Inhibitory coagulopathy in urgent surgery (is it possible to prevent lethality?)

Inhibitory coagulopathy in urgent surgery (is it possible to prevent lethality?

Three-channel Synergetic State Observer for Data Transmission System with Chaotic Dynamics

Abstract The paper presents the first developed procedure of state variables three-channel observer design for a nonlinear dynamic system. The state observer allows to estimate the values of parameters that are not available for direct measurement. Here, the observer is used to build a data secure communication system with a chaotic carrier bearing signal. As a chaotic carrier generator, we use the model of the novel chaotic attractor. The data transmission system is implemented by nonlinear mixing of useful signals into parameters of the chaotic generator model on the transmitter side and by reconstructing the useful signals on the receiver side with the designed state observer. The introduction of the state observer into chaotic generator data transmission system provides the system implementation without the use of chaotic synchronization. We provide step-by-step general description for a synergetic state observer design as well as example of the chaotic carrier bearing signal observer design procedure along with closed-loop system computer simulation results.</jats:p

Surgical and intervention treatment of secondary pancreatic infections

Introduction. Many experimental and clinical studies have improved our understanding of the pathophysiology of acute pancreatitis. Today, there are no disagreements over the timing and basic indications for surgery in this disease, but there are still various surgical approaches.&#x0D; Methods. A retrospective and prospective two-center controlled study was conducted in 582 patients with acute pancreatitis treated in 2004–2018. Age of patients was 53 ± 12,5 years. The classification of the disease was used according to the recommendations of the International Consensus 2012. Patients included in the study were treated in accordance with the IAP/APA (2013) recommendations adapted to local resources and procedures. Of 582 patients, 387 (66,5%) patients with mild to moderate heaviness performed complex treatment, including 89 patients undergoing surgery. According to the goals and objectives of the study, other patients were divided into two groups: the main group – 103 patients with secondary pancreatic infection, who used the tactic of treatment «step-up approach»; а comparison group – 92 patients with open surgical intervention.&#x0D; Results. In the comparison group were used open necrosectomy and drainage. Postoperative complicationshavearisenin52 (56,2%)patients. After surgery died 26 patients (28,3%), 19 had a 30-day mortality and 7 had a 90-daymortalityof them. In the main group 62 (60,2%) patients were treated by percutaneous controlled ultrasound intervention, 26 (25,2%) by videolaparoscopic necrosectomy and drainage and at 5 (4,9%) drainage through the wall of the stomach or duodenum. In 10 (9,7%) open operations were performed (minilumbotomy, upper medial, left or right-winged minilaparotomy with formation of mini-bursostomy) with pancreatic necrosectomy, including at 5 decompressive VAC-laparostomy local access. Postoperative complications have arisen in 33 (32%) patients. After surgery died 15 patients (14,6%), 6 had a 30-day mortality and 9 had a 90-day mortality of them. When comparing the two strategies of the treatment-tactical approach, the number of postoperative complications and mortality were lower than in the group of patients who performed only open surgical interventions (х2 = 6,976, p = 0,011).&#x0D; Conclusion. The our research showed that an individualized approach to patients with secondary pancreatic infection using the step-up approach provides a reduction in the number of laparotomic pancreatic necrosectomies and allows postponing «open» surgical interventions for a period after the 4th week from the onset of the disease and reducing the number of postoperative complications and mortality (х2 = 6,976, р = 0,031).</jats:p

ЛАПАРОТОМНІ ХІРУРГІЧНІ ВТРУЧАННЯ У ХВОРИХ НА УСКЛАДНЕНІ ПСЕВДОКІСТИ ПІДШЛУНКОВОЇ ЗАЛОЗИ ПЕРШОГО ТИПУ

The results of surgical treatment of 32 patients with complicated pancreatic pseudocyst, first type, using laparotomy are analyzed. For the treatment of patients with organ dysfunction (SOFA&gt;8) mini-invasive techniques were used for the purpose of pseudocyst decompression with the aim of “expectant” tactics. Laparotomy was performed as the main method of surgical treatment after parforming of mini-invasive techniques and stabilization of general condition. Patients with SOFA from 3 to 8 underwent laparotomy with surgical treatment of pseudocyst cavity followed by the formation of сystoenteroanastomosis while forming its walls. Patients with pseudocyst with thin walls underwent external drainage of their cavities. Complications occurred in 28.1% of patients after laparotomy as the first stage.Проанализированы результаты хирургического лечения 32 больных с осложненными псевдокистами поджелудочной железы первого типа с использованием лапаротомных вмешательств. Для лечения больных с дисфункцией органа (SOFA&gt;8) в больных применяли миниинвазивные методики с целью декомпресии псевдокисты с вижидательной” тактикой. Лапаротомные вмешательства проводили в качестве основного метода хирургического лечения после выполнения миниинвазивных методик и стабилизации общего состояния. Больным с SOFA от трех восьми проводили лапаротомию с хирургической обработкой полости псевдокисты, а в дальнейшем, при формировании ее стенок, формироование цистоэнтероанастомоза. Больным с псевдокистами с тонкими стенками проводили наружное дренирование их полостей. Осложнения возникли в 28,1 % больных после выполнения лапаротомии, в качестве первого этапа.Проаналізовані результати хірургічного лікування 32 хворих з ускладненими псевдокістами підшлункової залози першого типу з застосуванням лапаротомних втручань. Для лікування хворих з дисфункцією органу (SOFA&gt;8) у хворих застосовувалися мініінвазивні методики з метою декомпресії псевдокісти з метою “вичікувальної” тактики. Лапаротомні втручання виконували у якості основного методу хірургічного лікування після виконання мініінвазивних методик та стабілізації загального стану. Хворим з SOFA від 3 до 8 виконували лапаротомію з хірургічною обробкою порожнини псевдокісти, а в подальшому, при сформуванні її стінок, формування цистоентероанастомоза. Хворим із псевдокістами з тонкими стінками виконували зовнішнє дренування їх порожнини. Ускладнення виникли у 28,1% хворих після виконання лапаротомії, у якості першого етапу