[WAYS OF THE SURGICAL MISTAKES OVERCOME IN THE PAIN ABDOMINAL AND THORACIC SYNDROMS].

Experience of differential diagnosis of pleural diseases, accompanied by pleuroabdominal pain syndrome, simulating «an acute abdomen¼, was summarized. In a pleural exudate syndrome such a course was noted in 17 (3%) patients, of them 7 (1.23%) were operated on; and in a syndrome of spontaneous pneumothorax ­ in 3 (1.7%), 1 (0.4%) was operated. Diagnostic algorithm was proposed.

[ТRAUMAGENESIS, ЕPIDEMIOLOGICAL AND NOSOLOGICAL CHARACTERISTICS OF THE GUN-SHOT-EXPLOSIVE WOUNDINGS OF THE PEACE TIME IN CHILDREN].

Structure of the gun-shot-explosive woundings (GSEW) of the peacetime, occurred in 35 children, was analyzed with refinement, concerning a weapon kind and motif of application, as well as clinic-epidemiological and clinic-nosological characteristics of injuries. Аnalysis of the data was conducted in accordance to criteria and demands of evidence-based medicine, using the methods of nonparametric statistics and computeric technologies. Clinic-epidemiological characteristic of the wounded persons have had witnessed, that due to the GSEW accidents suffer children, ageing (11.97 ± 0.68) yrs, mainly boys. The main causes of GSEW were: careless handling of weapons - in 52.6% observations, hooligan's actions - in 28.9%. Clinical peculiarities of a peacetime GSEW in children have had depended upon the injury severity, caused by special kind of traumatic weapon and traumatic missiles applied.

[HORMONALLY-GENETICALLY DEPENDENT THERAPY, USING VITAMIN K IN PATIENTS, SUFFERING THE ULCER HEMORRHAGE].

Pathophysiological mechanisms of the vitamin K impact, including those in the gut with ulcerative affection, are studied still insufficiently. Investigations of pharmacogenomics of the vitamin K gives a new approach to therapy in patients, suffering gastro-intestinal hemorrhage. Possibilities of titration of the vitamin K3 (menadione) doses, depending on level of estrogenemia and genetic constitution, concerning genes-candidates ESR1 (rs2234693) and VKORC1 (rs9923231), were studied. There were examined 36 patients, who were treated for the ulcer hemorrhage. The blood serum concentration of estradiol was investigated in accordance to method of solid phase enzyme immunoassay, the genotyping procedure was performed in accordance to indices of polymerase chain reaction with analysis of the restrictional fragments length. The initial daily dose of menadione have constituted 20 mg. After a genotype determination made (first-second day after admittance to hospital) in patients with normoestrogenemia in genotypes CC/GG, CC/GA, CT/GG, CT/GA a vitaminotherapy was prolonged in daily dose of 20 mg, and in a conditionally-pathological variant of genotype the dose of vitamin K was enhanced up to 30 mg. Determination of hormones and the patients' genetic constitution makes possible to apply a personified approach for the vitamin K3 application in the ulcerative hemorrhage.

[ЕPIDEMIOLOGICAL AND NOSOLOGIC CHARACTERISTICS IN INJURED PERSONS, WHO HAVE DIED IN CONSEQUENCE OF A COMBINED SCELETAL TRAUMA].

The age­ and gender­related signs in 105 injured persons, who died because of combined skeletal trauma, circumstances and character of injuries, causes of death and impact of aggravating factors, were analyzed. There was established, that skeletal trauma have constituted the main cause of death in 10.48% of injured persons only, but as a component of combined injury it aggravates the traumatic disease course and, as a consequence, enhances probability of exitus lethalis. Trustworthy connection between the signs of gender, age, the injuries character and volume was established, what gives a certain information about course of traumatic disease and risk of exitus lethalis

[Possibilities of surgical treatment for advanced multiresistant pulmonary tuberculosis].

The results of surgical treatment of 37 patients, suffering relatively advanced pulmonary tuberculosis (PT), were analyzed. Chemoresistant PT was revealed in 35 (94.6%) observed patients, and multiresistant one--in 30 (81.1%). Preoperative preparation during 2-3 mo was conducted in two main directions: administration of a line II antibacterial preparations and a pneumoperitoneum (PP) establishment. A main operative procedure was resection. Intrapleural thoracoplasty in our own modification have constituted a seconf direction of treatment, it consisted obligatory of the 5 ribs resection. Initially a rib V was partially resected 8-10 cm in length, and a rib I was excised completely. Complications were absent. The patients were discharged from the hospital in 2-3 mo postoperatively. PP in 34 (91.9%) patients was completed in a same terms. In a remote postoperative period (1-4 yrs) a tuberculosis reactivation was absent. All operated patients were bacilli free.

[THE SPONTANEOUS PNEUMOTHORAX INTERPRETATION, DIFFICULTIES DURING HISTIOCYTOSIS X].

Since spontaneous pneumothorax can be a complication, and sometimes a manifestation of significant amount of intrathoracic and extrathoracic diseases, verifying the process can be very difficult. One of these diseases is the local (pulmonary) histiocytosis X. Authors cite the etiological diagnosis experience of spontaneous pneumothorax during current pathology. According to their data, spontaneous pneumothorax on the histiocytosis X background found in 3 patients. Complications developed during the disease later stages, and therefore the verification was complex and based on morphological data, consistent with the clinical and radiographic changes.

[Prophylaxis of thrombohemorrhagic complications in surgical treatment of chemoresistant pulmonary tuberculosis].

Analysis of thrombohemorrhagic complications was conducted in 98 patients, operated on for various forms of chemoresistant pulmonary tuberculosis. To prevent such complications it is necessary to prescribe heparin in minimal doses or fraxiparine preoperatively and intraoperatively. It permits to lower the prethrombotic background significantly, to prevent thrombohemorrhagic complications, and in their incidence--to eliminate thrombotic and hemorrhagic clinical features with minimal losses.

[Lymphangioleiomyomatosis of lungs and spontaneous pneumochylothorax].

Lymphangioleiomyomatosis occupies a special place among rare systemic diseases of lungs, which are manifested by respiratory failure and the gradual development of pulmonary heart. Manifestations of the pleural cavity in the form of pneumothorax and pleural effusion syndrome are characteristic for the disease. In order to verify the process, the authors recommend a study of pleural punctate with Sudan-III for detection of lymph and a CT-scanning after removal of the contents of the pleural cavity. "Cell" pattern of lungs in combination with chylothorax confirm the diagnosis of lymphangioleiomyomatosis. In particularly complex cases, in their opinion, the lung and pleura biopsy is required.

[Concurrent interventions for pulmonary tuberculosis complicated by chronic pleural tuberculosis].

Basing on the literature data analysis the authors suppose the insufficient studying of issues, concerning simultant interventions for pulmonary tuberculosis, coinciding with chronic phthysic pleurytis. Surgical treatment of such processes was performed in 181 patients, total pleurectomy--in 172 (95%) of them, partial--in 9 (5%). Various kinds of pulmonary resection as the additional intervention were performed in 172 (95%) patients, extrapleural thoracoplasty--in 15 (8.3%), diaphragmatic plasty--in 15 (8.3%). In early postoperative period the tuberculosis micobacteria have had disappeared in all the patients, permitting to interpret surgical intervention as a sanation one for every patient, and as a socially directed antiepidemic measure.

[Possibilities of bilateral transsternal pulmonary resection].

Possibilities of modern antibacterial therapy of pulmonary tuberculosis do not satisfy specialists. To apply a standard resection methods is not always possible because of the extended process present. The authors had summarized the experience of performance of simultaneous bilateral transsternal pulmonary resection for different forms of tuberculosis in 23 patients, proposing it as an alternative to present resectional methods.

[Pleural effusion and splenic abscess].

Based on literature data the authors demonstrate the complexity of differential diagnosis of pleural effusion syndrome (PES). At the same time they emphasize the quantitative increase in patients with splenic abscess (SA). The authors give the observation of SA, which is complicated by purulent pleurisy and pleural effusion syndrome. They accentuate erroneous diagnostic actions.

[The role of splenectomy in the treatment of idiopatic thrombocytopenic purpura].

Based on the earlier published data this article describes the role of the spleen in the development of some hematological diseases, the main of which is idiopathic thrombocytopenic purpura (ITP). The authors emphasize the role of splenectomy in the treatment of this disease. At 178 splenectomies performed at the clinic, 23,6 % of operations were carried out for hematological diseases, and among them 42,8 %--for ITP. The authors share their immediate and remote results of the treatment.

[Effect of the pleural exudate diagnostics system on thoracoscopy results].

The authors have shown using literature data the complexity of diagnostics of the syndrome of a pleural exudate which can be a main manifestation in most cases of pleural cavity diseases. Late diagnostics of an exudate creates great difficulties during a process verification. Two groups of patients have been observed using different systems of diagnostics of an exudate. Basic group consisted of 117 patients and the first method of radiodiagnostics was ultrasonoscopy. A Traditional roentgenography was used for patients from comparison group. Complications in the form of considerable pleural stratifications and diaphragm deformation have been noted in comparison group 4.7 times oftener than in the control group.

[Prophylaxis of pleurectomy complications].

Basing on the literature and the observations of their own data analysis, the authors suggest, that pleurectomy constitutes a reconstructive-restoration operation. Nevertheless, this procedure, due to its complexity and traumatism, not infrequently is complicated by various intraoperative complications, in particular, the life threatening--in 1.1% observations and dangerous for health--in 13.8%. The methods of prevention and overcoming of possible complications are determined.

[Operative treatment of chronic pleuritis].

Basing on the literature data and own experience, grounded on results of follow-up on 2000 patients, suffering an acute pleuritis and performance of more than 200 operative interventions--pleurectomy, the clinic-radiological classification of chronic pleuritis, mostly answering the practical health care necessities, was proposed by the authors.

[Fat embolism and syndrome of pleural effusion].

Authors present the frequency, pathological disorders and consequences of fat microembolia of the lung. Peculiarities of fat embolia in patients with blunt traumas of the foot and shin were shown in the article. Rare cases (2) of SPE manifestation in patients with fat embolia of the lung, experience of pathogenetic therapy of complications and recommendations regarding diagnostics of complications in patients with this disease are given in the article.

[Lung leiomyomatosis].

A rare disease of lungs, leiomyomatosis, is discussed in the article. The author presents pathomorphological changes of lungs, clinical manifestation and course of the disease based on literature data. One interesting clinical observation is given by the author.

[Crohn disease and infertility].

The authors review current literature on Khrone disease. They carried out their own observation on influence of Khrone disease on reproductive function of women as there are contradictory data. The authors showed that surgical treatment because of Khrone disease favored pregnancy, normal course of pregnancy and timely child birth.

[Degree of penetration of antibiotics in the parenhima of the prostate gland].

The article presents results of bacteriological research of a secret of prostate gland and blood serum on test-culture Sercina lutera ATSS 9341 in 57 patients with chronic bacterial prostatitis along with ampicillin sodium application through lymph and intramuscular injection of the antibiotic.

[Extrapleural thoracoplasty as an alternative to pulmonectomy].

Basing on the literature data, negative tendency for the modern tuberculosis course was substantiated. The main causes of conservative treatment failures for chronic and aged forms of tuberculosis were shown. The data concerning the surgical treatment character change for pulmonary tuberculosis, from resection toward thoracoplasty, were adduced. The authors consider extrapleural thoracoplasty as an alternative to pulmonectomy.