[Percutaneous cholecystostomy in multi-field hospital]. / Chreskozhnaya kholetsistostomiya v mnogoprofil'nom statsionare.

OBJECTIVE: To analyze the indications, technical features and results of percutaneous cholecystostomy. MATERIAL AND METHODS: A retrospective single-center study of the results of percutaneous cholecystostomy over 13-year period was carried out. The indications for surgery, technical features and outcomes were studied. RESULTS: The indications for percutaneous cholecystostomy were acute cholecystitis in 40 (63.5%) cases and obstructive jaundice in 23 (36.5%) cases. In acute cholecystitis, cholecystectomy was denied due to severe acute and decompensated chronic diseases. In case of obstructive jaundice, cholecystostomy was preferred if other methods of biliary decompression were impossible. Drainage with locking thread was used in 44 (69.8%) patients. A total of 13 (21.3%) cases of drainage migration were noted. Incidence of migration of catheters with locking threads was 13.6%, without locking threads - 41.2% (p=0.033). Subsequent cholecystectomy was performed in 10 (15.9%) patients. In case of obstructive jaundice, cholecystostomy did not lead to destructive cholecystitis in any case. Six patients with acute cholecystitis had progressive gallbladder destruction. Overall postoperative in-hospital mortality was 36.5% (n=23). Mortality in the group of acute cholecystitis was 32.5% (n=13), in the group of obstructive jaundice - 43.5% (n=10). Mortality was higher in acute cholecystitis Grade III (75.0%) compared to Grade II (21.9%; p=0.008). CONCLUSION: Cholecystostomy is a rare (reserve) intervention. Locking thread significantly reduces the incidence of migration of cholecystostomy catheter. Progressive gallbladder destruction required cholecystectomy in 15% of cases. Treatment of patients with acute cholecystitis depends on physical status and comorbidities.

Activated carbon additives for technetium immobilization in bentonite-based engineered barriers for radioactive waste repositories.

Safe disposal of nuclear waste in a geologic repository will rely on natural geologic features and engineered barriers to greatly retard the movement of radionuclides from the repository. Clay minerals including bentonite are effective in retarding the migration of many radionuclides, but are ineffective for anionic radionuclides, of which pertechnetate is of particular concern owing to its relatively long half-life and the lack of natural isotopes that dilute it. Activated carbon is proposed as an additive material for reducing pertechnetate mobility in the nearfield. Activated carbon materials of different origins quantitatively sorb pertechnetate from aqueous solution under oxidizing conditions during the first day of contact, and sequential extraction showed that 73 % of this technetium is in the strongly bound fraction. X-ray photoelectron spectra (XPS) and extended X-ray absorption fine structure (EXAFS) spectra both demonstrated that no reduction of technetium occurred in the studied systems. The interaction of technetium with a composite material consisting of bentonite and activated carbon was studied at the first time. Effective technetium sorption was shown, with distribution coefficients (Kd) up to 740 cm3. g-1.

[Analysis of the causes of recurrent postoperative ventral hernias]. / Analiz prichin retsidiva posleoperatsionnykh ventral'nykh gryzh.

OBJECTIVE: To study the causes of recurrent postoperative ventral hernias and methods for their prevention. MATERIAL AND METHODS: There were 58 patients with recurrent postoperative ventral hernias after various methods of abdominal wall repair for the period 2005-2017. RESULTS: The main causes of recurrent postoperative ventral hernias were identified. Local tissue rearrangement resulted recurrent hernia in 21 (36.2%) patients, that was observed even in patients with small hernia. Size discrepancy between endoprosthesis and hernial orifice caused a recurrence in 20 (34.5%) patients. In 11 (19%) patients, implant detachment followed by recurrent hernia occurred. Postoperative wound complications followed by recurrent hernia were diagnosed in 6 (10.3%) patients. Non-compliance with recommendations for wearing a bandage and restricting physical exertion also contributed to the development of recurrent hernia. Moreover, recurrent hernia occurred mainly in obese patients. Mean body mass index was 34.27±2.2 kg/m2. Recurrent hernia was again detected in 12 out of 35 patients in long-term period after surgical treatment. CONCLUSION: It is necessary to abandon local tissue rearrangement and to select a correct size of synthetic material for prevention of recurrent postoperative hernia. Preoperative body weight control is essential in patients with obesity. Wearing a bandage and restricting physical exertion are obligatory in postoperative period. Annual examination during 3-5 years after surgery is essential for timely diagnosis of recurrent hernia.