Calculation of tunnel incision parameters during phacoemulsification in patients with previous anterior radial keratotomy

Background. The purpose was the choice of the type of tunnel incision on the basis of mathematical calculations in cataract patients with a previous anterior radial keratotomy. Materials and methods. During the calculations, the formula for the chord length of a circle was used: L = 2R · sin(α/2), where R is the radius of the cornea, α is the angle (in degrees) between the two corneal incisions. The chord length was measured on the limbus (upper edge of the tunnel incision) and 2 mm from the limbus (lower edge of the tunnel incision). The chord 2 mm from the limbus is more important because the distance between kerato­tomy incisions at this site is smaller. From 0.4 to 1.0 mm must be added to the width of the knife blade, depending on the type of postoperative corneal healing, which will be the key to crossing the incisions. Results. The most common knives are those 2.2 mm long with a tunnel length of 2 mm. Therefore, we perform calculations based on this knife in patients with 8 and 12 keratotomy incisions and a corneal diameter of 12 mm vertically and 11 mm horizontally. In patients with 8 keratotomy incisions, a 2.2 mm knife can be used for a corneal tunnel incision, and in patients with 16 incisions, it is impossible to use a corneal tunnel. Conclusions. In cataract patients who have previously undergone anterior radial keratotomy, a special approach is needed to the choice of tunnel incision. The choice of access depends on the diameter of the cornea, the number of keratotomy incisions and the width of the knife and is calculated using the formula for the chord length of a circle.

ATTEMPT TO IMPROVE THE OPERATING AND TECHNOLOGICAL PROPERTIES OF THE COMBINED GRAIN WASHING MACHINE

Washing machines are used in the production lines of grain cleaning departments of flour mills for thorough cleaning of the grain surface, in particular, its grooves from the remnants of organic and mineral dust, microorganisms and mold. In addition, the grain mass during washing is cleaned of hydrodynamically light and heavy impurities - chaff, seeds of waste plants, straw fragments, mineral particles in the form of sand, small stones, lumps of earth, as well as spores and wormwood seeds. At the same time, foreign odors of grain disappear.Experience in the operation of Ж9-БМА machines shows that along with many advantages, they have some disadvantages. In particular, the productivity of the machine 10 t / h does not correspond to the productivity of the conjugated technological equipment of the production line, and the specific water consumption for washing grain is 1.8… 2.0 l / kg, which is too much in modern conditions of acute shortage of drinking water. Enterprises to abandon the use of washing machines. In addition, certain problems and inconveniences are caused by the design of the sieve shell of the impression column. Stamped sieves with scaly asymmetric holes have a low coefficient of living cross section, which complicates the process of dehydration of washed grain, quickly corrode and rub, require special attention during installation or replacement. Therefore, an attempt is made to eliminate these shortcomings.In particular, the reduction of water consumption is achieved due to the elimination of the grain hydraulic conveyor during its transfer from the washing bath to the pressure column. For this purpose, a device for mechanical overloading of grain by a rotary bucket device located within the alloy chamber is used. At the same time, attention was paid to the separation of light organic impurities from the grain. This decision needs further explanation.The functional diagram shows that the initial grain mixture enters the receiving device, which feeds it with a minimum vertical speed into the ascending water streams created by the screws of two grain augers rotating with the same frequency in the opposite direction. The augers pick up the grain and, keeping it afloat in a suspended state, mix it with the water of the washing bath. At the same time the grain is washed and particles are separated from it, which differ from it in terms of density: mineral impurities begin to sink, fall down and through the longitudinal slit in the auger trough fall into the area of the auger for mineral impurities. This auger transports the "stones" in the opposite direction to the funnel with the ejector of the hydrotransporter of mineral particles. Light impurities, during the transportation of grain by grain augers, float to the surface of the water, the level of which in the washing bath is maintained up to the axis of the augers. Together with grain and water, these impurities are pushed out of the bath into the alloy chamber.In the chamber, in the transverse direction, a pipe with a longitudinal absorption slot is installed, the lower edge of which is immersed in water so that the upper layer of water merges into this slot together with light impurities that have surfaced in the washing bath. The amount of water that fuses light impurities can be adjusted by the depth of immersion in water of the lower edge of the absorption hole. To do this, the pipe is rotated relative to its axis with a special handle with a clamp and a pointing scale. One end of the pipe is closed by a plug, and the other passes through a hole in the wall and drains the water with light impurities into the sink sump. The described device provides almost complete removal of light impurities and minimal consumption of floating water. This solution is in the invention according to the copyright certificate 701708404, developed by specialists of the department TOZV. In addition, certain problems and inconveniences are caused by the design of the sieve shell of the squeezing column. Dirt particles tend to stick to the outer surface of the sieve cylinder and block its holes. This can slow down and even stop the separation of water by centrifugation. Therefore, the upper outer surface of the cylinder is washed with water, which in automatic mode is periodically fed to the sieve by the control device and the solenoid valve. It also saves water.

Normal values of coronary arteries branching height in women

Morphometric analysis of the structures of the aortic bulb and coronary arteries is necessary for the planning of cardiac surgery and endovascular interventions. The aim of the study was to determine the height of the coronary arteries branching in healthy women of Lviv city and Lviv region and to determine the relationship between the height of the location of the orifice of the coronary artery with anthropometric indicators. Fifteen computed tomography images with contrast of female thorax without heart and ascending aortic lesions (normal) were selected for the study. The height of the upper and lower edges of the coronary arteries was measured; height of Valsalva sinuses. The comparison of the mean values was performed according to the Student’s t-test. The correlation between the observed variables (age, height, body weight, body mass index, body surface area, height of the sinuses of Valsalva) was calculated using the Pearson linear correlation method (r). According to the study, the population group consisted of persons of the second period of adulthood (46.67 %) and the elderly (53.33 %). According to the body mass index, 80 % were overweight or obese I-II degree. The mean height of the coronary artery orifice in women without structural changes of the heart and ascending aorta was: 11.19±1.96 mm for the left and 11.68±1.80 mm for the right. The height of the orifice of the right and left coronary arteries were almost the same, without statistical significance (p=0.26). Analysis of the correlation between the values of the height of the orifice of the coronary artery did not show a probable dependence on height, weight, age, body mass index and body surface area. There is a direct relationship between the parameters of the height of the lower edge of the right coronary artery and the height of the upper edge of the right coronary artery (r=+0.75, p=0.001) and between the value of the lower edge of the left coronary artery and the upper edge of the left coronary artery (r=+0.63, p=0.01). Thus, the analysis of the correlation between the values of the height of the orifice of the coronary artery in women in norm and anthropometric indicators did not show a significant relationship. There was no statistical significance between the indicators of the height of the orifice of the right and left coronary arteries in women.

Justification and selection of the optimal method for draining the field of the “Angrensky” open pit mine in Uzbekistan

An increase in the stability of the slopes of the sides of a quarry or a ledge when using drainage wells with a camouflage cavity is proved in the article by the polarization-optical method. On the obtained diagrams, the distribution of stresses within the massif clearly shows that in an intact massif, the main concentration of stresses is concentrated in the lower edge of the slope, which contributes to the formation of a plane of displacement of the massif and the development of deformations. The presence of a camouflage cavity leads to a redistribution of stresses with the formation of a stress concentration around the camouflage cavity and a significant decrease in the stress concentration in the lower edge of the slope. Thus, we can say that the use of wells with a camouflage cavity not only drains the rocks along the side, but also unloads the border massif, creating favorable conditions for increasing the stability of the drained slope of the side of the open pit.

Simplified paravertebral anesthesia technique and its application

C. Fervers (Zentralbl. F. Chir. No. 37, 1929), in order to avoid complications, inserts the needle with paravertebral anesthesia one finger away from the spinous processes towards the angle formed by the transverse process and the edge of the vertebral body (the outer end of the needle with the midline forms an angle of 20 -30 ). The designated angle is located normally in the thoracic part of the spine near the upper edge of the spinous process, in the lumbar part, in the middle of the lower edge of the spinous process. In this way, the needle easily reaches the vertebral wall, and the injected fluid washes the ramus anter. ram. communicans. During operations, the author recommends using paravertebral anesthesia only for unilateral processes, such as appendicitis, cholelithiasis, kidneys and ureters and hernias. For the purposes of differential diagnosis and therapy, paravertebral anesthesia can be used.

Spleen: an organ of multiple shapes

Introduction: The spleen is located in the upper part of the abdominal cavity. As an organ, the spleen can have various shapes and size. Material and methods: The human spleen was studied in 273 cadavers (154 men and 119 women) who did not have diseases of the spleen. The shape of the spleen was analyzed based on splenic index, Michels classification. Results: The most common shape of the spleen in men is the elongated one. It was encountered in 79 (51.3%) cases out of 154. In women, the most common shape was the intermediate. It was encountered in 51 (42.9%) of the 119 cases. Based on Michels classification the clinoid (wedge) shape was encountered in 102 (37.74%) cases, triangular in 59 (21.83%) and tetrahedral in 30 (11.1%). In 30.26% the shape of the spleen couldn’t be classified according to Michels classification. In 21 cases (7.77%) the spleen had a flat shape; in 27 (9.99%) – dome-shaped; in 1 case (0,37%) – Z-shape; in 18 (6.66%) – round shape; in 6 (2.22%) – irregular shape; in 2 (0.66%) - shape with a node in the hilum; in 1 (0,37%) – rhomboid shape, in 2 (0,74%) – bilobed shape and in 4 cases (1,48%) – lobular shape. The splenic fissures located on the upper edge of the organ were found in 81 (29.91%) cases, and also on the lower edge - in 41 (14.02%) cases. In 13 (4.67%) cases fissures were encountered on both sides. In 148 (51.4%) cases the spleen had no fissures on its surface. Conclusions: The spleen has various shapes beyond the classical wedge, triangular and tetrahedral. All of these shapes do not represent a pathological finding but in certain situation may require further analysis and interpretation depending on the imaging technique and experience of the physician.

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

263 MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

Minimally invasive esophagectomy (MIE) has developed for decades. However, conventional MIE requires transthoracic operation, it could increase the risk of many perioperative cardiopulmonary complications. Therefore, mediastinoscopy-assisted transhiatal esophagectomy has been proposed, but the traditional surgical methods have shortcomings, such as unclear vision, especially during the dissection of mediastinal lymph nodes. A new approach of mediastinal lymphadenectomy under single-port inflatable mediastinoscopy through one left-neck incision was proposed. Methods With pneumomediastinum, esophagectomy was to be performed over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy of 106recL has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Between the trachea and esophagus, the lymphadenectomy of 107 would be performed along the trailing edge of the trachea down to the carina. Results 56 patients with esophageal squamous cell carcinoma from March to September 2019 who underwent this operation. The mean age of 56 patients was 67.4 years, 46 were males, and 10 were females. Preoperative TNM staging: T1b, 10 cases; T2, 35 cases; and T3, 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. All of the 7 RLN palsy were left side, none of them appeared at 3-month postoperation. Conclusion This single-port inflatable mediastinoscopy technology could remove the upper mediastinal LNs on both sides with a single incision on the left neck, avoid trauma to the right neck. The bilateral RLN could be clearly exposed and protected under the mediastinoscopy. Compared with previous surgical techniques, this surgery is less invasive, and the bilateral RLN is more clearly revealed. The surgical procedure described here is the first mediastinal lymphadenectomy under mediastinoscopy through one single left-neck incision. Video https://www.jianguoyun.com/p/DUvIaIsQoPWPBhj1mt8C.

ANATOMICAL MODELING OF SUPER-, SUB-EYE PATCH AND CHIN OPENINGS IN FRUITS AND NEWBORN

Using modern anatomical methods, 57 preparations of human fetuses 4-10 months and 7 newborns were studied in order to create models of distances of supra-, suborbital and chin openings between themselves and to standard landmarks in fetuses and newborns taking into account their morphometric parameters. The model of the distance from the supraorbital foramen to bregma (Y1): Y1 = β0 + 0.092 x parietal-heel length of the fetus, where β0 :: 2,783, if the age period = 4 months; 3,106 = 5 months; -0.662 = 6 months; 4,728 = 7 months; 2,676 = 8 months; 0.402 = 9 months; -1,727 = 10 months; 9,094 = newborns; model of the distance between the supra- and suborbital foramina (Y2): Y2 = β0 + 0.011 x parietal-heel length of the fetus, where β0 :: 8,147, if the age period = 4 months; 9.086 = 5 months; 10,260 = 6 months; 12,020 = 7 months; 12,129 = 8 months; 15,164 = 9 months; 17,429 = 10 months; 18,808 = newborns; model of the distance between the orbital and chin openings (Y3): Y3 = β0 + 0.002 x parietal-heel length of the fetus, where β0 :: 8.987, if the age period = 4 months; 9,134 = 5 months; 9,892 = 6 months; 12,250 = 7 months; 11,636 = 8 months; 16,755 = 9 months; 17,877 = 10 months; 18,054 = newborns; model of the distance between the chin holes and the lower edge of the mandible (Y4): Y4 = β0 + 0.008 x parietalheel length of the fetus, where β0 :: 0.268, if the age period = 4 months; 0.178 = 5 months; 0.020 = 6 months; -0.152 = 7 months; 0.020 = 8 months; - 0.115 = 9 months; -0.079 = 10 months; -0.039 = newborns; model of the distance between the orbital foramina (Y5): Y5 = β0 + 0.030 x parietal-heel length of the fetus, where β0 :: 5,762, if the age period = 4 months; 5,895 = 5 months; 11,227 = 6 months; 13,793 = 7 months; 11,691 = 8 months; 11,173 = 9 months; 12,633 = 10 months; 14,494 = newborns; model of the distance between the orbital foramina (Y6): Y6 = β0 + 0.008 x parietal-heel length of the fetus, where β0 :: 9,272, if the age period = 4 months; 11,081 = 5 months; 13,467 = 6 months; 16,854 = 7 months; 15,912 = 8 months; 17,653 = 9 months; 22,635 = 10 months; 23,447 = newborns; model of the distance between the chin holes (Y7): Y7 = β0 - 0.014 x parietal-heel length of the fetus, where β0 :: 12,959, if the age period = 4 months; 15,282 = 5 months; 18,117 = 6 months; 23,178 = 7 months; 23,175 = 8 months; 30,496 = 9 months; 32,227 = 10 months; 33,272 = newborns.

Frequency of Placenta Previa on Ultrasonography in Females with History of Caesarean Section

Background: Placenta previa (P.P) is a condition where the lower edge of the placenta lies close to the internal os. It may partially or completely cover the internal os. Objectives: To determine the frequency of placenta previa on ultrasonography in females with history of Caesarean section. Methodology: This descriptive study was held in Ghurki Trust Teaching Hospital Lahore and Tehsil Headquarter Hospital, Pattoki. Convex Probe Esotae 2.5 5-7MHz and Logiqv3 (5-7MHz) was used in the study. 140 pregnant women with history of previous Caesarean section were included in the study and were examined through convenient sampling. Data was collected after signing the consent form. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: According to the data analysis, minimum age patient was of 18 years and maximum age was 41 years. 37(26.4%) women had 1 previous Caesarean section. 57(40.7%) women had 2, 31(22.1%) women had 3, 15(10.7%) had 4 of previous Caesarean sections. 86(61.4%) women had a history of bleeding. 54(38.6%) women had no history of bleeding. According to analysis of placenta previa, 126(90.0%) women did not have a placenta previa and 14(10.0%) women had placenta previa. Cross tabulation analysis between frequency of patients with placenta previa and previous Caesarean cases evaluated that 126 patients with previous Caesarean rate did not placenta previa confirmed on ultrasound whereas 14 patients with previous Caesarean section had placenta previa on ultrasound. Conclusion: Placenta previa is seen in ten percent of subsequent pregnancies in females who have a history of previous Caesarean section.