Laparoscopic Caudal Approach of the Inferior Vena Cava for Isolated Segment 1 Liver Resection.

Introduction:Isolated segment 1 laparoscopic liver resection is a very challenging procedure. Very few references are available about this laparoscopic technique, so the aim of this article is to show the main technical aspects of laparoscopic caudal approach for segment 1.Material and Methods: A 64 years old woman with a past medical history of a breast cancer previously operated (pT1N0M0, with positive hormonal receptors). Adjuvant treatment was done with radiotherapy and hormone-therapy (Tamoxifen). After 12 months of follow-up, a 18 mm single liver metastasis was detected in the segment 1, suggestive of metastatic disease. A complementary study was done with Magnetic Resonance Image, Computed Tomography and Positron Emission Tomography, without other lesions proven. Result:A laparoscopic resection of isolated liver segment 1 is performed with a caudal approach of the inferior vena cava. All the steps are carefully described. The surgery time was 120 minutes and the blood loss was less than 100 ml. No postoperative complications were registered. The patient was discharged on the third postoperative day.Conclusion:Liver 1 segment resection by laparoscopy with a caudal approach of the inferior vena cava is a secure technique in selected patients and it should be performed in experienced liver surgery and advanced laparoscopy centers, because of its high complexity.

Geological structure and magmatism of the Shchuchinsky megablock (Polar Urals)

Purpose of the work: determination of the geological structure, occurences of magmatism and geodynamics of the northernmost isolated segment of the paleooceanic sector of the Ural mobile belt – the Shchuchinsky megablock. Geographic disconnection with the southern structures of the Ural mobile belt and sub-ring structure have led to both a suspended interest and conflicting ideas about its geology, the composition of the host rock complexes, their age, genesis, and mineragenic specialization. Methodology of the work: generalization, analysis and synthesis of materials of long-term study of geology and magmatism of the region, including the conducted GDP-200/2 sheets Q-42-VII, VIII and GMK-200 sheets Q-42-III with extensive literary sources and creator-owned mineralogical-petrographic and petro-geochemical studies, including isotope-geochronological ones. Results. For the first time, the internal geological structure of the Shchuchinsky megablock, its magmatism, geodynamic conditions of formation and metallogeny are shown on the basis of the created geological map of pre-Mesozoic deposits and the developed author’s legend of the territory. Magmatic, metamorphic and sedimentary formations are combined into pre-Paleozoic (Archean-Proterozoic), Paleozoic and Mesozoic megacomplexes, characterized by specific formational-geodynamic parameters and ore content of their occurences at certain stages of the development of the region. Analytical information on the breed associations of the structure under consideration is given in a concise form. Conclusions. The results obtained indicate a probable polygenic-polychronous structure of the ophiolite association and subsequent island-arc-collisional complexes, including the so-called “femic” (AR – PR) base, involved in the vortex interplate system, which caused the annular structure of the Shchuchinsky ridge

Postsurgical residual lung complications following left upper trisegmentectomy

OBJECTIVESSegmentectomy has become an increasingly popular surgical procedure for small-sized lung lesions. Left upper trisegmentectomy (LUTS) is one of the most common segmentectomies performed because of its relative ease and simplicity; however, limited information is currently available on the specific postoperative complications associated with this procedure.METHODSAmong 2060 surgically resected cases in our institute between 2009 and 2016, 129 (6.2%) underwent LUTS. Postoperative chest X-rays and/or thoracic computed tomography (CT) scans were retrospectively assessed for all cases to assess postsurgical residual lung complications following LUTS. We categorized cases into 4 groups: type A (atelectasis of the lingular segment), type B (lung torsion of the lingular segment), type C (necrosis of the ‘isolated segment’) and type D (haematoma along stapling lines).RESULTSPostsurgical lung complications following LUTS were observed in 17 (13.1%) patients (type A: n = 7, type B: n = 1, type C: n = 4 and type D: n = 5). Three patients (2.3%) required surgical intervention because of type B (n = 1) and type C (n = 2), namely, decreased permeability and remaining ground glass opacities in the residual lung, showing an exacerbated systemic inflammatory response. In contrast, type A and D cases were successfully observed by chest CT without any surgical intervention, and patients recovered within a few months of surgery.CONCLUSIONSWe identified several postoperative residual lung complications following LUTS. Lung torsion or necrosis of the residual segment may require intensive care, including reoperation. Potentially serious complications always need to be ruled out after LUTS when radiological consolidation is detected postoperatively.

Serotonin differentially modulates the functional properties of damaged and intact motoneurons of the frog spinal cord

The role of serotonin in the recovery of motor functions in spinal cord injuries is intensively studied, but the mechanism of its action remains unclear. In this work, we used the preparation of an isolated segment of the spinal cord of an adult frog to compare the electrophysiological properties of damaged and intact lumbar moto- neurons and the modulating effect of serotonin (5-HT) on them. Due to specific morphology of the motoneurons (a very branched dendritic tree), we could reliably obtain damaged (on the surface of the slice) and intact moto- neurons (in the depth of the slice). Using intracellular recording, we found significant differences between these groups of neurons in the resting membrane potential, input resistance, properties of the action potential (amplitude, duration, fast and medium phases of the afterhyperpolarization), the frequency of spikes. We found that 5-HT reduced the amplitude of the afterhyperpolarization and increased the frequency of spikes in intact neurons, whereas in damaged motoneurons, 5-HT increased the amplitude of the afterhyperpolarization and did not affect the frequency of discharges. The results of the study show that the properties of the motoneurons and the effect of neuromodulators on them, in particular, 5-HT, can change after damage.

Effekt of blood flow shutdown on the vein damage when exposed to HIFU

The purpose. In the study we investigated the impact of the partial blood flow shutdown on structural changes in the rabbit vena cava posterior wall after exposure to high-intensity focused ultrasound (HIFU). Methods. Ultrasound Exposure: frequency of 1.65 MHz, the ultrasound intensity in the focus of 13.6 kW/cm, the area of the focal spot 1 mm, continuous ultrasound, exposure for 3 seconds. Results. Immediately after HIFU exposure all layers of the vein wall showed characteristic signs of thermal damage. A week after exposure structural changes in the intima, media and adventitia was minimal in the part of vessel with preserved blood flow, and after 4 weeks the changes were not revealed. A week after HIFU exposure partial endothelium destruction, destruction of myocytes, disorganization and consolidation of collagen fibers of the adventitia were observed in an isolated segment of the vessel, and in 4 weeks endothelium restored and signs of damage in media and adventitia persisted, but were less obvious than in a week after exposure. Conclusion. The shutdown of blood flow after exposure to HIFU promotes persistent changes in the vein wall. Vein compression appears to be necessary for the obliteration of the vessel, when using HIFU-technology.