Endovascular Occlusion of Giant Posttraumatic Pseudo-Aneurysm of Superior Mesenteric Artery Connected to Mesenteric Arteriovenous Fistula.

The aim of the study was to show the capabilities of endovascular occlusion of giant posttraumatic pseudo-aneurysm of superior mesenteric artery (SMA) connected to a mesenteric arteriovenous fistula (AVF) under the conditions of portal hypertension and life-threatening esophageal variceal bleeding. MATERIALS AND METHODS: A 27-old male patient underwent endovascular occlusion; the patient being hospitalized with a clinical picture of gastrointestinal bleeding. The examinations: ultrasound, esophagogastroduodenoscopy, multispiral computed tomography with angiography - revealed the source of bleeding to be esophageal varices against the background of portal hypertension caused by massive arteriovenous shunt, its source being AVF with an aneurysmal component (32×35 mm in size) between SMA and superior mesenteric vein (SMV) dilated up to 50 mm in diameter. Patient's past medical history recorded that 4.5 years ago the patient had undergone the resection of a small intestine area due to a penetrating stab wound in the abdominal cavity. Taking into consideration an extremely high operative intervention risk due to the condition severity related to blood loss, portal hypertension, and ascites, it was decided to embolize AVF with a vascular occluder - Amplatzer Vascular Plug II (USA), 14×10 mm in size. RESULTS: A unique endovascular intervention - transcatheter occlusion of pseudo-aneurysm and AVF separation - was performed in life-threatening esophageal variceal bleeding under the condition of a giant post-traumatic aneurysm of SMA and mesenteric AVF. Due to an extremely large-sized SMV and an arterial pseudo-aneurysm, first ever we used the technique applied for transcatheter occlusion of a cardiac septum defect.Occluder implantation enabled to completely close the communication of aneurysmatic AVF with SMV, and occlude the aneurysm cavity. During an immediate postoperative period portal hypertension was arrested. No recurrent bleedings occurred within 4 postoperative months.

[Operations of revascularization in surgery of cerebrovascular aneurysms].

Surgical revascularization of the brain is one of the most important trends in the development of neurosurgery. Restoration of adequate blood flow through pre- and intracerebral arteries promotes prevention and treatment of ischaemic lesions of the brain in various pathology. The present work was aimed at analysing the experience gained in performing revascularizing operations in patients with cerebral aneurysms at the department of neurosurgery. The authors analysed therapeutic outcomes in a total of 45 patients presenting with giant and complex aneurysms of cerebral arteries and treated from 2009 to 2014. Of the 45 patients with giant and complex aneurysms of cerebral arteries, 31 (68.8%) patients underwent open microsurgical interventions (including 10 patients with the use of different variants of revascularizing operation) and 14 (31.2%) patients were subjected to endovascular exclusion of the aneurysm from the blood flow. It was shown that performing revascularizing operations in patients with complex and giant aneurysms of cerebral arteries makes it possible to compensate circulation in the interested arterial basin and to obtain good functional results.

[Morphological, clinical, diagnostic features and the treatment of patients with giant brain aneurisms].

Retrospective analysis of treatment outcomes of 89 patients with GIAs, treated in Sklifosovsky Emergency Care Institute from 01.01.1992 till 30.11.2010, was performed. 67 patients were operated on, among them open surgery was conducted for 49 patients, endovascular embolisation - 18 patients. Severity of patients' condition was assessed according to Hunt - Hess (H-H) scale, level of consciousness - Glasgow Coma Scale (GCS), treatment outcomes - Glasgow Outcomes Scale (GOS). Hemorrhage due to GIA rupture was seen at у 64 (72,0%) patients, mass lesion signs - at 18 (20,2%), embolic events - at 3 (3,4%) and GIA without any symptoms - at 4 (4,4%) patients. Good and excellent outcomes were at 79,1% operated patients, total lethality among operated patients was 13,4%. Lethality among non-operated patients was 47,4%. Conservative treatment of patients with GIAs has low perspectives. Open and endovascular operative interventions are the high-risk surgery but they allow decreasing the lethality and morbidity rate among these patients compared with conservative treatment.

Assessing the polarization of a quantum field from stokes fluctuations.

We propose an operational degree of polarization in terms of the variance of the Stokes vector minimized over all the directions of the Poincaré sphere. We examine the properties of this second-order definition and carry out its experimental determination. Quantum states with the same standard (first-order) degree of polarization are correctly discriminated by this new measure. We argue that a comprehensive quantum characterization of polarization properties requires a whole hierarchy of higher-order degrees.

Quantum reconstruction of an intense polarization squeezed optical state.

We perform a reconstruction of the polarization sector of the density matrix of an intense polarization squeezed beam starting from a complete set of Stokes measurements. By using an appropriate quasidistribution, we map this onto the Poincaré space, providing a full quantum mechanical characterization of the measured polarization state.

[Prediction of respiratory complications after radical surgeries for non-small cell carcinoma of the lung].

A predictive role of volume-velocity (VV) indices of ventilation in prognosis of respiratory complications after radical surgeries for non-small cell carcinoma of the lung was evaluated. It is demonstrated that decreased VV indices of ventilation before surgery directly correlate with a respiratory complication rate after surgery. New methods of diagnosis of ventilation disorders and of monitoring are regarded as promising.

[Short-term results of radical surgeries for non-small cell cancer of the lung].

The results of radical surgical treatment of 358 patients with NSCCL were analyzed. Majority of patients were men (84.6%) and persons older 60 years -- 239 (66.8%) patients. Central cancer was diagnosed in 164 (45,8%) patients, peripheral -- in 194 (54.2%). There were 137 (38.3%) pneumonectomies, 184 (51.4%) lobectomies; 149 (41.6%) surgeries were combined. Complications after radical surgeries were seen in 92 (25.7%) of 358 patients, including 18 (5.0%) patients with <> complications and 74 (21%) patients with <> ones. Complications were seen more often in patients over 60 years and occurred less frequently after segmentectomy (7 patients). Lethality was 5.0% (18 patients). Respiratory complications (7 cases) and pulmonary embolism (5 patients) were the main causes of lethal outcome.

[Results of surgical treatment of lung cancer in patients over 70 years old]. / Rezul'taty khirurgicheskogo lecheniia raka legkogo u bol'nykh v vozraste starshe 70 let.

Results of surgical treatment of 345 patients (210 men--61%; 135 women--39%) over 70 years with non-small-cell lung cancer were analyzed. Central lung cancer was diagnosed in 141 (40.9%), peripheral--in 204 (59.1%) patients. Squamous cell cancer was seen in 233 (67.3%), glandular--in 67 (19.4%), dimorphic--in 22 (6.5%), large-cell--in 23 (6.8%) patients. Stage I of the disease was diagnosed in 121 (35.1%); stage II--in 49 (14.1%); stage III--in 175 (50.8%) patients. Rate of postoperative complications in the study group was 27.8%, lethality--6.4%. The highest lethality was after combined pneumonectomy. The most frequent postoperative complications were pneumonia (7.5%), arrhythmia (10.1%), pulmonary-heart insufficiency (4.9%). Five-year survival after radical surgery in patients over 70 years with lung cancer was 49%, in patients with stage I of the disease this parameter was the highest--71.4%.

Quasi-probability distributions for the simplest dynamical groups.

We prove that the Wigner-Stratonovich-Agarwal operator that defines the quasi-probability distribution on the sphere [for the SU(2) dynamical group] can be written as an integral of the SU(2) (irreducible unitary) representation element with respect to a single variable that labels the orbits in the coadjoint representation. This allows us to consider contractions of the SU(2) quasi-probability distribution to the cases of the Heisenberg-Weyl group and the two-dimensional Euclidean group.

[Surgical treatment of lung cancer in patients over 80 years of age]. / Khirurgicheskoe lechenie raka legkogo u lits starshe 80 let.

Growth of the specific fraction of individuals over 80 years of age among patients with lung carcinoma is illustrated by its incidence in Moscow. These patients account today for up to 8% of the total number of cases. Some of them may be successfully treated by operation. This was demonstrated in 11 cases. Recommendations on pre- and postoperative management of such patients are given. The authors emphasize that the patient's fate and the method of treatment should be prescribed only in an oncological medical institution.

[Method for angiographic identification of the labyrinth artery]. / Metod angiograficheskoi identifikatsii labirintnoi arterii.

Digital subtraction angiography in Stenvers standard setting performed atraimatically has been tried in 106 emergency cases admitted to N. V. Sklifosovsky Research Institute of Critical Care. This new method of identification (in 75% of the cases) and verification of the labyrinthine artery intravitally proved safe and reliable. The patients were exposed to cerebral angiography by various methods for diagnosis of the underlying disease. Standard methods of vertebral angiography were found unsatisfactory.

[Radiologic anatomy of the labyrinth artery]. / Rentrenoanatomiia labirintnoi arterii.

Carotid and vertebral angiographic investigations were performed to study x-ray anatomy of the artery of the labyrinth (AL) in 96 inpatients admitted to the N. F. Sklifosovsky emergency care clinic. According to the angiograms, AL originated from the distal parts of the inferior anterior cerebellar artery in 66.3% of the patients. In this case it has a straight form. When initiating from the proximal parts of the basilar artery (33.7% of the patients), AL was shorter (0.8 +/- 0.3 against 2.5 +/- 0.8 cm) and curved. In any case AL was situated along the upper edge of the pyramid before it entered the internal acoustic meatus. By the meatus or inside it AL forms a characteristic loop or semiloop. A complete AL left-right symmetry was observed in 61.8% of the cases.

[Predicting the probable passage of common bile duct calculi in patients with mechanical jaundice]. / Opredelenie veroiatnosti otkhozhdeniia kamnei kholedokha u bol'nykh mekhanicheskoi zheltukhoi.

The authors propose a mathematical method of predictingthe passage of common bile duct calculi. An original mathematical formula derived by a computer allows a 98% accuracy of the prognosis. The estimations were based on the principal parameters influencingthe choledochal calculi movement defined with the help of the regression analysis. Such prediction simplifies the choice of therapeutic policy in mechanical jaundice due to choledocholithiasis.