in different countries. In this regard, it is interesting to compare such indicators in order to increase the effectiveness of the criminal process by expanding the methods of obtaining evidence, increasing the level of protection of participants in the criminal proceedings and international cooperation in the field of criminal proceedings.

The aim of this work is to find by the methods of the Laplace transform the conditions for the existence of a strongly continuous resolving family of operators for a linear homogeneous equation in a Banach space with the distributed Gerasimov–Caputo fractional derivative and with a closed densely defined operator A in the right-hand side. It is proved that the existence of a resolving family of operators for such equation implies the belonging of the operator A to the class CW(K,a), which is defined here. It is also shown that from the continuity of a resolving family of operators at t=0 the boundedness of A follows. The existence of a resolving family is shown for A∈CW(K,a) and for the upper limit of the integration in the distributed derivative not greater than 2. As corollary, we obtain the existence of a unique solution for the Cauchy problem to the equation of such class. These results are used for the investigation of the initial boundary value problems unique solvability for a class of partial differential equations of the distributed order with respect to time.

To improve the outcomes in children with hepatoblastoma.There were 160 children with focal liver lesions who underwent surgery at the department of liver transplantation in 2008-2019. Patients with malignant tumors made up 77% (Overall and disease-free 10-year survival was 87.1% and 82.7%, respectively. Similar values were observed after resections (91.1% and 86.6%). At the same time, actuarial 4-year survival after liver transplantation for HB was 68%.Improvement of treatment outcomes may be achieved through multidisciplinary interaction ensuring timely drug therapy and liver transplantation.Единственным методом лечения пациентов с терминальными диффузными заболеваниями и нерезектабельными опухолями печени является ее трансплантация. С 2008 по 2019 г. в отделении пересадки печени РНЦХ им. акад. Б.В. Петровского прооперировано 160 детей с очаговыми образованиями печени. Злокачественные новообразования диагностированы у 123 (77%) пациентов, в том числе гепатобластома (ГБ) у 106 (86%). У 19 (18%) из 106 пациентов с ГБ потребовалось выполнение трансплантации печени. Медиана сроков наблюдения за пациентами после трансплантации на декабрь 2019 г. составила 24,3 мес, а более чем у

A comprehensive examination, involving ultrasonography (US) in 55 potential related donors of liver fragments, revealed no signs of diffuse liver lesion (DLL) in 45 cases (Group A), these were found in 10 cases (Group B).Liver fragment taking surgery was performed in Group A patients 1–2 weeks after US. All the 45 patients in this group were found to have a normal US pattern of the liver, as verified by its histological studies in all the cases; all these patients had also a mass body index (MBI) of lower than 25 kg/m2 . In Group B, all the 10 patients had the US signs comparable with mild or moderate DLL (increased liver parenchymal echogenicity, worse visualization of the small branches of the intrahepatic veins and diaphragm, and altered patterns of blood flow in the right hepatic vein) generally concurrent with a higher MBI. After 3–4-month treatment to reduce weight (conditioning), the liver US pattern normalized in 9 of the 10 Group B patients; only one patient with a MBI of 31.6 kg/m2 preserved the signs of mild DLL (histological studies of liver biopsy specimens revealed 10% steatosis in this patient, 2 % steatosis in 2 female patients; this condition was absent in the other 7 patients). All the patients in Group B were also operated on 1–2 weeks after the last US. The recipients from Groups A and B donors had no posttransplantation parenchymal complications.US in the tints of a gray scale along with the determination of blood flow patterns in the hepatic veins rather significantly shows the normal liver in its potential donors and reduces the need for serial diagnostic liver biopsies and other instrumental studies.

The paper describes two clinical examples of successful related liver fragment transplantation for type 1 glycogenosis in a one-year-old boy and a 6-year-old girl. The given first successful clinical experience suggests that liver fragments for type 1 glycogenoses can be transplanted from live related donors and offers promise for the radical treatment of patients with this pathology.

Purpose: the aim of this study was to assess the values of ARFI elastometry in normal subjects and effects of food intake and physical effort.Material and methods.ARFI elastometry measurements were done in 32 patients (20 (62.5%) volunteers and 12 (37.5%) potential liver fragment donors). Mean age of patients was 26.9 ± 5.3 years. The study was performed in fasting condition in right intercostals approach, while the patients were asked to stop normal breathing for a moment lying in supine position with the right hand placed above the head. For 20 volunteers ARFI elastometry was performed at 30 minutes after food intake (about 350 kcal) and at next day immediately after physical effort (20 squats). The study was performed using Siemens Acuson S2000 ultrasound system with a 6C1 transducer.Results.The stiffness of the right liver lobe in 32 healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38), the mean liver stiffness values of 20 volunteers in fasting condition were 1,21±0,09 m/s (95% CI 1.06 ± 1.38), 30 minutes after the meal – 1.22 ± 0.12 m/s (95% CI 1.01 ± 1.43) (р > 0.05). Physical effort didn’t make significant influence on the liver stiffness measurements (1.16 ± 0.12 m/s vs 1.20 ± 0.07 m/s, р > 0.05).Conclusion.Liver stiffness value in healthy subjects was 1.16 ± 0.12 m/s (95% CI 0.92 ± 1.38). There was no significant influence of food intake and physical effort on the liver stiffness measurements.

The approximate controllability issues for a class of control systems, whose dynamics is described by an equation in a Banach space with a linear degenerate operator at the Riemann — Liouville fractional derivative, is investigated. Under the condition of p-boundedness of the pair of operators in the equation the control system is reduced to subsystems on two mutually complement subspaces. It was shown that the approximate controllability of the whole system is equivalent to the approximate controllability of the two subsystems. Criteria of the approximate controllability for the system and two subsystems are obtained. Analogous results are got on the approximate controllability for free time and for systems of the same form with a finite-dimensional input. The obtained criteria were applied to the investigation of the approximate controllability for a distributed system with polynomials of a differential with respect to the spatial variables self-adjoint elliptic operator and for a system of the Scott-Blair — Oskolkov type.

Background Despite overall striking advances in survival of childhood liver tumors, outcomes remain poor for specific patient segments. We aimed to assess overall survival (OS) of this rare disease and evaluate the generalizability of prognostic variables included in international collaborative systems using, for the first time, harmonized clinical data from two geographically different cohorts (Greece and Moscow). Methods Data for children (0-14 years) with liver tumors were retrieved from two Southern-Eastern European areas (Greece; 2001-2019 and Moscow; 2012-2019). Kaplan-Meier curves were constructed, and OS values were derived from Cox proportional models controlling for study variables. Results A total of 171 newly diagnosed cases (54.4% males) were included. The OS5-year exceeded 80% in patients Conclusions Outcomes of patients with liver tumors registered in two SEE areas were comparable to those reported by major collaborative trials. Ongoing clinical cancer registration could facilitate comparison of outcomes between different study groups in order to shape state of the art of treatment.

The article describes the modern methods of diagnosis and treatment of patients with burn strictures of the esophagus. It describes the tactics of planning and supporting dilatation procedures, the reasons for complications and their prevention methods. We are discussing proposed and existing methods bougie with flexible conductor, which allows to minimize the radiological control during medical procedures.

The growing opportunities of the civil society institution and its specific influence on the processes occurring at the current stage of economic development highlights the current importance of this study. This necessitates an objective need to examine the concept and essence of welfare state (social state), as well as to analyze the civil society as an element influencing its formation, ensuring the prospects of development and formation of real rule-of-law democratic state. Thus, this article aims to study the current state of civil society institution and to justify the need for ensuring the high level of social security for its citizens, on the basis of social partnership and social responsibility of the state, business structures and civil society. The main research methods that enabled to comprehensively examine the studied problem were the analysis of theoretical and regulatory legal acts, study of the foreign experience. The article presents the results of legal regulation analysis and problems related to the formation of civil society institution in Kazakhstan.

In thin ferromagnetic films with perpendicular anisotropy, there exist stable large-radius dynamic topological solitons, which are stabilized owing to conservation of the orbital angular momentum of the magnetization field. The solitons can also exist if the projection of the total spin moment of the magnet onto the easy axis is not conserved, i.e., in the absence of pure uniaxial symmetry of the model. Even in the pure uniaxial case, the magnetization distribution in a soliton with a sufficiently large radius differs significantly from centrosymmetric.

Coupons of stainless steel, Inconel, beryllium, copper and aluminium bronze were exposed to tritium in hydrogen gas mixtures over a wide range of parameters: temperature up to 770 K, pressure from 1 × 10−4 MPa to 0.05 MPa, tritium concentration from 1 at.% to 98 at.%. The tritium concentration on the surface and distribution through the metals were measured using radiography, radioluminography, β-ray induced X-ray spectroscopy and acid etching methods. The effect of metal processing, such as forging, polishing and heat treatment on the tritium distribution was studied along with parameters relating to the exposure of the metal to tritium.

To develop a system to define the degree of liver disruption and severity of portal hypertension in children based on the International Classification of Functioning, Disability and Health (ICF).Studied the results of laboratory and instrumental methods 382 children: 267 patients with various liver diseases, including 49 patients who underwent liver transplantation, and 115 children without liver disease.Based on analysis of statistical data obtained were identified 10 indicators, a set of changes which can be used to assess the degree of disruption of the structure of the liver and the severity of portal hypertension: indicators that reflect the severity of fibrosis and cirrhosis of the liver (METAVIR score on a scale at fibroelastometrii, scores are Desmet at morphological study of the liver) and indicators that reflect the severity of portal hypertension (the diameter of the portal vein, splenic vein diameter, the length of the spleen, recanalization of the umbilical vein, esophageal varices, ascites, hydropericardium, hydrothorax). Each of the indicators was assessed on a 5-point system. Number of points reflects the sum of the changes of these parameters. Decrease the number of points on 0-4% (38-40 points) is regarded as a lack of structural failure of the liver and the severity of portal hypertension by 5-24% (30-37 points)--minor violations on 25-49% (20-29 points) -moderation disorders, 50-95% (3-12 points)--severe handicaps, 96-100% (0-2 points)--absolute violation. Studied the dynamics of children with autoimmune hepatitis, Wilson's disease and chronic hepatitis C.The proposed scoring system for assessing the degree of disruption of the structure of the liver and the severity of portal hypertension can be used as an objective criterion of the severity of the pathological process, to estimate the dynamics of defeat against the background of the therapy, determining the prognosis of the disease and as a criterion of the indications for liver transplantation.

Objective : Our aim was to on the basis of determining the degree of violation of the structure and function of the liver establish their relationships and to assess the dynamics of liver disease in its chronic illnesses in children. Methods : With the help of the developed scoring systems were used to assess the degree of liver dysfunction and the degree of disruption of the structure of the liver and the severity of portal hypertension. Results : The results of the diagnostic methods 252 children aged 1 to 17 years (mean age of 11.8±3,5) with Wilson disease (WD), autoimmune hepatitis (AIH), chronic hepatitis C (CHC) were analyzed; 48 patients underwent liver transplantation. In children with WD, AIH and CHC liver function reduced by 41.3±12.9 % to 28.8±12.5% and 19.1±7.8% respectively. Structure of the liver in children with WD, AIH and CHC was disturbed by 25.0±8.1% to 20.4±9.2% and 6.8±4.4% respectively. The function and structure violations of the liver more pronounced in liver cirrhosis. The use of the developed scoring systems to monitor the severity of liver damage in the dynamics and evaluation of the effectiveness of the therapy is demonstrated. The degree of liver dysfunction is directly dependent on the degree of its structure. Abnormal liver function ≥40% and ≥40% of its structure with treatment failure can be used as a criterion of indications for elective liver transplantation with its chronic diseases in children. Conclusion : Developed a point system to determine liver function and a point system to determine disruption of the structure of the liver and the severity of portal hypertension in children can serve as an objective criterion for assessing the severity of liver disease, monitoring their changes in the dynamics with the assessment of the effectiveness of the therapy and making decisions about the need for routine liver transplantation in its chronic illnesses in children.

Investigation of binary (Pd20Ag) and V-1 (Pd15Ag0.6Pt0.6Ru1.0Au0.2Al) alloys as a material for a palladium diffuser in an ITER Fuel Clean-Up System has been performed. Tritium exposure was as long as 2300 h. Calculated He-3 concentrations in the alloys reached 600 and 500 appm respectively. It was shown that after an initial increase of the alloy lattice parameter, its further decrease took place. Positron spectroscopy data have shown that simple defect concentration in the alloys was stable, but Helium bubble size and its concentration rose significantly during Tritium exposure. By microstructure investigation it was shown that Helium bubbles nucleation was uniform through the whole grain volume but bubble growth was observed predominantly along dislocations and grain boundaries. Tensile property investigations at high temperature (400 °C) have revealed a significant elasticity decrease in the alloys under study.

Pd–Ag alloys, a material for palladium diffuser of the ITER fuel clean-up system, were investigated after long-term usage exposition in tritium. Nucleation and evolution of the alloy structure defects as a result of a radiogenic helium-3 accumulation have been examined using electron microscopy, positron annihilation and X-ray analysis. The types of helium containing defects and their characteristics were determined. The early stage of helium bubbles forming was observed. It was shown that the simple defect concentration decreased slowly and helium-3 bubble sizes and concentration increased during the tritium exposure.

The results of a study of the properties of aerogel manufactured at the Laboratory of Nuclear Problems, Joint Institute for Nuclear Research, are presented. The technology of the production of aerogel samples and the optical characteristics of these samples are briefly described. A formula relating the refractive index of the aerogel to its density with regard to the dispersion of light is analyzed. The results of testing of an aerogel threshold Cerenkov counter are presented. Testing was performed using a beam of charged particles with momenta p ranging from p = ∼ 0.4–2.5 GeV/с. The efficiency of pion detection with p ≥ 1 GeV/с was ∼97%; the efficiency of proton detection with p ≤ 2.5 GeV/c, ∼4%.

The stable topological solitons with a small radius exist for ferromagnets with not small anisotropy. Even in the case of rather strong planar anisotropy, the spatial anisotropy of the soliton solution turns out to be so small that a soliton in dynamical experiments behaves similar to that for the case of a purely uniaxial model.

Malignant rhabdoid tumor (MRT) of the liver is a rare, highly aggressive tumor of early childhood. We report a 6-month-old boy who was diagnosed with MRT of the liver and presented with spontaneous tumor rupture. The patient underwent intensified chemotherapy and a radical surgical procedure. Twenty four months from the time of the diagnosis, he is alive without evidence of disease. This is the second report of prolonged survival after initial rupture of hepatic MRT.

This article presents the analysis of 24384 endoscopic investigations of the upper gastrointestinal tract in population of Leningrad region with symptoms of dyspepsia during the period 2007-2011.The results revealed erosive esophagitis in 5.4%, peptic strictures of the esophagus--0.2%, the columnar-lining esophagus (Barrett's esophagus)--1.1%, and esophageal adenocarcinoma--0.045%. This data shows a high prevalence of esophageal complications of GERD in a local population of Russians.

The investigation of life-time properties of Russian industrial Pd-membrane alloy V-1, as a material for a palladium diffuser of the ITER Fuel Clean-Up System, has been continued. The saturation experiment with duration up to 2004 h has been performed. The calculated helium-3 concentration in the samples was 466 appm. Investigation of the samples after exposure showed that mechanical properties were slightly changed. The lattice parameter was slowly decreased. Positron annihilation treatment showed that simple defect concentration was slowly decreased, and that the helium-3 bubble sizes and He-3 concentration were significantly increased during the exposure. Microstructures of the specimens showed a uniform distribution of helium-3 bubbles inside the grains.

The article presents an analysis of results of 24 384 endoscopic examinations of the upper gastrointestinal tract in population of the Leningrad oblast with symptoms of gastric dyspepsia during the period from 2007 to 2011. The detection of the columnar-celled metaplasia was 1.1%, adenocarcinoma of the esophagus--0.045%. Esophageal adenocarcinoma occurred in 3.95% of cases of the column-celled esophagus. Barrett's esophagus was revealed in males more often than in women (56.5% and 54.5% respectively). The peak incidence of esophageal adenocarcinoma in males was at the age from 46 to 60 years (36.4% of patients), in females--from 61 to 75 years (27.3% of patients). Intestinal metaplasia was detected in 72.7% of cases with esophageal adenocarcinoma: The diagnosis of long and short segment of column-celled esophagus revealed no significant difference in the development of esophageal adenocarcinoma.

To analyze the results of repeated reconstructions of choleresis after living related liver fragments transplantation.The study included 268 recipients (145 women and 123 men) aged 5 months - 61 years (mean age 16,11 ± 14,62 years) who underwent liver fragments transplantation in the department of liver transplantation of cad. B.V. Petrovskiy Russian Research Surgery Center from 1997 to 2012. Biliary reconstructions were performed at different terms after transplantation in 37 patients (13.81%). Complications followed repeated reconstructions, the initial conditions for biliary anastomosis formation during transplantation, the results of biliary reconstructions after transplantation were analyzed.In most cases despite the prevailing complications there is a combination of various biliary complications requiring biliary reconstruction. It was found that live rfragment used for transplantation, type of primary reconstruction of choler sis, number of bile ducts orifices of graft and biliary anastomoses do not demonstrate statistically significant effect on the incidence of post-transplant biliary reconstructions (p0.05). Poor prognosis in patients with biliary complications required biliary reconstructionsis determined by the development of graft dysfunction. Early reconstruction before development of liver transplant dysfunction is necessary condition of successful treatment. In the case of graft dysfunction liver retransplantation is unique method of treatment.Цель - проанализировать результаты повторных реконструкций желчеотведения после родственных трансплантаций фрагментов печени. Материал и методы. В исследование включены 268 реципиентов (145 женщин и 123 мужчины) в возрасте от 5 мес до 61 года (средний - 16,11±14,62 года), которым с 1997 по 2012 г. в отделении трансплантации печени Российского научного центра хирургии им. акад. Б.В. Петровского были выполнены трансплантации различных фрагментов печени. В различные сроки после трансплантации у 37 (13,81%) из этих пациентов выполнены билиарные реконструкции. Проанализированы спектр осложнений, послуживших показанием к выполнению повторных реконструкций, исходные условия формирования билиарного анастомоза при трансплантации, результаты выполненных после трансплантации реконструкций желчеотведения. Результаты. Чаще всего, несмотря на наличие превалирующего осложнения, имеет место сочетание различных билиарных осложнений, определяющих показания к выполнению билиарной реконструкции. Установлено, что ни вариант используемого при трансплантации фрагмента печени, ни вид первичной реконструкции желчеотведения, ни количество устьев желчных протоков трансплантата и формируемых билиарных анастомозов не демонстрируют статистически значимого влияния на частоту выполняемых после трансплантации билиарных реконструкций (р0,05). Неблагоприятный прогноз у пациентов с билиарными осложнениями, потребовавшими выполнения билиарных реконструкций, определяется развитием дисфункции трансплантата. Условием благополучного лечения пациентов является раннее выполнение реконструкции, до развития дисфункции трансплантата печени. В случаях ее развития единственным возможным методом лечения является своевременное выполнение ретрансплантации печени.

From 1997 to 2003 transplantation of liver's right lobe from alive related donor was performed in 64 patients (28 men, 36 women) aged from 6 to 61 years (mean age was 22.6 +/- 3.2 years). Body weight of recipients ranged from 18 to 92 Kg (52.7 +/- 2.8 Kg on average). Indications for surgery were following: cirrhosis of liver due to Wilson's disease (34), primary sclerotic cholangitis (6), viral cirrhosis of liver (6), primary biliary cirrhosis (4), Bayler's disease (3), Caroly's disease (3), Budd-Chiary syndrome (3), secondary biliary cirrhosis (2), cirrhosis of liver due to deficient of alpha(1)-antitrypsin (1), hepatocellular carcinoma (1), total nodular transformation of liver (1). Intensive care before transplantation was needed for 68.75% potential recipients. Donors of liver's right lobe were relatives of patients similar to blood group. Age of donors ranged from 18 to 49 years, mean age was 37.9 +/- 1.4 years. Donors underwent right-sided hemihepatectomy, there were no complications. Lethal outcome in recipients was seen in 2 (3.1%) cases and was not associated with function of transplant. Lethal outcome in long-term period after transplantation was seen in 4 (6.5%) cases. All the others patients survived and followed from 1 to 73 months (23.8 +/- 2.4 months on average). Quality of life was good. Transplantation of liver's right lobe from related donor is the independent line in orthotopic transplantation of liver and ensure reliable results.

Illustrated with case history (patient F), the authors represented diagnosis, prognosis, treatment, long-term consequences of local radiation lesions.

Today cryogenic circulating systems are used in many branches of technology as cryostats for superconducting devices and in cryogenic vacuum pumps where a high vacuum or a high capacity is required. One of the most important elements in these systems is the flow driver - the device which causes the cryogenic liquid to circulate. Systems which include a mechanical or jet pump are widely used, as are those in which the liquid is circulated by a compressor in a single-loop system. The operational principle of a new device for circulating cryogenic liquid - an expander pump - is as follows. Previously compressed gas, with a temperature somewhat higher than the saturation temperature, expands in a cylinder and does work by pumping the liquid. At the end of the expansion process, part of the working gas condenses and can completely or partially compensate the loss of liquid in the utilization loop. The use of an expander pump has many advantages over other flow drivers. These advantages are discussed.

The use of relative donors in the transplantation of the liver has shown a good performance as an alternative line in its orthotopical grafting. Shortage of donor organs actively stimulates the development of relative transplantation. The main problem of relative hepatic transplantation is the limited capacity of obtaining a required mass of a hepatic graft for obese recipients. To settle this problem, the Russian Surgery Research Center, Russian Academy of Medical Sciences, has developed an original safe procedure for obtaining the right lobe of the liver from an alive relative donor and for implanting it in a recipient. In November 1997 to October 2001, transplantation of the right hepatic lobe from an alive relative donor was made in 23 recipients (10 males and 13 females aged 9 to 55 (mean 22.3 +/- 3.1) years. Their body weight was 24 to 80 (mean 51.4 +/- 3.0) kg. Indications for surgery were as follows: hepatic cirrhosis (HC) at the end stage of the Wilson-Konovalov disease (n = 10), primary sclerotic cholangitis (n = 4), HC of viral etiology (n = 3), Bailer's disease (n = 2), primary biliary HC (n = 2), HC in the presence of alpha 1-antitrypsin deficiency (n = 1), and secondary biliary HC (n = 1). The donors of the right lobe of the liver were recipients' mothers in 9 cases, their fathers in 6 cases, sisters in 2 cases, sons in 1 cases, their daughter, brother, aunt, cousin in 1 case each. The donors' age ranged from 19 to 49 (mean 37.9 +/- 1.4) years. The donors underwent right hemihepatectomy, complications were absent in them. There were early mortality among the recipients. Two patients died in the late postoperative period. The remaining 21 recipients were survivors and followed up for 1 to 48 (mean 14.9 +/- 2.9) months. Their life quality was good. The use of the right lobe of the liver from an alive relative donor is the optimum alternative to transplantation of the cadaverous liver and partially compensates the shortage of donor organs for children, adolescents, and adults.

A comparative study was performed of general balanced anesthesia on the basis of neuroleptic analgesia (NLA) and inhalation low- and minimal-flow anesthesia with isoflurane in anesthesiological management of extensive operations on the liver. A total of 75 anesthesias were conducted. Because of low hepatotoxicity, absence of its metabolites' pharmacological activity, fast elimination from the body unchanged, isoflurane is effective in long and traumatic operations on the liver. Low-flow isoflurane significantly lowers pharmacological load with opiates, myorelaxants which is essential in patients with hepatic diseases. This leads to more rapid recovery of adequate spontaneous respiration and activation of the patient in low risk of postoperative iatrogenic complications.

The unique in Russia experience of 35 liver transplantations since 1990 has revealed benefits of the method and quite encouraging results with 81% survival of the recipients. But the extreme shortage of cadaveric donor organs followed by more than 60 per cent mortality in waiting list and absence of any real facilities to improve the situation dictate the living related donation to become a considerable alternative. Totally 12 living related liver transplant procedures were performed with no morbidity in donors. In 7 donors the routine surgical technique of harvesting were used to get left lateral segment in five and whole left lobe in two cases. The unique twin-to-twin liver left lobe donation with no consequent immunosuppression was observed in this series. New special technique of living donor surgery was successfully developed for liver right lobe harvesting. The living related liver right lobe replacement was used in 5 cases and appeared to become a real compensation of donor organs shortage for elder children with body weight more than 20 kg and adults.

The choice of anesthesia for a high risk operation, orthotopic transplantation of the liver (OTL), is discussed. The authors propose a protocol of anesthesia for OTL. For induction anesthesia, intravenous drugs should be preferred; the liver-free stage of the operation is carried out under anesthesia with a closed isoflurane contour, and the initial metabolic disorders of patients are corrected. When the bloodflow is let in the transplanted organ, intravenous drugs (ketamine, phentanyl, and benzodiazepines) should be administered in order to reduce the vasodilating effect of isoflurane and vasopressors for preventing relative hypovolemia. At the final stage of anesthesia, isoflurane is used. Before transporting the patient into intensive care ward, phentanyl in a dose of 1.5-3 micrograms/kg was injected, because of rapid elimination of isoflurane and awakening of the patient. This protocol maintained the hemodynamics and the major metabolic parameters at the optimal level.