Loss Volume Research Articles

The effect of coexisting autoimmune thyroiditis in children with Type 1 diabetes on optical coherence tomography results.

To assess the influence of thyroid hormones status and coexistence of autoimmune thyroiditis on optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) results in children with Type 1 diabetes (T1D). In the prospective, observational study (n = 175) we analyzed the impact of thyroid hormones on OCT results and the differences between the matched groups of children with T1D (n = 84; age = 13.14 ± 3.6; diabetes duration = 5.99 ± 3.3 years) and the children with T1D and autoimmune thyroiditis (AT) (n = 20; age = 13.94 ± 3.6; diabetes duration = 6.7 ± 4 years). We analyzed the following parameters: fovea avascular zone (FAZ), foveal thickness (FT), parafoveal thickness (PFT), ganglion cell complex (GCC), loss volume (global-GLV, focal-FLV), capillary vessel density: superficial (whole-wsVD, foveal-fsVD, parafoveal-psVD), and deep (whole-wdVD, foveal-fdVD, parafoveal-pdVD. The differences between the groups were tested by the unpaired t-Student test, Mann-Whitney U test as appropriate, whereas p level .05 was recognized as significant. We detected the significant correlations between thyroid-stimulating hormone (TSH) level and PFT (r = -0.14; p < .05), psVD (r = -0.18; p < .005). The level of free triiodothyronine (FT3) was correlated with psVD (r = -0.14; p < .05). We found significant correlation between free thyroxine (FT4) and fsVD (r = -0.17; p < .01). In the studied T1D and AT groups there were statistical differences in FT (p < .005), PFT (p < .03), GCC (p < .01), and GLV (p < .003). We did not observe any significant differences in the FAZ area between the groups. In our patients the co-occurrence of T1D and AT worsens the status of retinal parameters. Further studies are necessary to observe these relations and their potential influence on the occurrence of diabetic retinopathy (DR).

Comparison of using fractionated and unfractionated heparins after primary hip and knee arthroplasty in patients receiving programmed hemodialysis

INTRODUCTION . The risk of femoral neck fractures in hemodialysis patients is estimated at 25.6 per 1000 people per year. Hip arthroplasty is the treatment choice in these patients. One of the causes of general somatic complications is the significantly more frequent formation of blood clots. PATIENTS AND METHODS . The material for the study was data on 96 hemodialysis patients who underwent primary hip arthroplasty in the period from 2016 to 2019. THE AIM. Сomparison of various algorithms for the use of fractionated and unfractionated heparins after primary hip and knee arthroplasty in patients receiving programmed hemodialysis. RESULTS . The largest number of thrombosis was noted in group 1 (heparin was used only during hemodialysis procedures): in 4 patients (16.6 %), in group 4 (using fractionated heparin both during hemodialysis procedures and on interdialysis days): in 2 patients (8 %). When comparing the volume of the evacuated hematoma, the statistically significant volume was in group 2 (with the use of un fractionated heparin both during dialysis and on interdialysis days), on average 98 ± 52 ml. In the same group, the greatest number of infectious complications was noted: in 5 patients (21.8 %); in group 4: in 2 patients (8 %). CONCLUSION . Conducting thromboprophylaxis in hemodialysis patients after arthroplasty of major joints with fractionated heparins, both during the hemodialysis procedure and on interdialysis days, can reduce the number of thromboembolic complications to 8 % (16.6 % with the traditional method). Affect on the volume of blood loss and blood transfusion not statistically significant. At the same time, there is a significant decrease in the level of potassium by 8.8 %, total cholesterol by 7.3 %, triglycerides by 11.7 % with the daily use of fractionated heparins.

The Choice of Anesthesia During Organ-Saving Operations Concerning Patients With Placenta Accreta Spectrum Disorders

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

Results of prevention of massive postural bleeding in women with preeclampsy

Objective. To evaluate the effectiveness of a tranexamic acid for the prevention of critical bleeding in women with preeclampsia.&#x0D; Materials and methods. 31 puerperas with postpartum hypotonic bleeding. Inclusion criteria: reproductive age, severe preeclampsia, postpartum hemorrhage, volume of blood loss – 700 ml, voluntary consent to the administration of the tranexamic acid. Exclusion criteria: delivery by the caesarean section. When providing emergency care, along with other standard measures, 14 women (the main group) were injected with the tranexamic acid when blood loss reached 700 ml, 17 women (the comparison group) did not receive the tranexamic acid. Research methods: measurement of the volume of blood loss (by the calculation method and by the method of measuring blood loss), statistical analysis – comparison of populations by qualitative characteristics.&#x0D; Results and discussion. A bleeding with a blood loss of 700-800 ml was registered in 7 women of the main group and in 6 women of the comparison group, with a blood loss of 800-900 ml – in 6 and 4 women, with the blood loss 900-1000 ml – in 1 and 7 women, respectively. There was a significant difference in outcomes (blood loss – 900-1000 ml) depending on the use of the tranexamic acid (Fisher’s exact test – 0.04537; p&lt;0.05). Evaluation of the strength of the relationship between the frequency of aggravation of bleeding and the use of the tranexamic acid for the prevention of massive bleeding established a relationship of average strength (Cramer’s criterion – 0.387). Pregnant women with severe preeclampsia are at risk of the developing obstetric bleeding, which is associated with secondary changes in the hemostatic system in women with preeclampsia. With obstetric bleeding in women with preeclampsia, the balance between the coagulation, anti-coagulation and fibrinolytic systems is disturbed faster. Fibrinolysis is activated faster due to the limitation of thrombus formation due to the breakdown of fibrin in thrombi and the fibrinolytic properties of the fibrin breakdown products themselves. The use of the tranexamic acid in the obstetric bleeding is justified by the antifibrinolysis effect of the drug. Further research on the use of the tranexamic acid for the prevention of massive bleeding, confirmed by laboratory data, is highly relevant.&#x0D; Conclusions. The use of tranexamic acid with the onset of obstetric bleeding in women with risk factors for the secondary thrombocytopathy will prevent the aggravation of coagulopathy and reduce the incidence of massive obstetric bleeding caused by a disseminated intravascular coagulation.

Accidental perioperative hypothermia

The problem of perioperative hypothermia is still relevant. There are many reasons for that. One of them: a decrease in the patient’s body temperature during the operation often goes unnoticed, or is not perceived by medical staff as a serious complication. Perioperative unintentional hypothermia is a decrease in the patient’s core body temperature &lt;36 °C in the periods: 1 h before anesthesia, during surgery and 24 h after anesthesia. Usually a decrease in body temperature activates the hypothalamic mechanisms of thermoregulation, which provide first vasoconstriction, which reduces heat loss, and then the development of cold shivering (contractile thermogenesis) – heat production. Modern anesthetics affect the regulation of central temperature and lead to its reduction in the perioperative period. Unintentional intraoperative hypothermia accompanies many surgeries performed under general and regional anesthesia. It is perhaps the most important factor in the “triad of death” (hypovolemia, acidosis, hypothermia), which significantly increases the risk of complications, including: prolongation of the duration of action of anesthetics and muscle relaxants and the recovery period; increase in the volume of intraoperative blood loss; from the cardiovascular system complications up to fatal consequences; development of wound infection, increase in wound healing time; increasing the frequency of cold shivering, nausea and vomiting in the postoperative period. Thus, perioperative hypothermia leads to an increase in hospitalization and nosocomial mortality. An important role in the prevention and relief of perioperative hypothermia is played by the competence and motivation of the nurse to timely and effective action in all areas of the perioperative process using thermometry methods available in a specific medical institution (axillary, esophageal or tympanic), prevention of heat loss through the skin under the influence of the environment (room air temperature, operating and equipment), passive and active (convection systems) heating patients with a body temperature &lt;36 °C, rapid thawing and heating to 37 °C of allogeneic blood components. It is especially important during emergency operations, when it is necessary to start warming and temperature monitoring in the intensive care unit of the admission department.

Laparoscopic liver resection after laparoscopic pancreatoduodenectomy for liver metastases of ampulla of Vater adenocarcinoma

BackgroundRepeat laparoscopic surgery has become increasingly common. However, reports of liver resection after pancreatoduodenectomy are scarce, and we report the first successful case of a patient who underwent laparoscopic liver resection after laparoscopic pancreatoduodenectomy.Case presentationA 65-year-old man underwent laparoscopic pancreatoduodenectomy for ampulla of Vater adenocarcinoma. According to the American Joint Committee on Cancer (8th edition) staging guidelines, the tumour was labelled as stage IIIB (fT2N2M0). Twelve months later, a computed tomography (CT) scan revealed liver masses (in segments 3 and 5) and swollen para-aortic lymph nodes. After six chemotherapy courses of gemcitabine with cisplatin, the CT scan showed the disappearance of the para-aortic lymph nodes and progression of liver metastases. Nineteen months after the initial surgery, the patient underwent laparoscopic partial liver resection of segment 5 and left lateral sectionectomy. First, we performed the operation in the left half lateral decubitus position. In this position, the portal vein was isolated safely without hindering the hepato-jejunal anastomosis, although the adhesions around the hepato-jejunal anastomosis were dense. Therefore, we were able to perform liver transection safely with vascular inflow control. The operation duration was 235 min, and the volume of blood loss was 100 g. Macroscopically, the resected margins were negative. The patient was uneventfully discharged 12 days after the second operation. Afterwards, drainage was needed because of an intra-abdominal abscess. Currently, he has been alive for 8 months postoperatively, receives chemotherapy to suppress para-aortic lymph node metastases, and has not had another recurrence.ConclusionsLiver resection after pancreatoduodenectomy can be performed safely with an innovative body position to isolate the portal vein, which is a key point of the surgery. A laparoscopic approach for liver resection after pancreatoduodenectomy is a feasible option.

Usage of laparoscopic bilateral nephrectomy in combination with mini-laparotomy in the treatment of patients with autosomal dominant polycystic kidney disease and end-stage chronic renal failure

Introduction. Laparoscopic bilateral nephrectomy for autosomal dominant polycystic kidney disease has many advantages over open surgery, but a significant disadvantage is the long duration of the intervention, and the need to create access for extraction of large kidneys minimizes the cosmetic effect. Purpose of the study . To improve the outcomes of bilateral nephrectomy in patients with autosomal-dominant polycystic kidney disease. Materials and methods . Study design: a single-centre, retro- and prospective study from 2010 to March 2020, including 72 patients who underwent bilateral nephrectomy. The patients were divided into three groups depending on the nature of the operation: Group I (n = 42), midline laparotomy; Group II (n = 16), laparoscopic surgery and group III (n = 15), combined nephrectomy (the laparoscopic stage included the separation of the vessels of the kidney and ureter, separation of the kidney from the adrenal gland; then, the kidneys were mobilized and removed from the upper midline mini-laparotomy. Results. In group I, the median duration of surgery was 120 min (Q1 - Q3: 110 - 150), in group II — 205 min (Q1 - Q3: 192 - 267) and in the third — 165 min (Q1 - Q3: 145 - 175). The operation time in the third group was significantly higher than in the first (p = 0.049) and significantly lower than in the second group (p = 0.034). There was no significant difference between the groups (p = 0.125) comparing the volume of intraoperative blood loss. There was no significant difference in the incidence of intraoperative complications between the groups. The median access length for laparotomy was 25 cm (Q1 - Q3: 22 - 28), for laparoscopy 14 cm (Q1 - Q3: 14 - 15) and combined surgery — 16 cm (Q1 - Q3: 15 - 17), the differences were reliable. The median bed-day for the second group was 8 days (Q1 - Q3: 7 - 9), for the third — 9 days (Q1 - Q3: 8 - 11). Conclusion. Combined bilateral nephrectomy has all the advantages of laparoscopic surgery, but at the same time, it can significantly reduce the operation time without significantly increasing the length of the surgical approach.

Pérdida de suelo y modificación de escurrimientos causados por el cambio de uso de la tierra en la cuenca del río Conchos, Chihuahua

Introducción: El cambio de la cobertura original de suelo y la erosión consecuente, son problemas comunes en la cuenca del río Conchos, con un impacto directo para más de 1.3 millones de habitantes. El problema se acentúa con la tala desmedida, los incendios, la sobreexplotación y la contaminación del agua superficial y subterránea. Así mismo, acorde a los pronósticos de cambio climático, se prevé una pérdida de biodiversidad y modificación del régimen hidrológico en esta importante cuenca productora de agua.Método Se evaluó la cobertura reflejada por diferentes usos de suelo mediante el software ERDAS Imagine V 2014; a su vez, la pérdida potencial de suelos se analizó espacialmente, mediante la Ecuación Universal de Pérdida de Suelo (EUPS) y la cuantificación de escurrimiento, de acuerdo con la norma oficial mexicana NOM-011-CNA-2000.Resultados y discusión: Se determinó reducción en la cubierta forestal y la zona de pastizal, detectándose un notorio incremento de superficie en zonas agrícolas y matorrales. La erosión hídrica mostró una tendencia fluctuante, donde la clase más severa de pérdida fue de 0.02 y 0.008 tm ha-1 para los años de 1980 y 2000, y aumento de 0.01 para 2018. Los volúmenes de escurrimiento máximo para 1980, fueron de 348.38 M m3 con reducción de 137.36 M m3 para el 2000, y con aumento significativo para 2018 de 743.08 M m3.Conclusiones: El uso de información climática procedente de datos asimilados, permitió detectar espacialmente los procesos de pérdida de suelo y volúmenes de escurrimiento superficial, siendo el año 2018 el más susceptible a erosión de suelo, con 1689.15 hectáreas (ha) afectadas, y con un volumen de escurrimiento medio de 379.17 M m3. De acuerdo con el hidrograma en ciertos años, las altas precipitaciones no precisan grandes volúmenes, debido a que son lecturas in situ; sin embargo, a través del presente estudio se detectaron espacialmente las zonas afectadas, donde el cambio de uso de suelo y las precipitaciones sí modifican las condiciones, lo que permitirá un mejor control y conservación de los recursos naturales.

The Effect of Smith-Peterson Osteotomy on Blood Loss during Surgical Correction of Adolescent Idiopathic Scoliosis

Surgical correction of adolescent idiopathic scoliosis is inevitably accompanied by blood loss. About 37-85% of patients undergo allogeneic transfusions associated with a risk of serious complications. Prediction of the expected blood loss volume remains a topical problem. In this regard, there is a need to clarify predictors of increased blood loss. To assess the effect of vertebrectomy on the intraoperative blood loss volume during surgical correction of adolescent idiopathic scoliosis. A retrospective study included 511 adolescents who underwent posterior correction of spinal deformity. Two groups were allocated: Group I consisted of 303 patients who underwent multilevel transpedicular fixation; Group II included 208 patients who underwent multilevel transpedicular fixation combined with Smith-Peterson osteotomy. Intergroup comparisons revealed significant differences in the number of transpedicular fixation levels and the volume of blood loss, which were higher in Group II. After aligning the groups by the number of transpedicular fixation levels using the Propensity Score Matching method, no statistically significant difference was observed. We derived formulas for calculating the expected blood loss volume in Groups I and II. Comparison of the formulas revealed that the formula for Group II predicted a significantly lower volume of blood loss, by 2.51%, while the formula for Group I predicted a significantly higher volume of blood loss, by 3.27%. In our opinion, application of the formula that overestimates expected intraoperative blood loss is most reasonable due to a possibility of the worst case scenario during surgery; therefore, the formula for Group I approaches a universal model for use. Smith-Peterson osteotomy did not affect the amount of blood loss during surgical correction of adolescent idiopathic scoliosis, considering the number of transpedicular fixation levels.

Identifying ‘True’ Water Loss Information through the MFCA Model for Improved Cost-Saving Decisions in a Water Utility: A Case Study of the Doorndraai Water Treatment Scheme in South Africa

We identified the deficiency in the conventional accounting system in capturing water-loss-related information and its effect on cost-saving decisions in a water utility in South Africa. We employed the material flow cost accounting (MFCA) model in the case of the Doorndraai Water Treatment Scheme to highlight inefficient phases of the water purification processes for the manager to identify opportunities for corrective action. Findings reveal that the inability of the conventional accounting system in accurately capturing water loss information limits the scheme manager’s ability to recognize cost-saving opportunities. Consequently, we found that the implementation of the material flow cost accounting (MFCA) model identified the pumping process as a major contributor to the water scheme’s daily operating loss because of the pumping machine’s low capacitor. Besides, this pumping machine has been in operation for about five years, an indication that the water scheme had been operating at a loss daily for a number of years. Thus, we suggested that the water scheme should invest in procuring a more suitable pumping device to reduce the huge electricity cost incurred daily by the Doorndraai Water Treatment Scheme. Besides this, the paper extended the implementation of the MFCA by providing an example of how the managerial accounting system can support environmental and economic sustainability in water purification processes. Thus, we reiterate that one way of effectively managing water resources is to appropriately capture the volume of water loss and water-purification-related costs to improve its efficiency.

Economic Loss of Timber Caused by Over Stumps and Defects in Community Forests Terai Nepal

The economic loss of timber caused by over stumps and defects is an essential issue in forest science but study regarding this is very limited in Nepal. Thus, this research was objectively conducted to assess the volume of timber loss and associated monetary loss caused by over stumps and defects in logs and reason behind this. Three community forests namely Deurali, Jay Durga and Raniphanta community forests were selected for this research. Total enumeration was done so 375 stumps and 224 defected logs were measured from15 March to 15 April, 2019. The height and diameter at the butt end were measured using simple tape and D-tape respectively. Additionally, the length and diameter of defects in log was recorded. Total thirty key informant interviews and three focus group discussions were organized to assess the major causes of over stumps and defects. The timber volume loss caused by over stumps was calculated using cylindrical volume formula and volume loss caused by defect was calculated using formula, i.e. gross volume - net volume. The price of wood was collected from community forest to calculate the monetary value of timber loss. The principal component analysis was applied to assess the major causes of over stumps and defect in log. The highest total volume loss was recorded around 15.217 m3 (28.49%) caused by over stumps and out of this, it was 53.41 m3 timber loss in Deurali community forest. The loss due to defects in tree was ranged from 128.57 to 284.21 m3 in the community forests. The monetary value of loss caused by over stump was US$ 6971.14 of Shorea robusta in Deurali community forest and it was US$ 8100.52 because of defect. The principal component analysis showed that use of saw and axe for felling the trees in the community forests was considered as highest factor of over stump and diseases and over mature trees were key factors of wood defect. The research will be useful for policy makers and scientific community to monitor the timber loss.

Determination of the Volume of Early Hypotonic Hemorrhage by 3D Modeling of Ultrasound Investigation Results

An original method for determining the volume of early hypotonic hemorrhage is presented. The method is based on clinical application of 3D modeling of results obtained by ultrasound investigations of the uterine cavity and gravimetric assessment of the volume of external blood loss. A scheme for computation is described, a method for 3D modeling of the postpartum uterus is created, and the effectiveness of using this method for determining the volume of hemorrhage is assessed.

Asymmetrical vertebral column decancellation for the management of rigid congenital kyphoscoliosis

BackgroundCongenital kyphoscoliosis is a disease that often requires surgical treatment. Wedge osteotomies, such as pedicle subtraction osteotomy, are insufficient to correct this complicated rigid deformity. Vertebral column resection yields sufficient correction, but it is an exhaustively lengthy operation with a high risk of major complications. There are few effective and safe techniques for treating rigid congenital kyphoscoliosis. We aimed to investigate the technique of asymmetrical vertebral column decancellation (AVCD) for the treatment of rigid congenital kyphoscoliosis and evaluate the clinical and radiographic results of patients treated with the technique.MethodsBetween January 2013 to June 2017, the data of 31 patients with congenital kyphoscoliosis who underwent single level AVCD were reviewed. Preoperative and postoperative radiographical parameters and the visual analogue scale, Asia Spinal Injury Association, and Scoliosis Research Society-22 scores were documented. The patients were followed up for an average period of 29 months.ResultsThe average operative time was 273.9 ± 46.1 min. The average volume of blood loss was 782.3 ± 162.6 ml. The main coronal curve improved from a mean of 81.4° preoperatively to 24.7° at the final follow-up, and the coronal balance improved from 28.9 to 7.6 mm. The degree of local kyphosis improved from a mean of 86.5° to 29.2°, and the sagittal balance improved from 72.3 to 16.9 mm. All clinical outcomes also improved significantly from preoperatively to the final follow-up. No permanent postoperative neurologic complications occurred.ConclusionThe AVCD surgical procedure corrects spinal deformities in both the coronal and sagittal planes by way of a convex-sided Y shape osteotomy, achieves satisfactory realignment without additional neurological complications, and can be considered an alternative treatment for rigid congenital kyphoscoliosis.

Normotension — new approach in laparoscopic partial nephrectomy

Background. Minimally invasive partial nephrectomy is the gold standard in the treatment of stage I malignant tumors. To date, there are a large number of techniques for performing partial nephrectomy. The desire to develop a technique that included all the positive characteristics and had no restrictions on use led to the creation of a normotonic zero ischaemia partial nephrectomy. Materials and methods . A retrospective analysis of 45 patients was performed. 1st group included 24 (53.3 %) patients after laparoscopic normotonic zero ischaemia partial nephrectomy. 2ndgroup included 21 (46.7 %) patients who underwent laparoscopic hypotonic zero ischaemia partial nephrectomy. All patients evaluated such surgical parameters as the surgery time, the blood loss, and the duration of hospitalization. To assess pre-operative renal function, the CKD-EPI equation was used to calculate estimate glomerular filtration rate. Results. All patients were demographically comparable. Patients were also evenly distributed in terms of resection complexity according to the RENAL nephrometric scale. Acute kidney injury rate was significantly higher in the hypotension group: relative risk 5.4 (95 % confidence interval 1.59—20.55), odds ratio 11.3 (95 % confidence interval2.04—59.2);p = 0.007. In 1stgroup, the average operation time was 130min (Q1-Q3 110—140), and in 2ndgroup, 150min (Q1—Q3 115—227.5);p = 0.0159. The average volume of blood loss during laparoscopic zero ischaemia partial nephrectomy was significantly less than during hypotonic partial nephrectomy: 125 ml (Q1—Q3 50—200) and 450 ml (Q1— Q3200— 750) respectively, p <0.0001. Coclusion. In our study, laparoscopic normotonic zero ischaemia partial nephrectomy proved to be a possible alternative to existing resection techniques today. But to use this technique in clinical practice, further study and validation is required.

Methods of pharmacological correction of intrauterine growth restriction syndrome

Aim. Comparative analysis of the effectiveness of pharmacological correction of intrauterine growth restriction syndrome (IGRS) by monotherapy with diosmin and dipiridamol.&#x0D; Materials and Methods. Retrospective and prospective examination of 80 pregnant women with singleton pregnancy with gestational age from 28 to 36 weeks with confirmed diagnosis of IGRS of 1 or 2 degree asymmetric form was conducted. 75.0% Of pregnant women that participated in the study, were of the average reproductive age (23-29 years of age). The share of young first-time-mother in I group was 10.0%, in II group 15.0%, the share of age first-time-mothers was 17.5 and 10.0%, respectively. Extended history taking and history analysis, general clinical and obstetric-gynecological examination were conducted, laboratory and ultrasound methods were used. Newborns were evaluated on Apgar scale at birth and in 5 minutes. In the early neonatal period, inborn and transient pathological syndromes were evaluated.&#x0D; Results. In patients receiving diosmin (n=40), reduction of the resistance index of the right and left uterine arteries to 0.4400.004 and 0.4600.004, respectively, and of the umbilical artery to 0.560.02 was achieved, that is lower than in the group of patients taking dipiridamol (n=40). A positive influence of diosmin on the intrauterine condition of the fetus was found that was manifested by its increased compensatory capacities for adaptation to chronic hypoxia in reliably higher percent of cases as compared to dipiridamol. After pharmacological correction, a tendency to normalization of the main parameters of the system of hemostasis was found in higher percent in women taking diosmin. This, in turn, produced a favorable influence on the volume of blood loss in physiological deliveries. Thus, in I group the average amount of blood loss was 18015 ml, while in II group it was 26515 ml (р0.05). However, in operative delivery no such differences were obtained. In I group immediately after deliveries 10.0% of newborns were transferred to the resuscitation and intensive care unit, in II group transfer to resuscitation department was required in 37.5% of infants (0.05). All the rest of children immediately after birth in the satisfactory condition were placed to one ward with mother, and they did not require resuscitation measures.&#x0D; Conclusion. Increase in the compensatory capacities of the fetus was shown in the conditions of chronic intrauterine hypoxia in a reliably higher percent of cases after pharmacological correction with diosmin. This, in turn, produced a favorable influence on perinatal outcomes, birth of children with a higher parameters of mass and height and health index.

Intraoperative Red Blood Cell Salvage in Posterior Spinal Fusions for Idiopathic Scoliosis: Guidelines for Selective Use

Purpose: What are the patient and surgical factors which impact the cost-effectiveness of Intraoperative cell salvage (ICS) during primary posterior spinal fusions (PSF) for idiopathic scoliosis (IS). ICS can be useful in avoiding allogeneic transfusions, however it adds substantial charges ($800 - 1200 US) and requires larger volumes of blood loss in order to provide benefit. This study evaluates the role and effectiveness of ICS in primary PSF surgeries for pediatric IS patients. Methods: 180 primary, consecutive …

Results of the nerve-sparing radical prostatectomy in obese patients

Introduction. According to several studies, an increased body mass index (BMI) may be one of the unfavorable prognostic factors of prostate cancer (PC) associated with lower oncological and functional outcomes of radical prostatectomy (RP).Purpose of the study. To evaluate pathomorphological characteristics, recurrence-free survival, and restoration of erectile function (EF) after RP with nerve-sparing technique (NST) in obese patients.Materials and methods. The study group consisted of 91 patients with BMI ≥ 30 kg/m2 , the control group consisted of 356 patients with BMI &lt; 30 kg/m2 who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. A comparative analysis of pathomorphological results, the rate of complications, recurrence-free survival, and the dynamics of EF restoration in both groups was performed.Results. Obese patients had a larger prostate volume, a higher score for the International Prostate Symptom Score (IPSS) questionnaire. Unilateral and bilateral NST was used in both groups in equal proportions: 50.5% and 49.5% in the group with BMI ≥ 30 and 51.4% and 48.6% in the group with BMI &lt; 30 (p = 0.88 ) There were no significant differences between the groups in the rate of adverse pathomorphological characteristics, serious postoperative complications and the volume of intraoperative blood loss. The five-year recurrence-free survival after RP was 93.1% in the BMI group ≥ 30 and 95.1% in the BMI group &lt; 30 (p = 0.55). The total rate of EF recovery after RP with NST after 24 months was 75% and 78.5% (p = 0.24). The restoration of EF in obese patients was slower: sufficient for sexual intercourse EF after 6 and 12 months was observed in 17.9% and 32.1% versus 35.4% and 53.8% in the group with BMI &lt; 30, and the meantime to recovery was 10.9 (± 1) and 8.6 (± 0.6) months, respectively (p = 0.04).Conclusions. Obesity does not affect the pathomorphological and oncological results of RP with NST. EF recovery in patients with a BMI of ≥ 30 is slowed down, however, 24 months after surgery, the results are comparable with the potency level in patients with a BMI &lt; 30. The data obtained may be of value in counselling and planning surgical intervention in obese patients with PC.

Моделирование глубины проникновения дизельного топлива в защитную песчаную подушку

When deploying a temporary fuel storage warehouse, the primary source of soil contamination by oil products is technological losses related to the leakage of isolation valves. To protect the soil from contamination, containers are placed on a layer of sand. The thickness of the sand layer depends on the volume of possible losses. The purpose of the work is to model the depth of diesel fuel penetration into the protective layer of sand bed. The method of performing the experiment imitated a high rate of fuel penetration in the form of droplets onto the protective layer. The article considers the mechanism of fuel penetration into sand and factors, determining the penetration depth. It is established that the mechanism of fuel penetration into the protective layer has two stages, on each of which the penetration depth and rate of fuel distribution are different. The maximum penetration depth is reached on the first stage and depends on the quantity of fuel. The author developed the model, which allows the determination of the thickness of the sand bed protective layer with known granulometric particle composition necessary for the prevention of diesel fuel penetration into soil.

Case report: robot-assisted partial nephrectomy in patient with large tumor (T2)

The present article describes a clinical case of a robot-assisted surgery performed for a large tumor of the right kidney. Here, the surgery technique is described, and the main perioperative indicators are listed. Materials and Methods . A 39 year old man, according to ultrasound and MRI, revealed the growth of a right kidney in the upper third of the cyst measuring 105 × 85 × 79 mm with clear even borders, and a density of content from 13 to 22 HU, with vascularized vegetations along the capsule, and moderate contrast accumulation in thin partitions (Bosniak IV), the cyst deforms the sinus of the kidney in the upper section, the perinephral tissue was not infiltrated. Results . Kidney tumor was removed within healthy tissue. The total operating time was 290 minutes, while the surgical console time was 255 minutes. The volume of blood loss did not exceed 150 ml. The thermal kidney ischemia lasted for 33 minutes. The hemoglobin level was decreased by 10%, and the number of red blood cells — by 14 %. An increase in serum creatinine and urea levels was not observed. Patient spent one day in intensive care unit. After the surgery, two drains were placed to the resection area and were removed after the 4 and 5 days. The patient was discharged from the hospital on the 10th day after the operation. Conclusions . Here, we reported a clinical case of robot-assisted resection of a large kidney tumor in a young patient. The advantages of robot-assisted surgery are associated with excellent visualization, as well as precision and accuracy of movements, together with a high level of surgical experience, it reduces the risk of intra- and post-operative complications and the nephrectomy associated with them. The young age of the patient and the high risk of possible nephrectomy, in our opinion, could be the justification for performing robot-assisted interventions, reducing the risk of nephrectomy development.

P1080INCREASE OF POST DIALYSIS HEMOGLOBIN CONCENTRATION IS MORE APPROPRIATELY EXPLAINED BY PLASMA VOLUME CHANGE THAN INTRADIALYTIC WEIGH LOST

Abstract Background and Aims It is well known that haemoglobin significantly increases after haemodialysis and it is associated with the rate of weight loss during dialysis. However, it has been shown that the increase in haemoglobin is not always proportional to the rate of body weight loss during haemodialysis (ultrafiltration). The purpose of the study was to investigate the correlation between haemoglobin changes, body weight loss and plasma volume changes during haemodialysis Method A prospective study was performed on 92 patients in mid-week treatments. Pre-dialysis and post-dialysis haemoglobin and weight were measured. 27 patients were excluded because clinical instability, no change or a decrease in Hb and low pre-dialysis haemoglobin (&amp;lt; 9 g/dL). The correlation was statistically significant between %ΔPV and ΔHb in both groups (R2=0.59), whereas the correlation between %ΔBW and ΔHb was lower (R2=0.19). So, analysis show that only 19% of the variability in haemoglobin is explained by %ΔBW, and that 59% of the variability in haemoglobin is explained by %ΔPV. Results The mean age was 61.16 ± 13.11 year. The men were 52 (56%). The mean pre-dialysis Hb was 11.31 ± 1.16 g/dL, the mean post-dialysis Hb level was 12.53 ± 1.47 g/dL. The mean absolute change of haemoglobin (ΔHb g/dL) and percent of change of haemoglobin (%ΔHb) were 1.22 ± 0.76 and 9.44 ± 5.31, respectively. Average percent of weight change (%ΔBW) was - 2.44 ± 1.01. Percent of plasma volume change was - 9.22 ± 5.46. The patients were divided in two groups according post-dialysis haemoglobin level: Group A with haemoglobin Hb &amp;lt; 13 g/dL (64 patients) and group B with Hb ≥13 g/dL (28 patients). The mean time average haemoglobin concentration (TAC Hb) in all patients was 11.68 ± 1.11 g/dL.(Predicted Hb TAC was calculated according Krisper′s formula) In both groups there was an increase in %ΔHb, but in the group with post dialysis Hb ≥ 13 g/dL, %ΔHb was greater than in group B with post dialysis Hb &amp;lt; 13 g/dL (13.08 ± 5.11 versus 7.87± 4.61, P = 0.000) despite the relatively small difference of %ΔBW between the two groups (- 2.85 ± 0.95 versus - 2.23 ± 1.02; P = 0.010). However, the difference in %ΔPV between the two groups was significant (- 12.90 ± 5.63 versus - 7.61 ± 4.57; P &amp;lt; 0.000). Conclusion The intradialytic changes in haemoglobin levels are predominantly determined by changes in plasma volume. Changes in body weight are of little predictive value in evaluation of variation of haemoglobin levels. TAC Hb determination should be performed in patients with large variations in plasma volume, because the plasma volume has very little effect on TAC Hb.