Search

A review of the literature on one of the methods of treatment of unresectable primary and metastatic liver cancer, namely radio embolization, is presented. A detailed description of the procedure for performing radioembolization of the liver vessels, possible complications, indications and contraindications to this method, lists the necessary equipment and tools. Particular attention is paid to the description of the microspheres used in radioembolization. A modern review of clinical studies, including those still unfinished, devoted to the method of radioembolization with unresectable primary and metastatic liver cancer is given.

Background. Minimally invasive surgery techniques are widely used in the treatment of primary and metastatic liver cancer. Objective. The goal was to evaluate the effect of the endovascular access on the efficiency and safety of chemoembolization of liver arteries (CELA) in patients with unresectable liver metastases. Methods. In 30 patients with unresectable liver metastases, CELA was performed using the transradial and transfemoral approaches. The microcatheter technique was used for superselective chemoembolization of the liver arteries with introduction of drug-saturated microspheres (HepaSphere). All the digital material was statistically processed using the STATISTICA 6.0 software package (StatSoft, 2001). The results were considered statistically significant at p0.05. Results. In the normal type of the blood supply to the liver, only the left radial access with only the right hepatic artery embolization demonstrated a significantly shorter duration of CELA and fluoroscopy, which amounted to 334.3 min and 9.91.3 min, respectively (p0.05). When performing CELA by means of microspheres 50100 um from the right femoral access with embolization of only the right hepatic artery, the above assessment criteria were the highest 6711 min and 19.15.3 min, respectively, but without a significant difference between the other options for the puncture access. During the first CELA using a femoral access, the postoperative hospital stay in the studied group of patients was 70.8 days, and the postembolization period lasted 1.430.5 days, which is significantly longer (at p0.05) in comparison with the same parameters for the right radial arterial access, for which they were 30.6 days and 1.150.4 days, respectively, and for the left radial arterial access, for which they were 40.5 days and 10.001 days,respectively. Conclusion. The use microspheres as a embolization material allowed the application of the microcatheter technique for hqTACE, and expanded the possibilities of the transradial access. A significantly better tolerance and safety of the transradial access was proven in 76.2% of the studied patients in whom it was applicable. The repetitions of CELA donot affect the severity of the post-embolization period, partially due to a lowered use of the contrast medium and superselective embolization of the affected areas of the liver with the preservation of a more intact parenchyma.

The aim of this study was to introduce a clinical example of a one-time hybrid reconstruction of symptomatic occlusion of the right subclavian artery with subclavian steal syndrome and critical stenosis of the brachiocephalic trunk in a patient after an aorto-femoral bifurcation bypass surgery and multiple reconstructions of distal anastomoses.

Aim. To assess overall survival and recurrence-free period in patients with locally advanced pancreatic cancer who underwent irreversible electroporation of the tumor in combination with chemotherapy. Matherials and methods. It was performed a prospective analysis of overall survival in 23 patients who underwent irreversible electroporation of unresectable pancreatic cancer for the period from May 2012 to March 2017. Control group consisted of 35 patients with pancreatic cancer stage III who received standard chemotherapy alone. Results. Mean age of patients was 61 years (range 45–80). All procedures were successful. Fifteen patients had pancreatic head cancer, 8 – cancer of pancreatic body. Preoperative chemotherapy has been applied in 20 (86.9%) patients for 4 months prior to surgery on the average. Seventeen (73%) patients underwent chemotherapy after electroporation procedure. 90-day mortality was 4.3% (n = 1) in electroporation group. Surgery was followed by improved local recurrence-free survival (12 and 6 months, respectively, p = 0.01) and distant recurrence-free survival (15 and 8 months, respectively, p = 0.03). Overall survival was 18 and 11 months, respectively (p = 0.03). Conclusion. Irreversible electroporation of locally advanced pancreatic cancer is safe. Four-month chemotherapy followed by surgical procedure is associated with good local response and better overall survival compared with chemotherapy alone. These data will be validated in further multicenter study.

Cervical pregnancy is a currently important medical and social problem, characterized by relatively high mortality and often leads to a loss of fertility in women of reproductive age. This clinical case demonstrates a possible approach of conservative therapy in conditions of excessive bleeding in women interested in the reservation of reproductive function, using high-tech minimally invasive methods of treatment in combination with chemotherapy.

Introduction: Advanced cases of carcinomas with parametrial and fornix infiltration often cause massive genital bleeding, with severe anemia, fast deterioration, and a high risk of death for patients. One method of stoped bleeding is transarterial chemoembolization, which has been studied. Methods: Seven women with advanced uterine and cervix cancer or the pelvic locoregional recurrence withgenital massive bleeding were treated using an endovascular therapy (transarterial chemoembolization (TACE) using cisplatin or doxorubicin or gemcitabine). Ware used HepaSphere (Bioshere Medical, France) filled with saturated 50 mg doxorubicin or 500 mg gemcitabine or 50 mg cisplatin. Results: On average, the total operative time for the procedure was 52 minutes. In all cases, the achieved control bleeding. By the 7th day were signs of reduction in tumor size, 1/3 of its original size. The maximum effect on the tumor size was achieved within 14-20 days. In 2 cases, chemoembolization performed twice at an interval of 21 to 28 days, due to a good picture of the ultrasound tumor vascularization. All operations are carried out under the I/V anesthesia and we had no adverse reactions or complications. Conclusions: Arterial chemoembolization dominant vessels tumor is a reliable method of stopping the genital bleeding at any time during of the planned treatment. It is to improve the quality of life of patients. Antitumor efficacy of drug has a lasting effect. The method is applicable as a minimally invasive, effective for treatment of cancer patients.

The clinical observations showing the diagnostic and therapeutic capacities of minimally invasive percutaneous roentgen-surgical techniques in the diagnosis and treatment of hepatopancreatoduodenal zone diseases are presented. In these cases, the use of minimally invasive surgical techniques on various stages of diagnosis and treatment have helped to correct diagnosis, and effective treatment, discarding traditional traumatic surgery. In the first clinical observation percutaneous radiosurgical method drainage of an abscess of the liver allowed to reveal chronic form of fascioliasis and conduct specific treatment. In the second - to establish the cause of recurrent subhepatic abscess, in the third-to remove concrements of common bile duct, if unable to perform open surgery or endoscopic papillosfinkterotomiya and remove concrements. Common to all three clinical observations is the fact that up to minimally invasive roentgen-surgical methods of treatment were carried out public activities, which for various reasons proved ineffective. The latest minimally invasive radiosurgical methods allow not only to establish an accurate diagnosis, but may be intermediate or final treatment.This is especially important in severe patients at impossibility of the surgery and if necessary, stabilization of the general status and improving metabolic and functional parameters of the upcoming radical operation. In most cases, a variety of minimally invasive surgical techniques are not competing among themselves, but only complement or substitute one another in every concrete clinical situation.

One possible cause of resistant abdominal pain syndrome is a chronic intestinal ischemia caused by varying degrees of occlusion of the mesenteric vessels. Due to the variety of clinical manifestations, just noticeable their specificity and lack of awareness of general practitioners timely diagnosis of the syndrome of chronic abdominal ischemia is difficult. The main methods of diagnosis at this stage are: ultrasound duplex scanning, spiral computed tomography, magnetic resonance computed tomography angiography in the mode of indirect and direct angiography. The method of choice of surgical treatment is percutaneous transluminal angioplasty and stenting of the arteries.

The present report describes a 80-year old female suffering from shortness of breath, chest pain and weakness by reason of critical aortic stenosis. The patient with high risk open surgical intervention successfully underwent miniinvasive treatment – transcateter aortic valve implantation (TAVI).

It is described the clinical case of a rare disease – cholangiocarcinoma of the common bile duct, which developed in patient with chronic pseudotumor-like pancreatitis. It is reflected the complexity of diagnosis at an early stage of the disease. The method of confocal laser endomicroscopy was for the first time applied for the given pathology for diagnostic purposes that allowed to clarify and verify the diagnosis. The authors suggest that in diseases of the pancreato-biliary zone the method of confocal laser endomicroscopy can be crucial in cases of inefficiency or uninformativeness of other methods.

Report and literature review of the rare disease – celiac trunk compression syndrome are presented. We discuss as typical manifestations of disease, and the most controversial aspects of the pathogenesis, diagnosis and treatment. We propose a diagnostic algorithm for early detection of the disease, and show that to achieve a good effect, may be required several stages of intervention. With the accumulation and codifying of experience it is possible to develop a more detailed indications to different types of surgery.

The article is dedicated to actual problem of diagnostic and treatment of patients with mechan- ical jaundice of different genesis. The authors consider that using of low invasive methods of biliar decompression – endoscopic and transcutaneous – is of great importance now. It is described effi- ciency, indications and contraindications for each low invasive method in details. The authors offer their own algorithm of diagnostic and treatment in patients with mechanical jaundice.

Методика эндопротезирования аневризм брюшной аорты за последние десятилетия используется все более часто. Данное вмешательство показано пациентам с высоким хирургическим и анестезиологическим риском открытого оперативного пособия. Рассматривается опыт 29 эндопротезирований аневризм брюшной аорты EXLUDER Core у пожилых пациентов с высоким риском открытого оперативного вмешательства. В ближайшем и отдаленном периоде летальных исходов не отмечено. После эндопротезирования аневризмы брюшной аорты не отмечено кардиальных и дыхательных осложнений в ближайшие сроки после операции. При динамическом наблюдении (1, 6, 12 мес. после операции) пациентов при компьютерной томографии осложнений (миграции эндопротеза, увеличение диаметра аневризмы, эндоликов I типа) не отмечено. Таким образом, эндопротезирование аневризмы брюшной аорты является методом выбора для пациентов группы высокого риска.

This research is devoted to analyzing of the case of pulmonary embolism in a young woman with deep vein thrombosis taking oral contraceptives and successfully treated by surgical methods. Pulmonary angiography performed in patient L. allowed to confirm the diagnosis ofpulmonary embolism and reveal the localization of the thrombus. The treatment included selective thrombolysis by actilyse through catheter in the pulmonary artery. The treatment was not only non-invasive but included surgical intervention. Using of invasive methods, thrombolysis and anticoagulant medication allowed to stabilize the condition of the patient and prevent development of right ventricular failure.

Uterine arteriovenous malformation (AVM) is a rare condition. Congenital AVMs have multiple vascular connections, may manifest at other sites, and involve surrounding structures, whereas acquired AVMs usually have a single connection between an artery and a vein. AVMs may be diagnosed by Doppler ultrasonography, computed tomography, magnetic resonance imaging and angiography. The article presents the literature and case report of AVM with the tactics of treatment of rare diseases.

A complex physicomathematical analysis of vacuum sublimation drying has been given. Approaches to calculation and designing of sublimation dryers have been proposed.

Are clinical observations of various diseases of the bile ducts, including cholangiocarcinoma, developed with chronic diseases pancreato-biliary zone. Reflected the complexity of instrumental diagnostics at an early stage of the disease. For the first time at the given pathology diagnostic purposes was applied the method of probe confocal laser endomicroscopy allowed in all cases to clarify and verify the diagnosis. Describes the technique of the research, its results are compared with other diagnostic methods. The authors suggest that in the diagnosis of pancreatic and biliary zone method probe confocal laser endomicroscopy can be crucial in inefficiency or uninformative other methods.

We describe a 56-years-old patient with spontaneous extracranial vertebral artery dissection, which was provoked by neck movements. Clinically dissection manifested with transient ischemic attacks in vertebrobasilar system which lasted during 3 months and often combined with occipital headache. Contrast angiography revealed subtotal stenosis of segment V1 of the right VA, extending from the ostium for a length of 1-1.5 cm with thread-like double lumen (true and false lumens). The rest part of V1 segment of the right VA was irregularly narrowed up to 40-50%. A good contrast filling of the rightVA beginning from segment V2 was carried out by the collateral circulation from thyreocervical trunk. No atherosclerotic plaques in extra- intracranial arteries were found. The patient was subjected to stenting of segment VI of right VA that resulted in a complete restoration of the arterial lumen. No postoperative complications were observed.

The authors report herein a successful therapeutic outcome in a patient presenting with a posttraumatic subclavian artery aneurysm complicated by an embolism to arteries of an upper extremity, treated by means of endovascular prosthetic repair combined with a bypass-grafting operation on the arteries of the upper limb involved. A detailed description of the methodology and the course of the operation is provided. In the postoperative period, the clinical manifestations of ischaemia of the upper limb were completely relieved. The outcome of the operation was confirmed by intraoperative angiography, as well as by postoperative duplex scanning.

Аномальное впадение одной или нескольких правых легочных вен в нижнюю полую вену в сочетании с гипоплазией правого легкого и смещением сердца вправо (декстракардией) получила название синдрома«турецкой сабли». Аномалия была впервые описана G. Cooper в 1836 году на аутопсийном материале. Данная патология является редкой врожденной аномалией, встречающейся от 1 до 3 случаев на 100 000 новорожденных.Нами представлено крайне редкое наблюдение синдрома «турецкой сабли» у пациента старшей возрастной группы, иллюстрированное данными мультиспиральной компьютерной томографии с трехмерной реконструкцией.

Certain features of the mechanism for the growth of the condensed phase during desublimation of water vapor in vacuum are examined. Approximate equations are found for the duration of water-vapor desublimation on a flat plate.

We carried out an experimental investigation of the structure of the mass flow of a substance over a sublimating surface. It was shown that agitation of the medium over the sublimation surface leads to overheating of the surface of the material and increases the intensity of the process.

Experimental results are presented and computational dependences are obtained for the heat and mass transfer during sublimation of ice.

It has been established that the temperature or corresponding pressure gradient created by radiant heating is the motive force of the sublimation process. A reduction of temperature at the phase interface causes the crystallization (desublimation) of migrating vapor molecules on the surface. The branchlike growth of the crystals is accompanied by the eventual separation and entrainment of the individual branches, which characterizes the molar-molecular sublimation process.

A photographic study was conducted of the sublimation mechanism for water, in a single macroscopic capillary,under vacuum, supplied radiatively with heat. It was found that the sublimation in a capillary is analogous to that in a body with capillary pores.

On the basis of experimental studies of the temperature fields over a permeable plate during ice-water sublimation from it into a vacuum, we propose an explanation for the mechanism of heat and mass transfer.

Vacuum sublimation and condensation (desublimation) curves have been obtained with thermal flux probes. The results are used as a basis for optimizing the process parameters in vacuum-sublimation drying.

The mean effective thermal conductivity and the density of ice desublimated under vacuum have been determined experimentally. It is shown that the desublimation rate becomes maximum within the 1.0–2.5 mm Hg pressure range.

Results are given of visual and cinephotographic observations on a film model (containing a grid) of the sublimation mechanism of ice for a capillary body under vacuum under conditions of continuous water supply.

The thermal resistance of vacuum-shield insulation is evaluated on the basis of earlier test data [1] on the anisotropy of heat conduction through it.

The effect of various ions on the process of crystallization (desublimation) on the sublimating surface of samples of polycrystalline ice in a vacuum with radiant heat supply is studied. Extremal effects of great crystal growth were discovered upon change in the pH of the polycrystal (liquid phase) and for certain ions in the ice crystalline lattice.

Experimental data for the thermal conductivity parallel to the layers of vacuum-screen insulation at various temperatures and vacua of 760-5 · 10−7 mm Hg are given. The anisotropy of the thermal conductivity is determined.