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O.I. ZHAVORONKOVA, V.A. VISHNIEVSKI, D.A. IONKIN, O. MELEKHINA, A.B. SHURAKOVA

Institute of Surgery named after A.V. Vishnievski, Moscow, RUSSIA

Improvement of theresults of treatment of patients with focal hepatic neoplasm from the point of view of surgical radicalism and within the optimization of oncologic aid.

Materials and Methods: radiofrequency ablation (RFA)has been introduced in the Institute of Surgery named after A.V. Vishnevsky, since 2002, The method was performed with the application of Radionics Cool-Tip Ablation System device and a set of water-cooled electrodes of a single or cluster type, both as a directional intervention to focal neoplasms of primary and secondary origin in 132 patients, and at the stages of separation and/or treatment of a cut during liver resection of various sizes in 49 patients with metastases: colorectal cancer - 27, ovarian cancer - 3, renal cancer - 1, gastrointestinal stromal tumor – in 1, as well as primary hepatic cancer - in 14 and parasitic liver lesions - in 3.

In local tumor destruction the total number of sessions constituted 231 - 80% of interventions - performed percutaneously; first time – for the treatment of newly diagnosed metastases, repeatedly – to influence on focuses of continuing growth and / or residual nodes. In 20% of the observations RFA was performed at the intraoperative stage after the removal of parenchymal lesions on the remaining segments of the liver. The positioning of the electrodes was performed under ultrasound guidance, the optimal complex of studies for the assessment of the adequacy of the RFA is a combination of ultrasound and MRT, the latter shall be performed in the first 24 hours, in their dynamic observation their alternations and supplement by one another is possible.

The results of RFA in focal liver formations were observed in 124 patients within the periods ranging between 3 and 70 months. with the assessment of 1, 2, 3, 4, 5-year survival rate – there was revealed its significant increase. Survival median in a most representative group with secondary colorectal liver constituted 31 months. The use of RFA method for hepatic resection provided reliable parenchymal hemostasis and cholestasis, sufficient radicalism was ensured.

Complications occurring during RFA: fluid accumulations, abscesses, exudative pleuritises were removed by minimally invasive puncture-drainage interventions in the postoperative period.

ASPECT

1. Check whether you know the following linguistic terms.

2. Deictic (perfectivity –, imperfectivity, state, activity, accomplishment -, semelfactive, achievement, dynamism, durativity-ь, telicity , punctual, iterative aktionsart –, inceptive, inchoative

2. Match the terms and their definitions.

a) Aspect-related terms

b) Aktionsart. Two terms are synonyms. What are they?

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The term 'aspect' designates the perspective taken on the internal temporal organisation of the situation, and so 'aspects' distinguish different ways of viewing the internal temporal constituency of the same situation. The 'situation' is meant here as general term covering events, processes, states, etc., as expressed by the verb phrase or the construction. Unlike tense, which is situation-external time, aspect is situation-internal and non-deictic, as it is not concerned with relating the time of the situation to any other time point.

Aspectual meaning of a clause can be broken up into two independent aspectual components: aspectual viewpoint and situation type.

Aspectual viewpoint is the temporal perspective from which the situation is presented. An aspectual viewpoint can span an entire situation, as in the perfective, or it can span only part of it, as in the imperfective. The perfective indicates that the situation is to be viewed as a bounded whole, looks at the situation from outside, without necessarily distinguishing any of its internal structure. The imperfective looks at the situation from inside, or looks inside its temporal boundaries, and it is crucially concerned with its internal temporal structure. Perfectivity and imperfectivity are not objective properties of situations, and so the same situation can be presented from either viewpoint. In the English John read that book yesterday; while he was reading it, the postman came, the different forms of the verb 'read' refer to the same situation of reading (which in both cases is located in the past through the use of the appropriate tense), but the situation is presented in two different ways, with a difference in aspect.

Situations unfold in time in different ways. This component of the aspectual meaning of a clause indirectly classifies the situation according to its temporal properties. Smith (1991/1997) distinguishes five types of situation: state, activity, accomplishment, semelfactive, and achievement. They differ in the temporal properties of dynamism, durativity, and telicity.

a) Aspectual viewpoint.

Match in pairs the characteristics with the aspectual viewpoints.

concerned with the internal temporal structure

indicates that the situation is to be viewed as a bounded whole

looks at the situation from inside

spans an entire situation

spans only part of a situation

without distinguishing internal structure

b) Situation type. Use the words and phrases given below to provide examples for the situation types.

The following table, based on Smith (1997:3, 20), provides a summary of situation types, with typical examples from English:

build a house; knock; know the answer; laugh; learn Greek; love Mary; reach the top; stroll in the park; tap; walk to school; win a race;

4. Read the text

Verbs tend to have inherent aspectual meaning because the situations described by them tend to have inherent temporal properties. Three types of lexical aspectual oppositions are frequently identified:

Punctual and durative - these refer to situations which are not conceived of as lasting in time (punctual), versus situations which are conceived of as lasting for a certain period of time, however short it may be (durative). Inherently punctual situations can be further interpreted as semelfactive (taking place only once) or iterative (repeated). Many languages recognise a class of verbs that under normal circumstances can only refer to punctual situations (or iteration of punctual situations). N.B. In Slavonic linguistics, the term semelfactive is often used to refer to punctual situations irrespective of whether they are used iteratively or not.

Telic and atelic - these refer to situations which have an internal structure consisting of a process leading up to the terminal point and the terminal point (telic), versus situations which do not have an inherent endpoint (atelic). In this semantic distinction, it is particularly clear that situations are not described by verbs alone, but rather by the verb with its arguments (subject and objects), and it is in fact difficult to find sentences that are unambiguously telic or atelic. The telic nature of a situation can often be tested as follows (Comrie 1976:44-45): "if a sentence referring to this situation in a form with imperfective meaning (such as the English Progressive) implies the sentence referring to the same situation in a form with perfective meaning (such as the English Perfect), then the situation is atelic; otherwise it is telic. Thus from John is singing one can deduce John has sung, but from John is making a chair one cannot deduce John has made a chair. Thus a telic situation is one that involves a process that leads up to a well-defined terminal point, beyond which the process cannot continue." N.B. The term 'telic situation' corresponds most closely to Vendler's (1967:102) 'accomplishment'.

Stative and dynamic - roughly, these refer to situations which continue and do not change over time (stative), versus situations which involve necessarily change (dynamic). More precisely (Comrie 1976:49), with a state, unless something happens to change that state, the state will continue (e.g. standing, or knowing). With a dynamic situation, the situation will only continue if it is continually subject to a new input of energy, whether from inside or from outside (e.g. running, or emitting light). Since punctual situations inherently involve a change of state, they are always dynamic. N.B. Sometimes the distinction between states and non-states is referred to as 'states' and 'actions'. However, the term 'action' is also used in a more restricted sense, for a dynamic situation that requires the involvement of an agent. Similarly, the term 'event' is used to refer to a dynamic situation viewed perfectively, and the term 'process' - to a dynamic situation viewed imperfectively.

Date: 2014-12-28; view: 987