[Reconstruction of total portosystemic shunt into selective portosystemic shunt in a child]. / Rekonstruktsiya total'nogo portosistemnogo shunta v selektivnyi portosistemnyi shunt u rebenka.

To date, side-to-side splenorenal shunt (SRS) and its analogues (splenosuprarenal shunts (SSRS)) are mainly used for portal hypertension. These are total portosystemic shunts characterized by total blood shunt from portal vein into inferior vena cava. The latter is fraught with a significant risk of complications such as pulmonary hypertension, decreased portal liver perfusion, liver failure and hepatic encephalopathy. Prevention of these complications is still an urgent problem in modern surgery. However, we proposed a new method of treatment, i.e. reconstruction of SRS and SSRS into selective shunt. This procedure was performed in 37 patients after 2020. We present laparoscopic reconstruction in an 11-year-old girl with portal hypertension and signs of hepatic encephalopathy identified after previous SSRS.

Analysis of the boundary integral equation for the growth of a parabolic/paraboloidal dendrite with convection.

The growth of a parabolic/paraboloidal dendrite streamlined by viscous and potential flows in an undercooled one-component melt is analyzed using the boundary integral equation. The total melt undercooling is found as a function of the Péclet, Reynolds, and Prandtl numbers in two- and three-dimensional cases. The solution obtained coincides with the modified Ivantsov solution known from previous theories of crystal growth. Varying Péclet and Reynolds numbers we show that the melt undercooling practically coincides in cases of viscous and potential flows for a small Prandtl number, which is typical for metals. In cases of water solutions and non-metallic alloys, the Prandtl number is not small enough and the melt undercooling is substantially different for viscous and potential flows. In other words, a simpler potential flow hydrodynamic model can be used instead of a more complicated viscous flow model when studying the solidification of undercooled metals with convection.

Dendrite tips as elliptical paraboloids.

This review article summarizes current theories of the steady-state growth mode of dendrites in the form of elliptical paraboloids. The shape of dendrite tips is analyzed, temperature and solute concentration distributions are described in its vicinity, and a solution of the hydrodynamic problem of a viscous incompressible fluid flowing against a dendrite tip is developed. A significant difference in analytical solutions describing a dendrite tip as an elliptic paraboloid as compared to an axisymmetric morphology is shown. The system of nonlinear equations for determining the stationary velocity of dendrite growth and the radii of curvature of the dendrite tip along the major and minor axis of the ellipse, respectively, is derived. The developed theory is compared with experimental data on the growth of ice crystals consisting of D2O or H2O.

Dendritic growth of ice crystals: a test of theory with experiments.

Motivated by an important application of dendritic crystals in the form of an elliptical paraboloid, which widely spread in nature (ice crystals), we develop here the selection theory of their stable growth mode. This theory enables us to separately define the tip velocity of dendrites and their tip diameter as functions of the melt undercooling. This, in turn, makes it possible to judge the microstructure of the material obtained as a result of the crystallization process. So, in the first instance, the steady-state analytical solution that describes the growth of such dendrites in undercooled one-component liquids is found. Then a system of equations consisting of the selection criterion and the undercooling balance that describes a stable growth mode of elliptical dendrites is formulated and analyzed. Three parametric solutions of this system are deduced in an explicit form. Our calculations based on these solutions demonstrate that the theoretical predictions are in good agreement with experimental data for ice dendrites growing at small undercoolings in pure water.

[Efficiency of minilaparotomy in the treatment of choledochal malformation in children]. / Otsenka effektivnosti mini-laparotomii pri lechenii mal'formatsii obshchego zhelchnogo protoka u detei.

OBJECTIVE: To evaluate an effectiveness of minilaparotomy in the treatment of choledochal malformation (CM) in children. MATERIAL AND METHODS: The study included children with CM who underwent surgery from January 2010 to May 2020. All patients were divided into 3 groups depending on surgical approach: minilaparotomy (ML), laparoscopy (LS) and laparotomy (LT). We analyzed surgery time, early postoperative outcomes and cosmetic results. RESULTS: There were 99 patients with CM for 10 years. ML was performed in 39 patients, LS - in 51 patients, and LT - in 9 patients. Significantly (p-value <0.001, Kruskal-Wallis test with Dunn paired comparison test, p<0.05) less surgery time was observed in ML group. According to Clavien-Dindo classification of surgical complications, we found a significant prevalence of complications in the LS group (p - 0.018, Kruskal-Wallis test). Moreover, LS was characterized by insignificant (p>0.05) predominance of the most severe complications requiring multiple redo surgeries. CONCLUSION: Currently, open surgery is a "gold standard" in the treatment of children with CM. LS is not preferred in children with CM. ML ensures favorable early outcomes in children with CM.

The role of presepsin in the diagnosis and assessment of severity of sepsis and severe pneumonia.

AIM: The aim of this study was to evaluate marker of inflammation presepsin to improve diagnosis of severe pneumonia, sepsis. MATERIALS AND METHODS: 75 patients with pneumonia, sepsis, other inflammatory diseases aged from 17 to 78 years were examined. These patients have been investigated for the level of the presepsin. Presepsin level was quantified on immunohemilyuministsentny analyzer Pathfast (Mitsubishi Chemical Medience Corporation, Japan) in pg/ml. All patients had obtained an antibacterial therapy in other health care organizations before entering the hospital. RESULTS: Рresepsin at the general group of patients with pneumogenic sepsis was 3196.9±1202.16 pg/mL (n=14, x̅±m), with abdominal sepsis - 2506.7±448.32 pg/mL (n=28), with other inflammatory diseases - 671.6±124.55 pg/mL (n=11). Рresepsin of patients with pneumogenic sepsis was 1125.3±240.59 pg/mL (n=3), presepsin of patients with severe pneumonia was - 362.6±76.29 pg/mL (n=13, р<0.05), non-severe pneumonia - 157.3±33.02 pg/mL (n=9, р<0.05). CONCLUSION: The high level of presepsin is an indication of an active infectious disease and reflects the severity of the pneumonia and development of sepsis. Keeping a high level against the backdrop of earlier presepsin ongoing antibiotic therapy is an indication of their lack of effectiveness. A significant variability of presepsin should be taken into account.

[Laparoscopic decompression of celiac trunk in children]. / Laparoskopicheskaia dekompressiia chrevnogo stvola pri kompressionnom stenoze u detei.

MATERIAL AND METHODS: For the period 2013-2016 four patients were treated at the Filatov Children's City Clinical Hospital #13. There were 2 children aged 14 years and 2 children aged 17 years. All patients have been diagnosed via anamnesis, complaints, pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. After comprehensive examination 3 patients underwent laparoscopic decompression of celiac trunk. In all cases celiac trunk compression was predominantly caused by median arcuate ligament of the diaphragm combined with neurofibrotic tissue of celiac plexus. RESULTS: All patients were discharged after laparoscopic decompression of celiac trunk. Intra- and postoperative complications, as well as cases of conversion were absent. Mean time of surgery was 65 minutes. In all cases postoperative period was smooth (4 days on the average). Two patients underwent follow-up examination in long-term postoperative period: pulse-wave doppler sonography, contrast-enhanced MDCT and angiography. In both cases reduced severity, incidence and duration of pain syndrome were observed. CONCLUSION: Clinical examples show some problems in diagnosis and treatment of compressive stenosis of celiac trunk due to rarity of pathology especially in childhood. Nevertheless, combination of abdominal ischemia and celiac trunk stenosis confirmed by instrumental diagnosis is indication for surgical treatment.

[Extract of Hirudo medicinalis leeches: biogenic substance for the creation of effective drugs].

Investigations of the extract of medicinal leech Girulux established parameters that enable one to verify the authenticity of related drugs using the characteristics of their UV spectra the and anticoagulant and antithrombin activity. The limits of pH must range from 5.5 to 7.5. Pilot-scale series of medical leech extract are in compliance with terms of "microbiological purity" quality characteristics. The natural storage has been used to assess the temporal stability of leech extract. The obtained characteristics showed that the activity of extract was retained after 3-year storage.

[Computed tomographic findings in patients with chronic pulmonary obstruction and diabetes mellitus].

The study included 40 patients aged 33-71 years with chronic pulmonary obstruction (CPO) and diabetes mellitus (DM). They were examined by multilayer CT with detailed analysis of parenchymal tissues. The main microvascular changes in lung parenchyma included dilation, focal opacity (2-5 mm), and beaded vessels. In patients with isolated CPO, these changes were less pronounced than in those with combined pathology. All patients presented with bronchial deformities, bronchoectasia, emphysema, and cysts. Microvascular pathology in lung parenchyma appears to be a manifestation of universal diabetic microangiopathy responsible for the unfavourable development of CHD in DM patients.

[The comparative analysis of high-risk behaviour related to HIV infection in users of psychoactive drugs with stimulating action and opioids].

To study clinical and psychological characteristics associated with high-risk behaviour related to HIV infection in 2006-2007 years, we examined 68 patients with psychoactive drugs (with stimulating action) and opioids (heroin) dependencies. Patients were stratified into 2 groups: users of psychoactive drugs (UPS)--34 patients and opioid users (OU)--34. Behavior of UPS differed from that of OU by using more drug injections per day although the former used syringes of other users less often. Therefore, the risk of being infected was lower in the UPS group compared to the OU group. The evaluation of the risk through sexual transmission did not reveal significant between-group differences.

[Changes in external respiration function in response to berotek and histamine in diabetic patients].

AIM: To study airways reactivity in patients with diabetes mellitus (DM). MATERIAL AND METHODS: Berotek and histamine tests were performed in 29 DM patients (type 1 DM - 20, type 2 DM - 9 patients) and 39 DM patients (12 and 27 patients, respectively). The age of the patients varied from 16 to 66 years. RESULTS: Positive berotek test was in 6 (20.7%) patients (delta FEV1 > 200). Of them 5 had type 1 DM. Positive histamine test was registered in 9 patients with type 2 DM (23.1%). This indicates bronchial hyperreactivity (BH). A qualitative analysis with Fisher's criterion detected correlation between BH and type of DM, BH and intake of sugar reducing tablets. Correlations between BH, body mass index, diabetes duration and late complications were not found. CONCLUSION: DM patients have predisposition to bronchial spasm. Positive bronchodilation test was mainly in type 1 DM, BH in response to histamine was obtained in type 2 DM. Different mechanisms of a bronchospasm in type 1 and 2 DM are demonstrated. Predisposition to bronchospasm may play an unfavourable role in the course of nonspecific pulmonary diseases in DM patients.

A stable prostacyclin-like substance produced by the medicinal leech Hirudo medicinalis.

The medicinal leech Hirudo medicinalis produces a low-molecular mass compound with properties similar to those of prostacyclin. It extracted with organic solvent, had affinity to 6-keto-PGF1alpha antibodies, inhibited human platelet aggregation induced in vitro by thrombin (by 50% at 4 pg/ml), and caused hypotension and secretion of plasminogen (t-PA) into the blood stream of rats. A main distinction from prostacyclin is stability of the substance due to covalent binding with the polypeptide chain of destabilase. Because of the high aggregability of destabilase, the molecules of the protein-lipid complex are organized into micelles that can change their spatial orientation depending on the nature of the solvent. Incorporation of hirudin and blood plasma kallikrein inhibitor into the micelle structure causes the formation of liposomes (with a molecular mass of the structural monomer 25 kDa). This complex with polypeptides provides not only stability but also rapid transmembrane penetration. The pure prostacyclin-like substance has a molecular mass of 391 Da and can be produced on destruction of the destabilase polypeptide chain.

[Effective correction of lung hyperinflation in pneumonia using positive end-expiratory pressure]. / Effektivnaia korrektsiia giperinfliatsii legkikh pri pnevmonii s pomoshch'iu dykhaniia s polozhitel'nym davleniem v kontse vydokha.

AIM: Study of PEEP effects on breathing biomechanics in patients with pneumonia. MATERIALS AND METHODS: In 37 patients with pneumonia breathing biomechanics was studied using Masterlab (Jaeger). PEEP (3-10 cm H2O) was employed during 20 min. RESULTS: Sputum expectoration, expiration and inspiration were improved, lung hyperventilation observed in pneumonia reduced after PEEP. CONCLUSION: There is early expiration obstruction of the airways in pneumonia. PEEP removes this obstruction through control of lung hyperinflation. Thus, PEEP can be applied in the treatment of pneumonia.

Destabilase complexes--natural liposome produced by medicinal leeches Hirudo medicinalis.

Electrophoretic analysis of destabilase preparation demonstrates the presence of protein combinations with MW 12.3, 25 and 50 kD. Fraction (MW 12.3 D) is a monomer of destabilase aggregation having properties of micellar proteins and represents a stable lipid-protein complex, where the role of lipid component is played by the stable analogue of prostacyclin (MW 391 D). The synthesis of a low molecular fraction of destabilase is fulfilled with bacteria--symbiont of leeches Aeromonas hydrophila. When the destabilase (MW 12.3 kD) contacts with blood a process of complexe formation is triggered with hirudin and blood plasma kallikrein inhibitor, forming a stable 'destabilase complex' (DC; MW 25 kD), possessing also a high aggregation capacity. Polymer forms of the destabilase complex form a liposome changing its spatial orientation depending on the nature of the solvent. Such structural organization provides a high stability of DC components and a rapid penetration through cellular membranes (transmembrane transfer) and it also provides prophylactic antithrombotic action in the case of peroral application to animals, due to the blockade of vascular platelets (inhibition of platelet aggregation by prostacyclin analogue) and plasmic (inhibition of thrombin activity and blood plasma kallikrein) links of the hemostasis process. Destabilase fraction with MW 50 kD is a dimer of the destabilase complex. As a result of DC destruction (liposome), hirudin, prostacycline analogue and blood plasma kallikrein inhibitor are released.