2.1 PURPOSE OF PNEUMOTIC WEDGE
CAPTURE PKR-560
Purpose of the complex
The set of equipment for working with pipes is designed for screwing, unscrewing, hanging, storing, feeding and ejecting pipes. This complex includes the following mechanisms and equipment: a rotor with a roller liner and a pneumatic wedge grip PKR 560 M, an auxiliary winch LV, an automatic stationary drilling wrench AKB-ZM2, a pneumatic pendant wrench PBK-4, machine keys with pneumatic spark plug releasers, PRS and a receiving bridge with shelving. On the drilling rigs BU 2900/175 DEP and BU 2900/200 EPK-BM, two types of rotors are used: R-560 (Figure 1) and R-360.
Purpose and design of the R-560 rotor
The rotor is designed to transmit rotation to the drill pipe string during drilling, fishing operations, perceive reactive torque when drilling with downhole motors and support the weight of the pipes on the table during tripping and running the casing.
1, 13 - body; 2, 18 - ball bearing; 3 - table; 4 - wheel;
5 - roller insert; 6 - roller; 7 - flooring; 8 - gear;
9 - filler neck; 10 - roller bearing; 11, 24, 25 - gasket;
12 - drive shaft; 14 - sealing ring; 15 - plug;
16 - ball shut-off valve; 17, 19, 26, 30 - bolt; 20 - bar;
21 - liner; 22- covers; 23 - nut; 27 - handle; 28, 29 - arrow;
Figure 1. Rotor R-560
The rotor housing (Figure 1) is the main part on which all other parts are mounted. It absorbs and transfers to the base of the drilling rig all the loads that arise during the drilling process and during tripping operations.
Pneumatic wedge gripper PKR-560
The pneumatic wedge gripping bracket PKR-560 (Figure 2) is attached to the rotor body with bolts.
Specifications
Pneumatic wedges are installed in the rotor, serve to grip the pipes and keep them from rotating. Pneumatic wedges can be in two versions: with manual drive release or with mechanized drive release. The housing is installed in the hole of the rotor table. On the outside of the housing there are four vertical grooves that serve as a guide for guide strips connected to the ring.
Inserts with a centralizer are installed in the inner hole of the housing, which are sockets for wedges. The wedges, hingedly connected to the holders, are attached last to the upper ends of the guide bars. On the inner surface of the liners there are inclined planes that serve as guides when moving the wedges and as support when gripping the pipe string. The wedges are equipped with dies with a toothed notch, which ensures reliable gripping of pipes. Three dies are installed in each wedge, with the middle die having longitudinal and transverse notches, and the upper and lower ones having only transverse notches.
The control cylinder is installed on a sub-rotor bracket attached to the rotor. The pneumatic cylinder is fixed on the bracket with an axis. A lever is mounted on the control cylinder bracket, the long end of which is connected to the ring using rollers, and the short end is connected to the pneumatic cylinder. Using a cylinder and a lever, the ring with the bar and wedges is raised or lowered. The pneumatic cylinder is controlled by a control valve.
I - under the floor of the drilling rig; II - to the receiver of the drilling rig
5 - control cylinder bracket; 6 - control cylinder;
7 - sub-rotor bracket; 8 - lever; 9 - axis; 10 - ring;
11 - stabilizer; 12 - wedge; 13 - holder
Figure 2. Pneumatic wedge gripper PKR 560 M-OR
Installation of a pneumatic gripper on the rotor can be carried out if the level of the surface of the rotor table does not rise above the drilling rig floor by more than 500 mm, and the rotor beams are extended to a size of more than 780 mm. The installation of the wedge grip must be carried out with the installation of a bracket with a pneumatic cylinder and a lever. Check the free movement of the pneumatic cylinder along the bracket. The bracket with the pneumatic cylinder is moved to the extreme left position and fixed with an axis. After this, a housing with guide bars and a ring is installed in the rotor hole. The cylinder bracket is moved to the front position, ensuring that the lever rollers fit into the groove of the ring. Connect the air hoses. The guide bars are raised to the top position and wedges are installed on them. After all four wedges are installed, test lifting and lowering is performed. By turning the control cylinder rod, the wedges in the raised position are installed vertically so that the toothed surface is parallel to the gripped pipe.
Development of production and investment programs organizations of the utility complex - producers of goods and services in the field of heat supply
Development of production and investment programs for public utility organizations - producers of goods and services in the field of heat supply
L.D. Solovyova, Deputy Director - Head of the Department of Legal Regulation of the Utilities Sphere of the Department of Housing and Communal Services of the Ministry of Regional Development of the Russian Federation (report at the International Forum “Russian Heat Supply: Problems and Development Trends”)
General issues of development of public utility organizations
Quite a lot has been said and written about the existing problems of the housing and communal services sector. And if literally two years ago the situation could be characterized by the phrase: “We have many projects, but we have no money,” now everyone says: “We have a lot of money, but we have no projects, nowhere to invest.” At the same time, investors remain faced with high risks of investing in public utility infrastructure systems (Fig. 1). Risk reduction is possible through the transition to secured public-private financing (Fig. 2).
As a rule, when an investor comes, he comes with his interest in a certain organization of the utility complex (PCC) and this is enough for him to start making money. His interest is not linked to the interests of the city, is not linked to the development interests of others utility companies. A certain imbalance arises - “pulling towards oneself” financial resources. Therefore, effective interaction between government authorities and resource supply organizations is very important.
State control in accordance with Federal Law No. 210-FZ of December 30, 2004 “On the basis for regulating tariffs of public utility organizations” should be carried out through integrated development programs (ICD). The presence of RCC is a mandatory condition in many Federal laws for the provision of federal support. This is also written down in the regulations on the provision of subsidies for interbudgetary transfers developed by the Ministry of Regional Development of the Russian Federation. The first RCCs of municipalities have already begun to arrive at the Ministry of Regional Development of the Russian Federation, but you can’t look at them “without tears”; for example, some of them consist of only a few pages.
It is necessary to clearly understand that the PKR is an integral part of the General Plan for the Development of a Municipal Entity, and the norms prescribed in the Town Planning Code indicate that by 2010 all municipalities must have Master Plans for their development.
From January 1, 2009, the maximum payment index for citizens will be set by the subject Russian Federation. Only the aggregate utility payment index will be regulated. The Ministry of Regional Development of the Russian Federation in the near future should submit for consideration to the Government of the Russian Federation a draft resolution on the calculation of limit indices. A necessary condition for establishing limit indices in the draft resolution is the presence of the RPC and the law of the constituent entity of the Russian Federation on the criteria for the availability of tariffs for the consumer. These two main factors will influence regulation.
Comprehensive Development Program
In accordance with Federal Law No. 210-FZ, the program for the integrated development of municipal infrastructure systems (SCI) of a municipality is a program for the construction and modernization of SCI, which ensures the development of these systems in accordance with the needs of housing and industrial construction, improving the quality of goods supplied (services provided) and improving the environmental situation on the territory of the municipality.
RCC solves the following problems:
■ determining target indicators for the development of SCI;
■ determining priorities and sequence of development of SCI;
■ balanced development of SCI;
■ ensuring environmental safety of SCI development.
For a municipal formation, PKR is a tool for integrated management and optimization of the development of the city's infrastructure, which allows you to link the goals and rates of development of the city's infrastructure (electric power, heat supply, water supply), identify problem areas and, in conditions of limited resources, optimize them to solve the most pressing problems.
At no other level of government is there such a function as organizing electricity, heat, water, and gas supplies. It should be noted that this function is not a “planning meeting” in the morning with the deputy head of the municipality responsible for providing housing and communal services, and this is not a daily redistribution of funds to pay for or repair something. There is no development of one resource without the development of another, interconnected with it. It is impossible to build elements of a water supply or heating system without generation sources. You cannot talk about thermal energy, for example, without gas. This is a whole complex, and municipal authorities must understand this.
As mentioned above, RCC - necessary condition to receive financial support at the federal level. For example, in accordance with Federal Law No. 185-FZ of July 21, 2007 “On the Fund for Assistance to the Reform of Housing and Communal Services,” approval of tariffs and surcharges based on the RPC is a necessary condition for receiving funds from the said Fund, and in accordance with the Federal Law dated July 24, 2008 No. 161-FZ “On promoting the development of housing construction” - a condition for the allocation of land plots for housing construction.
PKR is a management tool (including through further monitoring) of private enterprises. The RPC allows you to influence the development plans and motivation of private companies that own infrastructure facilities in the interests of the city, which is practically impossible by other methods; allows (through monitoring) to evaluate and control the activities of these companies.
From the position of the municipal authorities, management of an enterprise is possible only if it is a municipal enterprise (MUP), and if infrastructure elements are transferred to a private enterprise, then management becomes impossible. But this position is wrong. If the RCC is built correctly, the illusion of lack of control goes away. It is through the PKR that the municipality manages any enterprise of any form of ownership. It would be even better for the municipality if it were a private enterprise, because For mistakes made, a private enterprise pays from its own funds, and the mistakes of municipal unitary enterprises are compensated from the budget of the municipality.
RPC is a tool and a necessary basis for effective tariff setting. The RPC and the investment and production programs of the OKC drawn up on its basis are the basis for setting tariffs.
For investors, the RPC is also a tool within which he can make decisions “where to enter, how to enter and how much it costs.” Investors receive a “signal” from the authorities about where investments in infrastructure will be needed, as well as an infrastructure development plan approved by the authorities with priorities for several years ahead. The RPC approved by the representative body of the municipality and the QCC investment programs and tariffs (including long-term ones) approved on its basis are a legitimate mechanism for guaranteeing the required level of tariffs for the investor for the period specified in the RPC.
There is a position of the heads of administrations of the constituent entities of the Russian Federation and municipalities, which can be expressed by the phrase: “You give us money, and we will figure it out ourselves.” At the same time, the reasonable size necessary funds and many cannot even name the time frame for their development. In this case, the PKR is also a tool for the investor that provides the ability to control the results of their investments.
Monitoring
In accordance with the order of the Ministry of Regional Development of the Russian Federation dated April 14, 2008 No. 48 “On approval of the methodology for monitoring the implementation of production and investment programs of public utility organizations,” monitoring of these programs of municipalities will be carried out directly, without the participation of a constituent entity of the Russian Federation. This is not surprising; as a result, the enterprise looks like “in the palm of your hand.” Bye for heat supply organizations Only investment programs will be monitored, but over time, it is possible that an agreement will be reached with the Federal Tariff Service (FTS) to extend this monitoring to production programs.
Tariff regulators for utility companies now have a tool that allows them to revise tariffs based on monitoring results, and not only “plus”, but also “minus”, which will not be very pleasant for resource-supplying enterprises. Moreover, revision is possible during the regulation period. Tariffs “minus” will be revised, because in all our orders, resolutions and laws it is written that any investment or production program- This is, first of all, the achievement of specific goals. If in the production program the goal is energy and resource conservation, expressed by a certain percentage, then the regulatory authorities through certain time must compare the results obtained with the declared ones. In the event that the values specified in the investment program are not achieved, there is no explanation of the reasons (accident, cold winter etc.) will not help and tariffs will be reduced. Regulatory authorities will not immediately, not this year, but will definitely master this regulatory tool.
It is also necessary to reconsider the idea of the investment program. In accordance with Federal Law No. 210-FZ, this is to a greater extent a program not of an enterprise, but of a municipal entity. The company does not need an investment program. The municipality issues terms of reference, and the enterprise realizes his desire for something using only a production program.
The example of Moscow is surprising in connection with the establishment of the amount of fees for connection to heating networks, despite the fact that the city investment program was not approved. At the same time, the connection fee is set only when there is an approved investment program and the amount of the fee is calculated only in accordance with the volume of this program.
Methods for developing anti-ship missiles
In order to develop a full-fledged anti-ship missile system, a significant amount of time, money and highly qualified developers are required. Therefore, during the transition period, it will be possible to develop a simplified program, with the condition that in the future there will be a transition to full RCC (Fig. 3). The only difference will be that the so-called simplified anti-ship missile system will not contain promising schemes for the development of SKI, but at the same time it will have enough detailed analysis SKI.
Prospective schemes for the development of communal infrastructure are a detailed study of the development engineering systems urban infrastructure:
■ with details on the territory of the settlement and the compilation of electronic models;
■ with calculations to ensure the regulatory reliability of the provision of a utility service (resource);
■ with specific technical solutions(specific configurations and diameters of pipelines, type of equipment at sources, their placement on the territory);
■ with approval of land allotment;
■ with receipt of preliminary technical conditions for connection to electrical, thermal and gas networks;
■ with environmental impact assessment and development of measures to reduce impact.
As a result of the development of a complete RPC, specific packages of investment projects are obtained. A municipality can quite easily put up objects for specific investment attractions for competition, because the land has already been registered, preliminary documents have been drawn up technical specifications etc., i.e. everything that is often missing in today's projects. A complete RPC will make it possible to simply announce investment competitions to attract any investor and for sufficiently long investment periods.
It does not matter which of the two options will be used to create the RPC - in any case, Russian legislation has already created the legal field for the implementation of these measures.
According to estimates of time costs for a city with a population of 150 thousand people. the development of a simplified RCC scheme will require about 2-3 months, and complete scheme- about 8 months.
Components of anti-ship missiles
As mentioned above, the PKR is the main part of the Master Plan for the development of a municipality, and therefore must necessarily include a forecast of territorially distributed demand. Both in a simplified and in a complex (full) scheme, RCC is the basis of the foundations.
Forecast of geographically distributed demand for utility resources(heat, electricity, drinking water, etc.) is formed on the basis of the use of GIS technologies coupled with the city geographic information system.
The basis for forecasting territorially distributed demand is the principle of forming a calculated element of territorial division (planning quarter, cadastral quarter, BTI quarter, production or industrial zone, etc.). In each element of the territorial division, the demand for resources is modeled, based on the analysis of urban planning plans for the development of the housing sector, social sphere, and industry.
In the future, there will be a widespread transition to representing utility infrastructure (CI) systems in the form of electronic models. There are regions and municipalities that are already carrying out such work. Electronic models are structured databases of engineering infrastructure elements, linked to the territory, which allow you to carry out all the necessary engineering calculations for the design of heat supply systems. They contain a complete description of heating networks and their objects (pipeline diameters, lengths, years of installation, years of major repairs, sectional fittings, etc.). An electronic model is a tool for developing projects for the development and reconstruction of engineering facilities, taking into account all systemic restrictions of urban planning. Accordingly, if electronic models have been developed, then you can experiment: combine circuit elements, separate them, do analyzes and make predictions.
Combining models of territorially distributed demand for resources and electronic circuits of engineering communications and main facilities makes it possible to solve the problems of optimal provision of energy resources to the urban environment. In this case, demand forecasts are combined and then the most rational approaches to the development and reconstruction of engineering systems are developed. On the basis of integrated models, problems of redistribution of thermal (electrical) load between sources are solved different types, with the main goal function being to reduce costs and losses in their production and transport.
For each option for the development of an electricity, heat and water supply system, a set of certified models is used, which makes it possible to establish all the effects of implementing the most rational scheme, ensuring that the permissible environmental impact limits are not exceeded.
Due to the excitement that has arisen around the sale of quotas for greenhouse gas emissions, a situation may arise when in 5 years you will have to purchase these quotas back, but at a much higher price. To prevent this from happening, an analysis of the development of electricity, heat and water supply systems for municipalities is urgently needed now.
When discussing the problem of energy supply, as a rule, issues of excess or lack of power are considered and very rarely issues of reliability, especially in heat supply. For example, at one of the conference calls on preparations for heating season when deciding complex issue related to energy supply, the answer was that reliability of energy supply is not really a problem, because If something happens, you can always use a mobile power generator. This idea of reliability now exists in many municipalities, therefore, the RPC must necessarily include an assessment of the reliability of the provision of SCI services and resources. It is necessary to consider possible emergency scenarios and develop projects for the construction of emergency heat and water supply schemes.
As a result of using electronic models in the form of tables and graphs, we can see the stages of project implementation: the receipt of money, the amount of work, the deadlines for implementation, etc. You can plan everything and manage everything. And if it becomes clear that the needs of the municipality are so great that they cannot be realized in 3-5 years, then it is possible to create a program for both 7 and 9 years. But all this can be understood only by analyzing an already existing electronic model.
A very important issue for the municipality is the abolition of economic management. It will be necessary to form a municipal treasury consisting of networks and infrastructure facilities that will be transferred to the management of private companies. The formation of the treasury of a municipality, the formation of the revenue part of its budget - this is also connected with the RKR.
Another important component of the RPC is the development of long-term tariff projects and assessment of the effectiveness of investments. Such precedents already exist. Last year, the FTS for the State Unitary Enterprise Vodokanal of St. Petersburg established three-year tariffs in connection with the implementation of the enterprise program, and this year in the Kirov region. For heat supply organizations, a separate order of the Federal Tariff Service established three-year tariffs. But it is quite difficult to talk about long-term tariff setting taking into account our inflation, taking into account our fluctuating economy. At the same time, if the preparation of anti-ship missiles is carried out in in full, then this will allow us to avoid the risks that are inherent in the concept of long-term tariffs, and therefore, we will get a tariff process that can really work reliably.
The RPC necessarily includes an assessment of the availability of housing and communal services and the purchasing power of the population (Fig. 4). The entire project, through iterative procedures and logistics changes, is selected so as not to exceed the minimum purchasing power of the population for housing and communal services.
RCC also includes:
■ logistics and aggregated assessment of the size of investments;
■ assessment and optimization of the use of own and borrowed funds for project implementation;
■ assessment of the reduction in operating costs during project implementation;
■ assessment of existing and future indicators and performance indicators of the QCC.
Rules of interaction
Regulatory bodies created in municipalities are obliged, first of all, to draw up regulations for their work, i.e. strictly prescribe all the features of their interaction with the OKK. And if, for example, in the production program, OKC did not include measures related to current operation in order to ensure a high-quality continuous supply of services, and an accident occurred in the winter, then only OKK is to blame. But if the organization is all necessary measures included in the program, but the regulatory authorities considered the activities insignificant and “cut out” some of them in order to reduce costs (for example, citing the need for significant expenses in connection with the upcoming elections), then in this case the regulatory authority is to blame. But all changes must be recorded in writing, and all these issues must be taken into account in the interaction regulations.
Among primary kidney tumors it is necessary to distinguish
- renal cell carcinoma (RCC), developing from the epithelium of the tubules and collecting ducts of the kidney, and
- malignant tumors of the renal collecting system (renal pelvis and calyces), represented mainly by transitional cell carcinoma.
Renal cell carcinoma (RCC) accounts for approximately 2-3% of all malignant neoplasms. Men get sick 1.5 times more often than women. Also, RCC develops more often in the urban population compared to the rural population. RCC occurs primarily in people between 50 and 70 years of age, but can also occur in adolescents and young children.
The incidence of RCC in the world is gradually increasing, this increase is approximately 1.5-5.9% per year. In addition, in most countries of the world there is a slight increase in survival rate for this pathology. It is believed that the main reason for the increase in the number of cases of the disease and the improvement in prognosis for RCC is the widespread use of ultrasound diagnostic methods, which has been observed in recent decades. This leads to early detection of asymptomatic forms of RCC. Currently, 25-40% of all cases of RCC are discovered incidentally. However, about 25% of patients already have metastases at initial treatment, and after surgical treatment localized and locally widespread forms renal cell carcinoma Half of the patients develop distant metastases.
Kidney cancer was first described by G. Konig in 1826. Subsequently, in 1855, S.R. Robin and in 1867, W. Waldeyer, came to the conclusion that the source of RCC is the epithelium of the renal tubules. In 1883, P. Grawitz, noting that lipid-rich RCC cells were similar to adrenal cells, concluded that kidney tumors originated from remnants of adrenal tissue. This fundamentally incorrect assumption has led to the use of the term "hypernephroma" to refer to these tumors. In addition, synonyms for RCC are “Gravitz tumor” and “renal adenocarcinoma.”
Distinctive features of RCC from other malignant tumors - an unpredictable course, frequent development of paraneoplastic syndromes, resistance to radiation and chemotherapy, and the possibility of exposure to immunotherapy. In RCC, cases of long-term, tens of years stable progression of the metastatic process have been described; cases of spontaneous regression of metastases without any treatment are relatively often observed.
Etiology and pathogenesis
Revealed large number potential etiological factors contributing to the appearance of RCC (viral infections, chemical and industrial hazards, dietary habits). However, epidemiological studies have not shown a significant influence of these factors on RCC. One of the most proven risk factors for RCC is tobacco smoking.
In smokers, the risk of developing renal cell carcinoma (RCC) increases by 1.4-2.3 times compared to non-smokers. Obesity, especially in women, and abuse of phenacetin-type analgesics are associated with an increased incidence of RCC. As for the influence of occupational factors, the risk of this disease is increased among workers metallurgical industry, tanning industry and those who work with asbestos and cadmium.
It must be emphasized that the influence of the above factors is not very large and is not shown in all studies. In patients with end-stage chronic renal failure who are on chronic hemodialysis for a long time, in 35-47% of cases the kidneys undergo cystic degeneration. In the epithelium lining these cysts, renal cell carcinoma (RCC) develops approximately 30 times more often than in healthy people. In addition, there are known genetic factors in the development of RCC, which manifest themselves in cases of familial kidney cancer. These include von Hippel-Lindau syndrome, familial papillary renal cell carcinoma, and familial clear cell RCC. These cases are characterized by the development of the disease at a young age, bilateral kidney damage and multicentric tumor growth. When studying the first two forms of familial kidney cancer, the role of genetic factors in the development of RCC was clarified.
Von Hippel-Lindau syndrome (VHL)- the most common form of familial RCC, inherited in an autosomal dominant manner. Typical manifestations of this syndrome are the development of a clear cell version of RCC, kidney cysts, pheochromocytomas, retinal angiomas, hemangioblastomas of the brain and spinal cord, cysts and pancreatic cancer. Genetic studies have shown that the cause of this disease is a mutation of a gene located on the short arm of chromosome 3. It turned out that the discovered FGL gene belongs to the group of suppressor genes and encodes the synthesis of an intracellular protein that plays an important role in regulating the cellular response to various damaging factors, such as hypoxia and starvation. It has been shown that the FGL gene mutation is present in 25% of sporadic clear cell RCC.
Familial papillary cancer kidneys is not associated with a mutation of the FGL gene. Research conducted in National Institute Cancer Research Center USA showed that activation of the MET proto-oncogene, located on the long arm of chromosome 7, is responsible for this form of kidney cancer. The same changes are observed in cases of sporadic papillary RCC.
Pathological anatomy
Macroscopically, kidney tumors most often have a round shape and sizes from several millimeters to tens of centimeters, sometimes occupying half of the abdominal cavity. Decay and cystic degeneration of the tumor are observed in 10-25% of cases; in 10-20% of cases, calcifications are detected in the tumor, located in the thickness of the tumor, in contrast to cysts, where calcifications are located on the periphery. Kidney tumors usually grow slowly, compressing the surrounding parenchyma, resulting in the formation of a pseudocapsule, and stretching the fibrous capsule of the kidney. Invasion of the kidney capsule indicates a more unfavorable prognosis and reflects the aggressive nature of the tumor.
In RCC, invasion of Gerota's fascia is very rare, only in cases of high-grade tumors. In this case, the tumor can grow into the lumbar muscles, neighboring organs (liver, spleen, pancreas, intestines), vertebral bodies and the side wall of the abdomen. A unique feature of kidney cancer is its tendency to spread through large veins in the form of a tumor thrombus, which is observed in 10% of cases. A tumor thrombus usually fills the lumen of the vein without growing into its wall (floating thrombus), spreads through the blood flow from the renal vein to the inferior cava and can reach the right side of the heart and even the pulmonary artery. Bilateral kidney tumors occur in 2-4% of cases. In 10-20% of patients with RCC, multicentric tumor growth is observed, most often with papillary histological variant and hereditary forms of kidney cancer.
In 1993, the previous classification of RCC, dividing tumors into four types - clear cell, granular cell (dark cell), tubulopapillary and spindle cell (sarcomatous), was replaced by a new classification based on the achievements of molecular genetic research and the study of hereditary forms of RCC.
According to modern views There are five types of kidney cancer:
- clear cell (typical),
- papillary,
- chromophobic,
- collecting duct cancer and
- unclassified RCC.
Sarcomatous kidney cancer is a low-grade variant of other histological types.
Kidney cancer options
Clear cell (typical) kidney cancer
Clear cell (typical) kidney cancer accounts for 70-80% of all RCCs. On section, these tumors have a characteristic yellowish color, which reflects the high lipid content in their cells. These tumors are rich in blood vessels (hypervascular). With this type of kidney cancer, a pathology of the 3rd chromosome or a mutation of the FGL gene is detected in the genotype of tumor cells.
Papillary Renal Cell Carcinoma (RCC)
Papillary RCC occurs in 10-15% of cases. The prognosis for this form of RCC is relatively favorable. In the past, small papillary renal tumors were often classified as renal adenomas. These tumors are characterized by multicentric growth (up to 40%) and poor blood supply (hypovascular pattern on the angiogram). Common genetic abnormalities in this form of kidney cancer are trisomy of chromosomes 7 and 17, loss of the Υ chromosome, and activation of the MET proto-oncogene on chromosome 7.
Chromophobe renal cell carcinoma (RCC)
Chromophobe RCC appears to develop from the cortical collecting duct. This variant of RCC occurs in 4-5% of cases. Electron microscopy reveals many vesicles containing mucopolysaccharides in the cytoplasm of cells, which makes tumor cells chromophobic. The prognostic value of this variant of RCC has not yet been precisely determined.
Collecting duct cancer
Collecting duct cancer (Bellini) occurs in less than 1% of all RCC cases, mainly in young people. These tumors develop from the medulla of the kidney and are often diagnosed in advanced stages. Tumors are difficult to treat, which makes the prognosis for this form of RCC unfavorable.
Unclassified cases of kidney cancer
Unclassified cases of kidney cancer that cannot be classified into any type represent variants of RCC that have not yet been studied. Among benign kidney tumors, the most common are oncocytoma, adenoma and angiomyolipoma of the kidney.
Oncocytoma (eosinophilic adenoma) of the kidney
Oncocytoma (eosinophilic adenoma) of the kidney accounts for 3 to 7% of all kidney tumors. Oncocytoma is a round, well-circumscribed tumor, microscopically consisting of eosinophilic cells, which is due to the high content of mitochondria in them. A stellate scar is often found in the center of the tumor; angiography reveals the radial course of the arteries in the tumor, which makes it look like a wheel with spokes. Despite the good prognosis and benign course of oncocytoma, cellular atypia and germination of the kidney capsule are sometimes observed. Unfortunately, there are no reliable methods for diagnosing oncocytoma before surgery, so most urologists adhere to aggressive surgical tactics when this disease is suspected.
Small kidney adenomas
Small kidney adenomas are found at autopsy in 7-23% of cases. Most often adenomas small sizes, well limited, homogeneous in cellular characteristics, with a papillary or tubulopapillary structure. Currently, most morphologists agree that there are no reliable morphological and immunohistochemical criteria to clearly differentiate adenoma and kidney cancer. Previously, it was believed that the criterion for a benign tumor was its size less than 3 cm, but later it was shown that up to 5% of such tumors can metastasize. Thus, the diagnosis of renal adenoma is currently controversial. Most experts agree that any solid epithelial tumor of the kidney is potentially malignant and should be treated surgically in compensated patients.
Angiomyolipoma (AMJI) of the kidney
Angiomyolipoma (AMJI) of the kidney is a benign tumor consisting of mature fatty, smooth muscle tissue and blood vessels. AML occurs in 0.3% of the population, more often in women. In 20% of cases, AML is detected in patients with tuberous sclerosis, a hereditary disease characterized by dementia, epilepsy, sebaceous gland adenomas and the frequent development of multiple AML kidneys. AML has a characteristic radiological picture, consisting in the presence of areas of fatty density in the tumor on CT. This pattern is almost pathognomonic for AML, although areas of fat have been described in several cases of renal cancer. At ultrasound examination the tumor is hyperechoic and produces an acoustic shadow. The course of AML is benign and characterized by slow growth. However, it can be complicated by spontaneous tumor rupture and retroperitoneal bleeding, in some cases leading to hemorrhagic shock and death. To determine the indications for treatment of AML, it is necessary to take into account the fact that small tumors (less than 4 cm in greatest dimension) grow slowly and rarely lead to bleeding, while tumors larger than 4 cm grow faster and often have a high risk of complications. Therefore, for patients with AML larger than 4 cm in the greatest dimension, it is advisable to offer tumor removal, and for smaller tumors, dynamic observation is recommended. When planning surgery, preference should be given to an organ-preserving approach.
Clinical picture
Localization of the tumor in the retroperitoneal space, which is inaccessible to palpation and can accommodate a large volume of tissue, leads to the fact that symptoms associated with local tumor growth occur when the tumor reaches a large size.
Before the advent of imaging techniques in medicine, the diagnosis of RCC could be suspected based on the classic triad of symptoms:
- lower back pain,
- macrohematuria,
- the presence of a palpable tumor.
All these symptoms indicate an advanced stage of RCC and are rare today. More often, individual symptoms that make up the classic triad are identified. Most tumors are currently detected incidentally during ultrasound examination, usually performed for nonspecific complaints. All signs of RCC can be divided into symptoms associated with local growth, metastatic lesions, and paraneoplastic. Gross hematuria is most often observed, which can appear against the background of complete well-being.
The mechanism of hematuria is associated with tumor growth into the renal cavity system and destruction of blood vessels. Often, after hematuria in the kidney area, acute pain occurs due to obstruction of the ureter by blood clots, which disappear after the worm-shaped blood clots are discharged in the urine. This manifestation of the disease in the form of hematuria, complicated by renal colic, makes it possible to determine which side of the kidney is affected.
Characteristic features of hematuria in renal cell carcinoma are:
- sudden onset
- profuseness,
- intermittent nature,
- often painless,
- the presence of clots (most often worm-shaped),
- the appearance of a sharp pain syndrome after hematuria.
Low back pain is the second most common classic symptom of kidney cancer. The pain may be dull in nature, which is associated with stretching of the fibrous capsule of the kidney or compression of the lumbar nerve plexuses by the tumor. Acute pain in the lower back, such as renal colic, is usually associated with bleeding into the renal pelvis and the formation of clots that obstruct the outflow of urine. It should be noted that when urolithiasis gross hematuria can be observed after the onset of pain; with kidney tumors, gross hematuria usually precedes renal colic. The rarest and most late symptom of the classical triad is a palpable tumor, which is also characteristic of a common tumor process. Local tumor growth, leading to compression of the testicular vein, or damage to the renal vein by a tumor thrombus can lead to the development of varicocele on the affected side. Damage to the IVC by a tumor thrombus contributes to swelling in the lower limbs, however, this rarely happens, since, as a rule, collateral outflow of blood has time to develop.
Kidney cancer is often detected in patients seeking help for symptoms associated with the development of metastases. Thus, with massive damage to the retroperitoneal lymph nodes, lymphostasis can be observed in the lower extremities. Patients with RCC experience enlarged supraclavicular lymph nodes, bone pain, pathological fractures, and neurological disorders due to brain damage.
RCC is characterized by a high frequency of development of various paraneoplastic syndromes, which has given grounds to call kidney cancer a “therapeutic tumor.” Kidney tumors can produce large quantities renin, erythropoietin, 1,25 dihydroxycholecalcitriol (vitamin D3), prostaglandins, human chorionic gonadotropin, insulin, various cytokines and other substances that can lead to phenomena such as hypercalcemia, hyperthermia, erythrocytosis, hypertension, anemia, cachexia, neuropathy, accelerated ESR, coagulopathy and liver dysfunction not associated with its metastatic lesions (Stouffer syndrome). All these conditions are relieved after radical removal of the tumor. The return of these symptoms usually indicates a relapse of the disease or the development of distant metastases.
Diagnosis of renal cell carcinoma (RCC)
The objectives of the examination of a patient with a suspected diagnosis of renal cell carcinoma (RCC) include radiological confirmation of the diagnosis of kidney cancer, assessment of the extent of the tumor and, in the case of planning surgical treatment, assessment of the function of the contralateral kidney. The examination program includes the determination of a number of laboratory parameters, the use of ultrasound, X-ray and radioisotope imaging methods and, in rare cases, a puncture biopsy of the tumor.
Among the laboratory parameters when examining a patient with RCC, the most important are the level of creatinine in the blood, which reflects the total renal function; the level of alkaline phosphatase, which increases in the presence of metastases in the liver and skeletal bones, and the level of calcium in the blood, which often increases in RCC and causes the development of paraneoplastic syndrome, complicating the course of the disease.
Most kidney tumors are detected by ultrasound, which is a screening test for this pathology. The diagnosis is confirmed by computed tomography of the abdomen with or without bolus contrast enhancement. Additional research methods (magnetic resonance imaging, renal angiography, inferior vena cavagraphy and tumor biopsy) are used quite rarely for limited indications.
To assess the local extent of the tumor, the condition of regional lymph nodes, the venous system and abdominal organs, contrast-enhanced CT is best suited. The condition of the lungs is assessed with a chest x-ray. Bone scintigraphy, radiography of skeletal bones, CT scan of the brain are performed as indicated in the presence of symptoms characteristic of possible damage to these organs.
The presence of contralateral kidney function can be determined by contrast-enhanced CT, or excretory urography or radioisotope renography is used for this purpose.
Excretory urography
Excretory urography was widely used to diagnose renal cancer in times before the widespread use of ultrasound and CT. Signs of a kidney tumor are an increase in the shadow of the kidney, its rotation and displacement by the tumor, deformation of the pyelocaliceal system and amputation of the calyces. The diagnostic significance of such signs is insufficient, since they are observed only in large tumors, and can also occur in benign pathologies. Today, excretory urography is of greatest importance as a method for assessing the function of the contralateral kidney.
Ultrasound examination (ultrasound)
Ultrasound (US) is now widely used as a screening method for suspected kidney tumors or nonspecific low back pain. The advantages of this research method are its low cost, accessibility, non-invasiveness, and lack of radiation exposure. Ultrasound can clearly differentiate a simple renal cyst from a solid tumor or suspicious formation that requires further examination using CT. Characteristic echographic signs of a malignant neoplasm of the kidney are uneven contours of the tumor formation, reduced echogenicity, heterogeneity of the structure due to the presence of cystic areas and calcifications. Often, when the tumor is large, a hypoechoic area is found in its center, which is a zone of necrosis. Cystic tumors may have thick walls irregular shape and echo-dense nodes of various sizes in the walls of the cyst. Ultrasound is considered to be a less reliable method of examination than CT, since visualization of the tumor may be difficult due to shielding by the ribs or in obese patients, whose retroperitoneal lymph nodes are often poorly visualized due to gas contained in the intestine. In addition, the results of the study largely depend on the qualifications of the doctor performing the ultrasound. Ultrasound clearly visualizes the inferior vena cava and the right parts of the heart, which makes it possible to reliably determine the upper limit of the tumor thrombus in RCC.
Computed tomography (CT)
Computed tomography (CT) is currently the method of choice for the diagnosis and staging of RCC. CT can differentiate between kidney cancer and angiomyolipoma based on the detection of areas of fatty density in the tumor. The use of a bolus injection of contrast agent helps differentiate between renal cancer and complex cysts. In addition, CT allows one to evaluate the condition of the retroperitoneal lymph nodes, renal and inferior vena cava, liver, adrenal glands, lungs and mediastinum. In a native, non-contrast study, tumors are visualized as a volumetric formation of solid density with a heterogeneous structure and areas of liquid density (disintegration) and calcifications in the center of the tumor. Evaluation of a space-occupying lesion on CT usually requires the administration of a contrast agent. After native scanning and determination of the zone, 100-150 ml of iodide contrast agent is administered intravenously at a rate of 3 ml/s, after which the study is repeated. In this case, the image is enhanced first of the cortical layer of the kidney, then the medulla, and finally the filling of the renal pyelocaliceal system with contrast. Bolus contrast enhancement results in heterogeneous enhancement of the image of solid renal tumors and their clearer delineation from the surrounding renal parenchyma, which is considered pathognomonic for epithelial renal tumors. Taking into account the rarity of benign tumors and the lack of clear criteria for differentiating them from cancer, all solid masses of the kidney, whose density increases after intravenous administration of a contrast agent, should be considered kidney cancer, unless proven otherwise after morphological verification.
The use of spiral CT made it possible to obtain a clearer image of the tumor. This method allows you to complete the examination in a short time and avoid breathing movements during scanning. Modern computer programs make it possible to perform three-dimensional image reconstruction, which contributes to better planning of the course of kidney resection.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) can also be used to diagnose and stage kidney tumors. With the advent of contrast agents for MRI, this study began to approximately match CT in terms of diagnostic capabilities. MRI provides better images of tumor thrombus in the renal and inferior vena cava. Contrast-enhanced MRI may be used in patients with an allergy to iodide contrast agent or with renal failure in which the administration of iodide contrast is contraindicated. However, MRI is more expensive, complex and time consuming, which limits its use in patients with kidney cancer.
Renal angiography
Renal angiography is currently rarely used. Before the era of widespread development of CT, angiography was one of the main methods for diagnosing RCC. Classic signs of RCC were the hypervascular nature of the tumor, a large number of small tortuous vessels and arteriovenous shunts. Currently, spiral CT with a bolus injection of contrast avoids this invasive study, since it makes it possible to obtain a three-dimensional reconstruction of the renal vessels in the arterial phase.
Percutaneous biopsy
Percutaneous tumor biopsy under ultrasound or CT guidance is also used quite rarely. Although renal biopsy is rarely complicated by bleeding or tumor dissemination, this procedure cannot be used to differentiate between malignant and benign renal tumors due to large quantity false negative results in RCC. The current indication for aspiration biopsy of a renal mass is a suspected abscess or infected renal cyst. Trephine biopsy is performed in cases of differential diagnosis of kidney cancer with metastatic tumors or kidney lymphoma.
Classification
Currently, the ΤΝΜ classification is applicable.
ΤΝΜ-classification
Category ΤΝΜ is established on the basis of physical examination and radiological diagnostic methods. Regional lymph nodes are retroperitoneal lymph nodes: lateroaortic, preaortic, retroaortic, laterocaval, precaval, retrocaval, interaortacaval, renal hilum lymph nodes.
T - primary tumor
TX - the primary tumor cannot be assessed.
T0 - no data on the primary tumor.
T1a - tumor no more than 4 cm in greatest dimension, limited to the kidney.
Tib - tumor more than 4 cm, but not exceeding 7 cm at its greatest
dimension limited to the kidney.
T2 - tumor more than 7 cm in greatest dimension, limited
kidney.
T3 - the tumor spreads into large veins or invades the adrenal gland or surrounding tissues, but does not extend beyond the Gerota's fascia.
T3a - tumor invasion of the adrenal gland or perirenal tissue - within Gerota's fascia.
T3b - tumor extends into the renal vein or inferior
vena cava below the diaphragm.
T3c - tumor extends into the inferior vena cava above
diaphragm.
T4 - tumor extends beyond Gerota's fascia.
N - regional lymph nodes
NX - regional lymph nodes cannot be assessed.
N0 - no metastases in regional lymph nodes.
N 1 - metastasis in one regional lymph node.
N2 - metastases in more than one regional lymphatic
node.
M - distant metastases
MX - distant metastases cannot be assessed.
M0 - no distant metastases.
M1 - distant metastases.
Pathohistological classification
In the pathohistological classification, the categories pT, pN and pM correspond to the categories T, N and M. Note. Histological examination of material after regional lymphadenectomy should include 8 or more lymph nodes. If, upon histological examination, the lymph nodes are without metastases, but their number is less than 8, then they are classified as pN0.
G - histopathological differentiation
GX - degree of differentiation cannot be assessed.
G1 is a well-differentiated tumor.
G2 - moderately differentiated tumor.
G3 is a poorly differentiated tumor.
G4 - undifferentiated tumor.
Grouping by stages
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T1 N1 M0
Stage III T2 N1 M0
Stage III T3 N0 N1 M0
Stage IV T4 N0 N1 M0
Stage IV Any T N2 M0
Stage IV Any T Any N M1
People who come across advertisements for the rental or sale of real estate for the first time are often perplexed when they see a huge number of different abbreviations. And understanding the essence of advertisements is very difficult. In newspapers with real estate advertisements and on websites and bulletin boards for renting and buying and selling housing and commercial real estate, they usually do not provide any explanations of such abbreviations and abbreviations. For beginners, figuring out what exactly is written in the advertisements takes a lot of effort. And realtors who compose the texts of advertisements often without hesitation use their usual abbreviations of professional terms in order to describe the object of rent or sale in as much detail as possible and keep within the allotted number of characters.
The task of understanding professional real estate abbreviations is further complicated by the fact that there is no standard for such abbreviations. Moreover, different regions may have their own different established abbreviations for real estate. The same term can have several different abbreviations. And the same abbreviation can be deciphered differently. Abbreviations can be indicated in either uppercase (capital) or lowercase letters.
Below is a table of abbreviations used in advertisements for the rental and sale of residential and commercial real estate.
3/2/4 - example of recording "total rooms / tenants / neighbors"
% - commission as a percentage of rent per month
1B - high ground floor
2Blk - number of balconies - 2
2B3 - 2 rooms the apartment has been converted into 3 rooms.
2st - double-sided - windows on both sides
2-sided - double-sided - windows on both sides
A.N. - real estate agency
AUT.OT. - independent heating
AN - real estate agency
AOGV - autonomous heating and hot water supply
b - balcony
b/w - without balcony
used - without bath
b/w/p - without bad habits
b/d - without children
b/children - without children
b/w - no animals
used - alive - no animals
B/Z - glazed balcony
used furniture - no furniture
used - without finishing
used - without finishing
bzhn - Brezhnevsky
good - well-maintained
blk - balcony
BR - Brezhnevsky
brv - log
quarry - quarry
everyday life - household appliances
household/technical - household appliances
H/C - bath in the kitchen
in/furniture - built-in furniture
v/nabl - video surveillance
v/p - bad habits
bathroom - all amenities
in/out - all amenities
VP - counter purchase
Runway - counter purchase matched
built-in kitchen - built-in kitchen
entrance ok-st. - entrance and windows to the street
in-door - entrance from the yard
vkh-ul - entrance from the street
g.p. - year of construction
Hot water supply - hot water supply
G/K - geyser
G/O - gas heating
g/t - hotel type
GAR - garage
GBB - aerated concrete blocks
GW - hot water supply
GOST - hotel
D - wooden house
d/1 - rented for one person
d/1/dev - rented for one girl
d/y - documents are ready
d/got - documents are ready
D/C - shower in the kitchen
for couples - rented for a married couple
d/family - rented for a family
D/F - intercom
dv.m/dv. - double metal door
DG - documents are ready
divided into 2 - divided into 2 parts
der - wooden
dl - long
for 1/2/... h - for the specified number of people
dmf - intercom
DPKP - preliminary purchase and sale agreement
euro - euro renovation
Unified State Register of Rights to Real Estate
Railway - iron door
railway door - iron door
yellow - desirable
yellow - large-panel reinforced concrete
Housing and communal services - housing and communal services
ZhSK - housing construction cooperative
W/B - glazed balcony
z/v/pr - winter water supply
G/L - glazed loggia
ZB - glazed balcony
green dv - green yard
ZL - glazed loggia
I - mortgage, purchase with a mortgage is possible
Individual housing construction - individual housing construction
IZ - rooms are isolated
wear - wear
isol - isolated rooms
imp.s/t - imported sanitary ware
IND - individual construction
ind - individual project
ind - individual layout
K - brick
k - credit
K/M - brick-monolithic
K/U - utilities
kam - stone
kan - sewerage
KAF - tile
KGA - Committee on Urban Planning and Architecture
KGIOP - Committee for the Protection of Monuments
kz - frame-fill
kzb - expanded clay concrete
room - storage room
treasure - pantry
klb - calibrated log
kld - well
cln - column
com/u - utilities
comm - communications
cons - concierge
CAT - cottage
KP - utility bills
kp - who will suit
kp - large panel
KR - ship (house type)
krb - ship (type of house)
ktzh - cottage
KU - utilities
L - loggia
l/v/pr - summer water supply
L/Z - glazed loggia
L-6m - loggia area 6 m
LVP - easy counter purchase
LVP - easy counter purchase
Lj/zast - glazed loggia
Private subsidiary plot - personal subsidiary plot
M - monolithic house
m, f - man, woman
M/D - metal door
m/d - metal door
m/us. - sparsely populated apartment
small - sparsely populated apartment
mans - attic
MD - metal door
MDV - metal door
furniture - furniture
mzhb - reinforced concrete monolith
min. - minimum
min. - minutes
mk - monolith-brick
mon - monolith
mp - monolith-panel
MS - small-family communal apartment, small family
N.D. - new house
n/ - new
N/A - new home
n/house - new house
n/mans - unfinished attic
n/not prop. - no one is registered
N/S - normal condition
n/sant - new plumbing
N/U - non-corner apartment
n/south - not south
H1 - not the first floor
nd - no data
ND - new home
nez/s - unfinished construction
nct - German cottage
NJH - no one lives
NNP - no one is registered
new - new home
NP - not the last floor
NPP - not the first, not the last floor
NS - normal state
O/P - exchange selected
O/C - excellent condition
general - hostel
OK-DV - windows to the courtyard
OK-UL - windows to the street
OS - excellent condition
FROM PAGE - from builders
dept - finishing
OTD/VH - separate entrance
ex. passage - excellent maneuverability
OU - windows to the street
okhr - security, guarded
security dv - guarded yard
security/park - guarded parking
P - panel house
P.P. - direct sale
p/k - turnkey
p/kr - after major repairs
P/O - steam heating
P/O - stove heating
p/o - stove heating
p/pl - redevelopment
repair - after repair
p/assignment - assignment
pan - panel
park - parking
PB - foam concrete
PG - full-size apartment
PL/OK - plastic windows
plan. - layout
PN - panel
pnl - panel
PO - steam heating
Software - stove heating
POGR - cellar
under whom - for commercial purposes
underfloor - suspended ceilings
village - landings
PP - direct sale
PRIV - privatized
PRIVAT - privatized
PU - assignment
installment plan
reg - registration
register - registration
rivers - reconstruction
REM - after repair
resh - bars on windows
RSU - separate bathroom
rub - chopped
Russian Federation - for rent to citizens of the Russian Federation
S/P B/D V/P, M/O - married couple without children, bad habits, financially secure
s/p, b/d, v/p, m/o - married couple without children, bad habits, financially secure
c/u - bathroom
S/R - separate bathroom
S/S - combined bathroom
sar - barn
sb/shch - prefabricated panelboard
St. Rem. - fresh renovation
Sv/pl - open plan
SVOB - free
SD - house delivery
SZhF - old housing stock
signal - alarm
skr - old fund with major renovation
SM - adjacent rooms
cm - watch
SMA - automatic washing machine
adjacent - adjacent rooms
SNIP - building codes and rules
personal - property
Wed - urgent
SS - average condition
ST - glazed
ST - Stalinist
Art. pak - double glazed windows
st.mash/avt - automatic washing machine
st.pack - double glazed windows
st/pak - double glazed windows
stl - Stalinist
STF - old fund
SUR - separate bathroom
SUS - combined bathroom
SF - old fund
SFK - old building with major renovation
sfm - old foundation with metal ceilings
T - telephone
T/ET - technical floor
Thumb. - vestibule
TV - TV
tel - phone
tr/repair - repair required
HOA - homeowners association
tx - town house
beat/s - satisfactory condition
street - improved layout
st. - street
UP - apartment with improved layout
Federal Law 214 - Federal Law Federal Law-214 dated December 30, 2004
fin - Finnish house
fund - foundation
cotton - utility block
Cold water - cold water
cotton - outbuildings
C/S - good condition
HV - cold water supply
hg/v - cold and hot water supply
HL - refrigerator
XP - Khrushchev
storage place - good place
Khrsch - Khrushchev
HS - good condition
C - base, ground floor(windows above the asphalt)
C - assignment, assignment agreement
c/v/pr - central water supply
ts/kan - central sewerage
central heating - central heating
tsk. - basement, ground floor (windows above the asphalt)
b/d - private house
B/P - net sale (not exchange)
b/r - partial repair
b/w - partial amenities
CH/UD - partial amenities
black department - rough finish
Czech - Czech project
clean department - fine finishing
PE - net sale
shkb - cinder block, slag concrete
shield - shield
shield. - panel
e/o - electric heating
electric/water/from - electric/water heating
el/p/from - electric/stove heating
el - electricity
In examples of advertisements for apartment rentals in Moscow, you can see some of the abbreviations given.
On our message boards, the "Text" field can accommodate over 700 characters, including spaces and line breaks. Therefore, there is no need to use abbreviations for description.
You may also be interested in tips, and.
