PKR-560 (PKR-560 M, PKR-560 MU, PKR-560 MOR) pneumatic wedge grip (wedge grip) with manual retraction of the drive is designed for mechanized gripping in the rotor of tubing, drilling, weighted and casing pipes, as well as to transfer rotation from the rotor to the drill string and clean the outer surface of the pipes.

Wedge grip PKR-560 is used as a part of drilling rigs of BU2000, BU2500, BU3000, BU4000, BU5000, BU6500 classes, equipped with a rotor with a through hole of 560mm.

Wedge grip PKR-560 consists of a bushing, two conical inserts, wedges with rams. The bushing and liners are fixed relative to the table, and wedges with slips can move along the inclined grooves of the bushing. When moving down, the wedges slide along the inclined grooves of the liner and converge in the radial direction. Under the action of the radial force arising in the wedges from the column's own weight, the rams clamp the pipe, and the column is held in the rotor; to release the clamped pipe, the wedges move upwards simultaneously with the pipe string being lifted by the hook.

The PKR-560 wedge grip is driven by a pneumatic cylinder mounted on the rotor frame bracket. The rod of the pneumatic cylinder is connected to the short arm of the lever, the long arm of the lever at the end has a fork shape and is put on the rollers of the annular frame, to which the racks are connected, moving in the vertical guide grooves of the bushing.

The upper ends of the racks in the PKR-560 wedge grip are fixed in a traverse, which is connected with wedges by levers; under the action of compressed air supplied to the piston cavity of the pneumatic cylinder, the piston rod turns the lever counterclockwise, while the annular frame, together with the uprights, traverse and levers, moves up and raises the wedges. The reverse movement of the wedges in PKR-560 is carried out when compressed air is supplied to the rod end of the pneumatic cylinder and the lever is turned clockwise. The levers ensure the movement of the wedges in the radial direction when they are raised and lowered.

The weight of the drill string held by the slip grip PKR-560 is limited by the allowable contact pressure between the slips and the pipe body. To reduce contact pressures, elongated wedges and special dies are used, covering the pipe with a minimum gap between their longitudinal ends. In some designs, 6 wedges are used instead of 3, which contributes to a more even distribution of contact pressure.

At the request of the customer, the wedge grip PKR-560 is equipped with a wedge 140-146 mm with dies 60, 73, 89, 102, 114, 127, 140, 146 mm, 12 of each size, or a wedge 168-178 mm with dies 168, 178 mm 12 pcs. each size.

Scheme of the wedge grip PKR-560 (PKR-560 M):

Development of production and investment programs for organizations of the communal complex - manufacturers of goods and services in the field of heat supply

Development of production and investment programs for organizations of the communal complex - manufacturers of goods and services in the field of heat supply

L.D. Solovieva, Deputy Director - Head of the Department for Regulatory and Legal Regulation of the Public Utilities Department of the Department of Housing and Public Utilities 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 organizations of the communal complex

Quite a lot has been said and written about the existing problems of the housing and communal complex. 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 still face high risks of investing in 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 utility complex organization (UCC) and this is enough for him to start making money. His interest is not linked to the interests of the city, not linked to the interests of the development of other utilities. There is some imbalance - "pulling over" financial resources. Therefore, effective interaction of authorities with resource-supplying organizations is very important.

State control in accordance with the Federal Law of December 30, 2004 No. 210-FZ "On the basics of regulating the tariffs of organizations of the communal complex" should be carried out through integrated development programs (CDP). The presence of an RCC is a prerequisite in many federal laws for the provision of federal assistance. This is also recorded in the regulations on the provision of subsidies for interbudgetary transfers, developed by the Ministry of Regional Development of the Russian Federation. The first PKR of municipalities have already begun to arrive at the Ministry of Regional Development of the Russian Federation, but you won’t look at them “without tears”, for example, some of them consist of only a few pages.

It must be clearly understood that the PKR is an integral part of the Master Plan for the development of the municipality, and the norms prescribed in the Urban Planning Code indicate that by 2010 all municipalities should have Master plans for their development.

From January 1, 2009, the maximum index of payment of citizens will be set by the constituent entity of the 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 to the Government of the Russian Federation for consideration a draft resolution on the calculation of marginal indices. A necessary condition for the establishment of limit indices in the draft resolution is the presence of the GKR 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 communal infrastructure systems (CIS) of the municipality is a program for the construction and modernization of the CCI, which ensures the development of these systems in accordance with the needs of housing and industrial construction, improving the quality of the supplied goods (rendered services) and improvement of the ecological situation on the territory of the municipality.

RCC solves the following tasks:

■ determination of target indicators for the development of information and communication systems;

■ determining the priorities and sequence of development of the SRS;

■ balanced SCI development;

■ Ensuring the environmental safety of SCI development.

For the municipality, the PKR is a tool for the integrated management and optimization of the development of SKI, which allows you to link the goals and pace of development of the SKI of the city (electricity, heat supply, water supply), identify problem points and, in conditions of limited resources, optimize them to solve the most pressing problems.

No other level of power has such a function as the organization of electricity, heat, water, gas supply. 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 sources of generation. It is impossible to talk about thermal energy, for example, without having gas. This is a whole complex, and the authorities of the municipality must understand this.

As mentioned above, RCC is a prerequisite for receiving financial support at the federal level. For example, in accordance with the Federal Law of July 21, 2007 No. 185-FZ “On the Fund for Assistance to the Reform of the Housing and Communal Services”, the approval of tariffs and allowances based on the CRP 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 the promotion of housing construction" - a condition for the allocation of land for housing construction.

PKR is a management tool (including through further monitoring) by private enterprises. The RCC allows you to influence the development plans and motivation of private companies that own infrastructure facilities in the interests of the city, which is almost impossible by other methods; allows (through monitoring) to evaluate and control the activities of these companies.

From the position of the authorities of the municipality, enterprise management is possible only if it is municipal (MUP), and if infrastructure elements are transferred to a private enterprise, then management becomes impossible. But this position is wrong. If RCC is built correctly, the illusion of a 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 the mistakes made, the private enterprise pays at its own expense, and the mistakes of MUPs are compensated at the expense of the budget of the municipality.

The PKR is a tool and a necessary basis for effective tariff setting. The PKR and the investment and production programs of the OCC drawn up on its basis are the rationale for setting tariffs.

For investors, the RCC is also a tool within which he can decide "where to enter, how to enter and how much it costs." Investors receive a “signal” from the authorities about where infrastructure investments will be needed, as well as an infrastructure development plan approved by the authorities with priorities for several years ahead. The RCC approved by the representative body of the municipality and approved on its basis, the investment programs of the RCC and tariffs (including long-term ones) are a legitimate mechanism for guaranteeing the required level of tariffs for the investor for the period laid down in the RCC.

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: "Give us money, and we will figure it out ourselves." At the same time, many cannot even name the reasonable amount of the necessary funds and the timing of 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 Utilities Organizations”, monitoring of these programs of municipalities will be carried out directly, without the participation of the subject of the Russian Federation. There is nothing surprising in this, as a result - the enterprise looks like “in the palm of your hand”. So far, only investment programs will be monitored for heat supply organizations, but over time, an agreement may be reached with the Federal Tariff Service (FTS) to extend this monitoring to production programs.

The tariff regulators of utility organizations now have a tool that allows them to revise tariffs based on monitoring results, and not only “in plus”, but also “in minus”, which will not be very pleasant for resource supplying enterprises. Moreover, the revision is possible for the period of regulation. Tariffs "in the red" will be reviewed, because in all our orders, resolutions and laws it is written that any investment or production program is, first of all, the achievement of specific goals. If in the production program the goal is energy saving, expressed by a certain percentage, then the regulatory authorities after a certain time must compare the results obtained with the declared ones. In the event that the values ​​specified in the investment program are not reached, no explanation of the reasons (accident, cold winter, etc.) will help, and tariffs will be reduced. The 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 no longer a program of an enterprise, but of a municipal entity. The company does not need an investment program. The municipality issues the terms of reference, and the enterprise realizes its desire for something, using only the production program.

The example of Moscow is surprising, in connection with the establishment of the amount of payment for connection to heating networks, despite the fact that the city's 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.

RCC development methods

In order to develop a full-fledged RCC, a significant amount of time, money and high qualifications of developers are required. Therefore, during the transition period, an opportunity will be given to develop a simplified program, with the condition that in the future the transition to full RCC will be carried out (Fig. 3). The only difference will be that the so-called simplified PKR will not contain promising schemes for the development of the SQI, but at the same time it will have a fairly detailed analysis of the SQI.

Perspective schemes for the development of communal infrastructure are a detailed study of the development of engineering systems of urban infrastructure:

■ detailing the territory of the settlement and compiling electronic models;

■ with calculations to ensure the regulatory reliability of the provision of public services (resources);

■ with specific technical solutions (specific configurations and diameters of pipelines, type of equipment at sources, their placement on the territory);

■ with land allotment approval;

■ obtaining preliminary technical conditions for connection to electric, heat and gas networks;

■ with environmental impact assessment and development of impact mitigation measures.

as a result of the development of a complete CRP, specific packages of investment projects are obtained. A municipality can quite easily put up objects of a specific attraction of investments for a competition, because. the land has already been registered, preliminary technical conditions have been drawn up, etc., i.e. everything that is often missing in today's projects. A full PKR will allow simply announcing investment competitions to attract any investor and for a sufficiently long period of investment.

It does not matter which of the two options will be used to create the RPC - in any case, the Russian legislation has already formed 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 a 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 the municipality, therefore, it must necessarily include a forecast of territorially distributed demand. Both in the simplified and in the complex (complete) scheme, RCC is the basis of the foundations.

The forecast of territorially distributed demand for communal resources (heat, electricity, drinking water, etc.) is formed on the basis of the use of GIS technologies associated with the urban geographic information system.

The forecasting of territorially distributed demand is based on the principle of forming a calculated element of territorial division (planning quarter, cadastral quarter, BTI quarter, industrial or industrial zone, etc.). In each element of the territorial division, the demand for resources is modeled, based on the analysis of urban plans for the development of the housing sector, the social sphere, and industry.

In the future, there will be a widespread transition to the representation of 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 (diameters of pipelines, lengths, years of laying, 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 the systemic constraints of urban planning. Accordingly, if electronic models are developed, then it is possible to experiment: to combine circuit elements, to separate them, to do analyzes and make forecasts.

Combining models of geographically distributed demand for resources and electronic circuits of engineering communications and head facilities allows us to solve the problems of optimal supply of the urban environment with energy resources. In this case, demand forecasts are combined and then the most rational approaches to the development and reconstruction of engineering systems are developed. Based on the combined models, the problems of redistributing the thermal (electrical) load between sources of different types are solved, with the main objective function being to reduce costs and losses in their production and transport.

For each option for the development of the system of electricity, heat and water, a set of certified models is used, which makes it possible to establish all the effects from the implementation of the most rational scheme that ensures that the permissible limits of environmental impact are not exceeded.

Due to the hype that has arisen around the sale of greenhouse gas emission allowances, a situation may arise when in 5 years you will have to buy these allowances 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 the municipality is urgently needed now.

When discussing the problem of energy supply, as a rule, issues of excess or lack of capacity are considered, and very rarely - issues of reliability, especially in heat supply. So, for example, at one of the conference calls on preparations for the heating season, when solving a complex issue related to energy supply, the answer was received that the reliability of energy supply is not really a problem, because. in which case you can always use a mobile power generator. Such a perception of reliability now exists in many municipalities, so the CRP must necessarily include an assessment of the reliability of the provision of services and resources of the IRS. 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 timing of implementation, etc. Everything can be planned and managed. And if it becomes clear that the requests 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 require the formation of a municipal treasury, consisting of networks and infrastructure, which will be transferred to the management of private companies. The formation of the treasury of the municipality, the formation of the revenue side of its budget - this is also connected with the PKR.

Another important component of the PKR is the development of long-term tariff projects and the assessment of the effectiveness of investments. There are already such precedents. Last year, the FTS set three-year tariffs for SUE "Vodokanal of St. Petersburg" in connection with the implementation of the company's program, and this year in the Kirov region. for heat supply organizations, a separate order of the FTS sets three-year tariffs. But it is quite difficult to talk about the long-term establishment of tariffs taking into account our inflation, taking into account our fluctuating economy. At the same time, if the preparation of the PKR is carried out in full, then this will make it possible 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 PKR necessarily includes an assessment of the affordability of housing and communal services and the purchasing power of the population (Fig. 4). The entire project is selected by iterative procedures and logistics changes so as not to exceed the minimum purchasing power of the population of housing and communal services.

RCC also includes:

■ logistics and an integrated assessment of the size of investments;

■ assessment and optimization of the use of own and borrowed funds for the implementation of projects;

■ evaluation of operating costs reduction in the process of project implementation;

■ assessment of existing and prospective indicators and performance indicators of the QCD.

Interaction regulation

Regulatory bodies created in municipalities are obliged, first of all, to draw up regulations for their work, i.e. rigidly prescribe all the features of their interaction with the OCC. And if, for example, in the production program, the OKC did not include activities related to the current operation in order to ensure a high-quality continuous supply of services, and an accident occurred in the winter, then only the OKK is to blame. But if the organization has included all the necessary activities in the program, and the regulatory authorities considered the activities insignificant and “cut out” some of them in order to reduce costs (for example, motivating this by the need for significant expenses in connection with the upcoming elections), then in this case the regulator is to blame. regulation. But all changes must be recorded in writing, and all these issues must be taken into account in the rules of interaction.

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 collecting system of the kidney (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. RCC is also more likely to develop in urban populations than in rural populations. RCC occurs predominantly in people between the ages of 50 and 70 but may occur in adolescents and young children.

The incidence of RCC in the world is gradually increasing, this growth is approximately 1.5-5.9% per year. In addition, in most countries of the world there is a slight increase in survival in this pathology. It is believed that the main reason for the increase in the number of cases and improved prognosis in 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. Nevertheless, about 25% of patients already have metastases at the initial presentation, and after surgical treatment of localized and locally advanced forms of renal cell carcinoma, half of the patients develop distant metastases.

kidney cancer was first described by G. Konig in 1826. Subsequently, in 1855, Robin (SR Robin) and in 1867 W. Waldeyer came to the conclusion that the source of RCC is the epithelium of the tubules of the kidney. In 1883, P. Grawitz, noticing that lipid-rich RCC cells are similar to adrenal gland cells, concluded that kidney tumors originate 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's tumor" and "renal adenocarcinoma".

Distinctive features of RCC from other malignant tumors - an unpredictable course, the frequent development of paraneoplastic syndromes, resistance to radiation and chemotherapy, and the possibility of exposure to immunotherapy. In RCC, cases of a long, tens of years stable course of a metastatic process are described; cases of spontaneous regression of metastases without any treatment are relatively often observed.

Etiology and pathogenesis

A large number of potential etiological factors contributing to the occurrence of RCC have been identified (viral infections, chemical and industrial hazards, dietary habits). However, epidemiological studies have not shown a significant effect of these factors on RCC. One of the most proven risk factors for RCC is tobacco smoking.

Smokers have a 1.4-2.3 times higher risk of developing renal cell carcinoma (RCC) than non-smokers. Obesity, especially in women, and abuse of phenacetin analgesics are associated with an increased incidence of RCC. With regard to the influence of occupational factors, the risk of this disease is increased among workers in the metallurgical industry, the leather industry, and those who work with asbestos and cadmium.

It should 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 about 30 times more often than in healthy people. In addition, genetic factors in the development of RCC are known, which are manifested in cases of familial kidney cancer. These include von Hippel-Lindau syndrome, familial papillary kidney cancer, and familial clear cell RCC. In these cases, the development of the disease at a young age, bilateral kidney damage and multicentric tumor growth are characteristic. When studying the first two forms of familial kidney cancer, the role of genetic factors in the development of RCC was elucidated.

Von Hippel-Lindau Syndrome (FGL) is 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 variant of RCC, kidney cysts, pheochromocytoma, 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 the 3rd chromosome. It turned out that the detected FGL gene belongs to the group of suppressor genes and encodes the synthesis of an intracellular protein that plays an important role in the regulation of 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 RCCs.

Familial papillary cancer kidney is not associated with a mutation of the FGL gene. Studies conducted at the US National Cancer Institute have shown that the activation of the proto-oncogene MET, located on the long arm of the 7th chromosome, is responsible for this form of kidney cancer. The same changes are observed in cases of sporadic papillary RCC.

pathological anatomy

Macroscopically tumors of the kidney most often they have a rounded shape and sizes from several millimeters to tens of centimeters, sometimes they occupy half of the abdominal cavity. Disintegration 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. Tumors of the kidney usually grow slowly, compressing the surrounding parenchyma, resulting in the formation of a pseudocapsule, and stretching the fibrous capsule of the kidney. The germination of the kidney capsule indicates a more unfavorable prognosis and reflects the aggressive nature of the tumor.

Gerot's fascia is very rare in RCC, only in cases of highly malignant 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. The tumor thrombus usually fills the lumen of the vein without growing into its wall (floating thrombus), spreads along the blood flow from the renal vein to the inferior vena cava and can reach the right 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 noted, most often with a papillary histological variant and hereditary forms of kidney cancer.

In 1993, the previous classification of RCC, which divided 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 studies and the study of hereditary forms of RCC.

According to modern views, there are five types of kidney cancer:

1. clear cell (typical),
2. papillary,
3. chromophobe,
4. collecting duct cancer and
5. unclassified RCC.

Sarcomatous kidney cancer is a poorly differentiated 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, reflecting the high lipid content of their cells. These tumors are rich in blood vessels (hypervascular). With this variant 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 tumors of the kidney were often classified as renal adenomas. These tumors are characterized by multicentric growth (up to 40%) and poor blood supply (hypovascular picture on the angiogram). Frequent genetic disorders in this form of kidney cancer are trisomy of the 7th and 17th chromosomes, loss of the Υ chromosome, and activation of the MET proto-oncogene on the 7th chromosome.

Chromophobic Renal Cell Carcinoma (RCC)

Chromophobic RCC appears to develop from the cortical region of the collecting ducts. This variant of RCC occurs in 4-5% of cases. Electron microscopy in the cytoplasm of cells reveals many vesicles containing mucopolysaccharides, which makes tumor cells chromophobic. The prognostic value of this RCC variant has not yet been precisely determined.

Collecting duct cancer

Collecting duct cancer (Bellini) occurs in less than 1% of all RCCs, predominantly at a young age. 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.

Unclassifiable cases of kidney cancer

Unclassified cases of kidney cancer that cannot be assigned to any type represent RCC variants that have not yet been studied. The most common benign tumors of the kidney 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, due to their high content of mitochondria. A stellate scar is often found in the center of the tumor, and angiography reveals a radial course of arteries in the tumor, making it look like a spoked wheel. Despite the good prognosis and benign course of oncocytoma, cellular atypia and germination of the kidney capsule are sometimes noted. 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 adenomas of the kidney

Small kidney adenomas are found at autopsy in 7-23% of cases. Most often, adenomas are small, well-circumscribed, 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 between adenoma and kidney cancer. Previously, it was believed that the criterion for benign tumor is 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 adipose, smooth muscle tissues and blood vessels. AML occurs in 0.3% of the population, more commonly 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 of the kidneys. AML has a characteristic x-ray picture, consisting in the presence of areas of fat density in the tumor on CT. This pattern is almost pathognomonic for AML, although adipose tissue has also been described in renal cancer in a few cases. On ultrasound, the tumor is hyperechoic and gives an acoustic shadow. The course of AML is benign, characterized by slow growth. However, it can be complicated by spontaneous rupture of the tumor and retroperitoneal bleeding, in some cases leading to hemorrhagic shock and death. To determine the indications for AML treatment, 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, often have a high risk of complications. Therefore, in patients with AML greater than 4 cm in greatest dimension, it is advisable to offer tumor resection, and for smaller tumors, follow-up is recommended. When planning an operation, preference should be given to a organ-preserving approach.

Clinical picture

Localization of the tumor in the retroperitoneal space, inaccessible to palpation and capable of accommodating a large amount 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:

• 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 determined. Most tumors are now discovered incidentally on ultrasound, usually for nonspecific complaints. All signs of RCC can be divided into symptoms associated with local growth, metastatic lesion, and paraneoplastic. Gross hematuria is most often observed, which may appear against the background of complete well-being.

The mechanism of hematuria is associated with the germination of the tumor in the cavitary system of the kidney and the 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-like blood clots are excreted in the urine. Such a manifestation of the disease in the form of hematuria, complicated by renal colic, makes it possible to establish from which side the kidney is affected.

Characteristic features of hematuria in renal cell carcinoma are:

• sudden start,
• profuseness,
• intermittent character
• 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 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 plexus by the tumor. Acute low back pain in the form of renal colic is usually associated with bleeding into the renal pelvis and the formation of clots that prevent the outflow of urine. It should be noted that with urolithiasis, macrohematuria can be observed after the onset of pain, with tumors of the kidney, macrohematuria usually precedes renal colic. The rarest and latest symptom of the classic triad is a palpable tumor, which is also characteristic of a widespread 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 a varicocele on the side of the lesion. The defeat of the IVC by a tumor thrombus contributes to edema in the lower extremities, but this is rare, since, as a rule, collateral outflow of blood has time to develop.

Often, kidney cancer is detected in patients seeking help for symptoms associated with the development of metastases. So, with a massive lesion of the retroperitoneal lymph nodes, lymphostasis can be observed on the lower extremities. In patients with RCC, there is an increase in supraclavicular lymph nodes, bone pain, pathological fractures, neurological disorders with brain damage.

RCC is distinguished by a high incidence of various paraneoplastic syndromes, which gave reason to call kidney cancer a “therapeutic tumor”. Kidney tumors can produce large amounts of renin, erythropoietin, 1,25 dihydroxycholecalcitriol (vitamin D3), prostaglandins, human chorionic gonadotropin, insulin, various cytokines and other substances that can lead to such phenomena as hypercalcemia, hyperthermia, erythrocytosis, hypertension, anemia, cachexia, neuropathy, accelerated ESR, coagulopathy and liver dysfunction not associated with its metastatic lesion (Stauffer's syndrome). All these conditions are stopped after radical removal of the tumor. The return of these symptoms, as a rule, indicates a relapse of the disease or the development of distant metastases.

Diagnosis of renal cell carcinoma (RCC)

The tasks of examining a patient with a suspected diagnosis of renal cell carcinoma (RCC) include radiographic 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 in the examination of a patient with RCC, the most important are the level of creatinine in the blood, reflecting the total kidney function; the level of alkaline phosphatase, which increases in the presence of metastases in the liver and bones of the skeleton, and the level of calcium in the blood, which often increases with RCC and causes the development of paraneoplastic syndrome, which complicates the course of the disease.

Most kidney tumors are detected by ultrasound, which is a screening for this pathology. Diagnosis is confirmed by abdominal computed tomography with or without bolus contrast enhancement. Additional methods of research (magnetic resonance imaging, renal angiography, lower venacavography and tumor biopsy) are used quite rarely due to limited indications.

Contrast-enhanced CT is best suited to assess the local extent of the tumor, the state of the regional lymph nodes, the venous system, and the abdominal organs. The condition of the lungs is assessed with a chest x-ray. Bone scintigraphy, radiography of the bones of the skeleton, CT of the brain are performed according to indications in the presence of symptoms characteristic of a possible lesion of 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 kidney 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 pelvicalyceal 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 pathology. Today, excretory urography is of greatest importance as a method for assessing the function of the contralateral kidney.

Ultrasound examination (ultrasound)

Ultrasonography (ultrasound) is now widely used as a screening method for suspected kidney tumors or for nonspecific low back pain. The advantages of this research method are its low cost, availability, non-invasiveness, and the absence of radiation exposure. Ultrasound can clearly differentiate a simple renal cyst from a solid tumor or a suspicious mass that requires further examination using CT. The characteristic echographic signs of a malignant neoplasm of the kidney are the unevenness of the contours of the tumor formation, reduced echogenicity, heterogeneity of the structure due to the presence of cystic areas and calcifications. Often, with large tumor sizes, a hypoechoic area is found in its center, which is a zone of necrosis. Cystic tumors may have thick, irregularly shaped walls and echo-dense nodules of various sizes in the cyst walls. Ultrasound is considered to be less reliable than CT because visualization of the tumor can be difficult due to screening by the ribs or in obese patients whose retroperitoneal lymph nodes are often poorly visualized due to intestinal gas. In addition, the results of the study largely depend on the qualifications of the doctor performing the ultrasound. With ultrasound, the inferior vena cava and the right heart are well visualized, which makes it possible to reliably determine the upper border 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 allows differentiation of kidney cancer and angiomyolipomas based on the detection of areas of fatty density in the tumor. The use of a bolus of contrast agent helps to differentiate kidney cancer from complex cysts. In addition, CT allows you to assess 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 mass on CT usually requires the administration of a contrast agent. After native scanning and zone determination, 100-150 ml of iodine contrast agent is injected intravenously at a rate of 3 ml/s, after which the study is repeated. At the same time, there is an increase in the image, first of the cortical layer of the kidney, then the brain, and finally the filling of the renal pelvicalyceal system with contrast. Bolus contrast enhancement leads to non-uniform enhancement of the image of solid renal tumors and their clearer demarcation from the surrounding renal parenchyma, which is considered pathognomonic for epithelial renal tumors. Given the rarity of benign tumors and the lack of clear criteria for their differentiation 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 helical CT made it possible to obtain a clearer image of the tumor. This method allows you to perform the study in a short time and avoid respiratory movements during the scan. Modern computer programs make it possible to perform a three-dimensional reconstruction of the image, 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 has become approximately equivalent to CT in terms of diagnostic capabilities. MRI provides the best image of a tumor thrombus in the renal and inferior vena cava. Contrast-enhanced MRI may be used in patients who are allergic to iodine contrast media or have renal insufficiency for which iodine 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. Prior to the era of widespread development of CT, angiography was one of the main methods for diagnosing RCC. The classic signs of RCC were the hypervascular nature of the tumor, a large number of small tortuous vessels and arteriovenous shunts. Currently, bolus-contrast helical CT avoids this invasive study, as it provides 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 the high rate of false negatives in RCC. The current indication for aspiration biopsy of a kidney mass is a suspected abscess or infected kidney cyst. Trepan biopsy is performed in cases of differential diagnosis of kidney cancer with metastatic tumors or kidney lymphoma.

Classification

The ΤΝΜ-classification is currently applicable.

ΤΝΜ-classification

The ΤΝΜ category is established on the basis of a physical examination and radiological diagnostic methods. Regional lymph nodes are retroperitoneal lymph nodes: lateroaortic, preaortic, retroaortic, laterocaval, precaval, retrocaval, interaortacaval, hilar lymph nodes.

T - primary tumor

TX - 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 larger than 4 cm but not larger than 7 cm
measurement 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 Gerota's fascia.
T3a - tumor invasion of the adrenal gland or pararenal tissue - within the fascia of Gerota.
T3b Tumor invades the renal vein or inferior
vena cava below the diaphragm.
T3c Tumor has spread 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.

Μ - distant metastases

MX - Distant metastases cannot be assessed.
M0 - no distant metastases.
M1 - distant metastases.

Pathological classification

In the pathohistological classification, the categories pT, pN, and pM correspond to the categories T, N, and M. Note. Histological examination of the material after regional lymphadenectomy should include 8 or more lymph nodes. If, on 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 highly differentiated tumor.
G2 - moderately differentiated tumor.
G3 - 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

2.1 PURPOSE OF THE PNEUMATIC WEDGE

CAPTURE RCC-560

Purpose of the complex

The complex of equipment for working with pipes is designed for making up, unscrewing, holding on weight, storing, feeding and ejecting pipes. This complex includes the following mechanisms and equipment: a rotor with a roller insert and with a pneumatic wedge grip PKR 560 M, an auxiliary winch L V, an automatic stationary drilling key AKB-ZM2, a pneumatic suspension key PBK-4, machine keys with pneumatic candle breakers, PRS and a receiving bridge with racks. Drilling rigs BU 2900/175 DEP and BU 2900/200 EPK-BM use two types of rotors: R-560 (Figure 1) and R-360.

Purpose and design of the R-560 rotor

The rotor is designed to transfer rotation to the drill pipe string during drilling, fishing operations, to absorb the reactive moment when drilling with downhole motors and to support the pipe weight on the table during tripping and running the casing string.

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 - cork;

16 - shut-off ball valve; 17, 19, 26, 30 - bolt; 20 - bar;

21 - insert; 22- covers; 23 - nut; 27 - handle; 28, 29 - arrow;

Figure 1. R-560 rotor

The rotor housing (picture 1) is the main part on which all other parts are mounted. It perceives and transfers to the base of the drilling rig all the loads that occur during drilling and tripping operations.

Capture wedge pneumatic PKR-560

The gripping arm of the wedge pneumatic PKR-560 (Figure 2) is bolted to the rotor housing.

Specifications

Pneumatic wedges are installed in the rotor, serve to capture the pipes and keep them from turning. Pneumatic wedges can be in two versions: with manual retraction of the drive or with mechanized retraction. The body is installed in the hole of the rotor table. On the outer side, the body has four vertical grooves that serve as a guide for the guide bars associated with the ring.

Inserts with a centralizer are installed in the inner opening of the body, which are sockets for wedges. The wedges, hinged 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 the wedges move and as a support when gripping the pipe string. The wedges are equipped with serrated dies, which provide a secure grip on the pipes. Three dies are installed in each wedge, and the middle die has a longitudinal and transverse notch, and the upper and lower ones have only a transverse one.

The control cylinder is mounted on a rotary bracket attached to the rotor. On the bracket, the pneumatic cylinder is fixed with an axle. A lever is mounted on the control cylinder bracket, the long end of which is connected to the ring by means of rollers, and the short end to the pneumatic cylinder. With the help of a cylinder and a lever, the ring with a 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 drilling rig receiver

5 - control cylinder bracket; 6 - control cylinder;

7 - sub-rotary bracket; 8 - lever; 9 - axis; 10 - ring;

11 - stabilizer; 12 - wedge; 13 - holder

Figure 2. Grab wedge pneumatic RCC 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 floor of the drilling rig by more than 500 mm, and the rotor beams are moved apart to a size of more than 780 mm. The installation of the wedge grip must be done with the installation of a bracket with a pneumatic cylinder and a lever. Check the free movement of the pneumatic cylinder on the bracket. The bracket with the pneumatic cylinder is retracted to the extreme left position and fixed with the axle. After that, a housing with guide bars and a ring is installed in the rotor hole. The cylinder bracket is brought to the front position, ensuring that the lever rollers fall into the groove of the ring. Connect air hoses. The guide bars are raised to the upper position and wedges are installed on them. After installing all four wedges, test lifting and lowering are performed. By turning the stem of the control cylinder, the wedges in the raised position are set vertically so that the serrated surface is parallel to the pipe to be gripped.