The frequency of colorectal anastomosis leak is significantly higher than other intestinal, up to 19%. The anastomosis, created by electro-weld method, had productive type of inside healing. Aim — to evaluate the technical features and efficiency of electro-welded colorectal anastomosis (EWCRA), in comparison with other types of intestinal welded anastomoses. 8 EWCRAs were created at chronic experiment in the distal third of the direct segment of the swine colon. After analyzing their effectiveness, EWCRA was applied in 4 patients: two at a distance of 3-4 cm from the anal sphincter, and two at the level of the upper ampulla unit. Previous radiation was received by 2 patients. The age of the patients was 40–79 years old. EWCRA was applied in a moment, end to end, by using a tool with circular electrodes, and devices — sources of electric welding impulses EK-300M1 and Patonmed EKVZ-300, produced by the Electric Welding Institute. In pigs weighing 45–75 kg. this instrument was inserted into the rectal lumen through proximal colotomy, in humans — via transanal. Welding influence at the EWCRA was controlled visually, and by the impedance curve flow on the control apparatus screen. In the experiment, EWCRA healing was morphologically investigated in the planned healing periods. When fixing the gut on the instrument, the rigidity of rectal walls was noted, which required additional efforts to compress the electrodes to smooth the walls along the electrodes surface. During the test of rectal swelling with colored liquid, all EWCRAs were sealed. Pigs got up after 6–12 hours in an attempt to drink; by the end of the day, 7 out of 8 pigs had already demanded food. In the 2 pigs, the gut was empty at the end of the first postoperative period, at 6 - during the second (on average 25.4±5.1 hours). The thickness of the EWCRA substrate reached 0.3 mm. Recovery of EWCRA occurred initially, without signs of destruction of the welded tissue substrate and the intestinal walls around the EWCRA, by the typical post-welding productive proliferation healing type. In one patient, the leak of the lower EWCRA was detected on the 7th day, against the stool continuity, after the intestinal contents appearance by drainage. The patient got a stoma and recovered. In patients first stool was observed after 29–57 hours after the operation, including a patient with anastomosis dehiscence (48 hours). None had a feeling of obstruction, unbridled imperative calls to the chair etc. According to the endoscopy, the ulceration of the EWCRA site was limited by the epithelial layer, and did not lead to bleeding or necrosis deepening. One patient with an electrically welded descendent-rectoanastomosis, died on the 4th day as a result of acute cerebrovascular disruption. According to autopsy, EWCRA did not show signs of failure, the pattern of healing was consistent with productive inflammation, with the presence of a continuous connection, a powerful fibrilogenesis of the permeation zone of collagen fibers, the network of functioning newly formed small vessels of granulation tissue, the absence of tissue fragmentation. Of the 3 patients with EWCRA, it was traced up to 2 years — 3 patients, 3 years — 2, 5 years — 1. They did not have purulent complications. There was no ulceration or narrowing of the intestine through the EWCRA line, the gut lumen was restored, the mucosal folds were restored near the connection line. So, the electric-welded tool with circular electrodes using enables the in-moment colorectal anastomosis creation after the low anterior resection of the rectum. The greater the thickness of the muscular lays of the human rectum, and its individual diameter variations require to use a number of special tools.
На сьогодні існує велика кількість новоутворень стравоходу, необхідність їх диференційної діагностики обумовлена різними підходами до лікування даної патології. Особливо це стосується доброякісних утворень стравоходу (лейоміом) та гастроінтестинальних стромальних пухлин (GIST). Оскільки найбільш частими та доступними обстеженнями пацієнтів з патологією верхніх відділів шлунково-кишкового тракту є променеві методи, виникає необхідність оцінити їх ефективність у проведенні диференціації між різними утвореннями стравоходу та у спроможності виявити лейоміоми стравоходу у доопераційному періоді. Мета: визначити ефективність променевих методів діагностики для виявлення лейоміоми стравоходу. Матеріали і методи. Проведено ретроспективний аналіз даних 56 пацієнтів з лейоміомою стравоходу. У пацієнтів виконувались такі види променевих досліджень: рентгенографія стравоходу з розчином барію (n=48), комп'ютерна томографія органів грудної клітки з контрастним підсиленням (КТ ОГК) (n=35), магнітно-резонансна томографія з контрастним підсиленням (МРТ ОГК) (n=4). Результати. Чутливість променевих методів діагностики низька і склала: рентгенографії-31,25%, КТ ОГК-22,85%, МРТ-50%. Висновки. Кожен окремий метод променевої діагностики не має специфічних ознак для лейоміом стравоходу, проте використання комплексу з рентгенографії, КТ ОГК та МРТ дозволяє більш точно встановити діагноз.
The aim — to study the proliferation processes inside the intestinal anastomose created with live tissues electric welding technology during the early postoperative period.Materials and methods. The study was performed on 58 pigs of the breed «Ukrainian Big White» weighing 45 — 75 kg. Changes in intestinal anastomoses were examined on the 4, 7 and 21 day after its creation. The circular welded ileo‑ileal intestinal anastomose (n = 83), ileo‑colonic (n = 15) and colo‑colonic (n = 68) anastomoses were created in operating room for 54 animals (main group), and 4 stapled intestinal anastomoses — at control group. The electric welding devices EK‑300M1 and Patonmed‑300 were utilized, as well as prototypes of surgical equipment to create circular intestinal anastomoses. For the morphological study reason anastomoses were taken after clinical testing by stretching with a fluid inflating up to 29 — 33 mm Hg pressure, the IA line defect by fluid was not detected.Results and discussion. After 4 days, the welded intestinal anastomoses line did not have any exudative edema or deformation, and were thickened. There was a mucosa defect with great hyperplastic activity of epithelial cells at the edges. The defect bottom was covered by a layer of coagulated structures of the intestinal wall and a newly formed granulation tissue. In the mucosa, the submucosal layer and the muscular membrane the coagulation conglomerates, without any encapsulation or bacterial either macrophages activity or rejection were observed. Powerful fibers neogenesis, the spread of fibers along the structural shells, and a large number of already functioning newly formed blood vessels were found. In the control group, unlike the welded anastomoses, oncoming of the destructive period phase was observed. After 7 days during water probe achieved intraluminal pressure of 220 mm Hg wall led to intestine rupture far from welded anastomoses. To that period, we discovered the wide network of young fibrous connective tissue yet was formed, oriented mainly tangentially according the mesentery. After 21 days, the colon mucosa over welded anastomoses was healed; inside this scar the regeneration of the glands was revealed. The fibrous connective tissue was disseminated as bands, from submucous membrane to the muscular, tightly interwoven with bundles of oriented collagen fibers with bundles of smooth muscles. In addition to significant vascularization of the coarse‑fibrous connective tissue, restoration of large blood vessels functionality was observed. In animals from the control group, after 21 days, IA was seen as an uneven scar covered with epithelium, poor by blood vessels.Conclusions. The functioning up to 4th postoperative day newly formed vessels, which uniformly passed from one connected intestine edge to the other and were developing simultaneously with the network of young collagen fibers, leaving no sites of poor blood supply — indicated the course of the proliferation phase inside welded intestinal anastomoses without any complications, which started at the welding moment. The mesh character of the connective tissue growth from the zone of the electric welding connection along the natural membranes of the intestinal wall was a consequence of the productive type of inflammation in this zone — in contrast to the coarse‑fibrous organization of the staple anastomose line. The presence of the yet formed mucous glands in welded anastomose zone was the consequence of regeneration processes activation in the intestinal epithelium, maybe also of more subtle processes of tissues restoration.
АннотацияПри проектировании и эксплуатации сельскохозяйственного оборудования, аппаратов для хранения, транспортирования или переработки сыпучих материалов учитываются его физико-механические характеристики. Одними из наиболее важных физико-механических характеристик сыпучих материалов являются коэффициенты внешнего и внутреннего трения. В связи с этим, актуальной задачей является определение этих фрикционных характеристик сыпучих материалов. В статье показана связь свойств сыпучего продукта с его коэффициентом внутреннего трения при сопротивлении сдвига. Определены основные параметры универсальной установки для определения фрикционных характеристик сыпучих материалов -статического и динамического, внутреннего и внешнего коэффициентов трения. Ключевые словаТрение, динамическийкоэффициент трения, статический коэффициент трения, сыпучийматериал. AbstractPhysical and mechanical propertiesof bulk materialsmust be taken into account when designingand operation of the agricultural equipment, devices for storage, and transportation of bulks materials. One of the most important physical and mechanical propertiesof bulks materials are coefficients of external and internal friction. In this regard, definition frictional characteristics of bulks material are relevant. The article shows the relationship between the properties of the bulk product and its coefficient of internal friction in the case of shear resistance. The main parameters of a universal installation for determining the frictional characteristics of bulk materials-static and dynamic, internal and external friction coefficientsare determined.
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