[The assessment of surgical treatment of patients with malignant pleural effusion].

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

[Use of thrombin generation assay for the evaluation of coagulation and anticoagulant activity of hemostasis system in patients with abdominal sepsis].

Generally recognized factor, which complicates the course of sepsis, is the development of hypercoagulation syndrome. The increase of thrombin coagulation indicates on the elevation of risk of thrombus formation in microcirculation vessels, which could cause the formation of multiple organ failure. The thrombin generation assay is a new method of the evaluation of homeostasis system status. The test reflects the fermentation activity of thrombin and shows the functional condition, which arises in the interaction of procoagulant and anticoagulant. The diagnosis of generalized peritonitis had 30 patients (18 men and 12 women, aged 61+/-18,3 years) and they were included in the research. It was shown, that the use of thrombin generation assay in patients with the abdominal sepsis could give the well-timed analysis of hypercoagulation changes and the assessment of protein C system investment in the thrombin generation.

[Treatment of malignant etiology pleurisies using videothoracoscopy].

On the basis of an analysis of results of treatment of 123 patients by different methods of pleurodesis the authors have shown advantages of the method of videothoracoscopy.

[Prophylactics and treatment of peritoneal commissures].

The means for using prophylactic measures for prevention of the development of the adhesion process in the abdominal cavity are divided by the authors into two groups: for primary and secondary prophylactics. The mechanism of action of means for primary prophylactics is directed to restoration of the peritoneum mesothelium and its function; secondary prophylactics--to prevention of adhesions of scarry regenerated leaves of the parietal and visceral peritoneum. The findings are analyzed. The authors give recommendations for using means against adhesions. The necessity to choose the means for prophylactics depending on the state of the abdominal cavity is grounded (first operation or reoperation, planned or emergency operation). On the basis of the personal experience the authors recommend measures of the primary and secondary prophylactics of the adhesion process.

[Assessment of endogenous thrombin potential and influence on it of different regimens of heparin therapy in patients with abdominal sepsis].

Abdominal sepsis (AS) is a systemic inflammatory reaction of organism in response to the development of infectious process in organs of the abdominal cavity. The course of AS is complicated by hypercoagulation syndrome which facilitates progression of endogenous intoxication. The investigation included 26 patients (14 men and 12 women, mean age 65.5 +/- 16.4 years) with AS. The test of thrombin generation (TTG) used in patients with AS allows assessment of changes in the hemostasis system and control of the heparin dose. It was established that TTG revealed elevated endogenous thrombin potential of blood practically in all patients with AS. In the patients given 25 000 IU of heparin the TTG indices showed a reliably decreased endogenous thrombin potential and peak thrombin concentration as compared with a group of patients given 10 000 IU of heparin.

[Cytoreductive operations in complex treatment of patients with intrapulmonary metastases of colorectal carcinoma].

An analysis of results of treatment of 112 patients with metastases of intrapulmonary colorectal carcinoma (CRC) for the period from 1990 to 2006 has shown that cytoreductive opera tions for excision of the metastases are an effective method of treatment of this category of patients which allows a two times increased survival median as compared with analogous index in the group of patients exposed to palliative chemotherapy. Palliative chemotherapy fails to have statistically significant influence to survival of patients who have ablated intrapulmonary CRC metastases in the volume of complete cytoreduction.

[Possibilities of palliative operations in patients with intrapulmonary metastases of renal cancer].

Results of treatment of 51 patients with intrapulmonary metastases of renal cancer were analyzed. Surgical interventions in volume of complete cytoreduction were made in 31 of them. All the patients were followed-up after operations at the period from 3 through 68 months. A multi-factor analysis has shown that surgical metastasectomy gives reliably better results of treatment of patients with disseminated renal cancer. Regressive analysis in the group of operated patients has shown that involvement of the lymph nodes of the bronchopulmonary group and mediastinum gave reliably worse results of treatment of this group of patients.

[Surgeon's strategy in recurrent adhesive intestinal obstruction].

The authors propose an individual decision on the character of treatment: strangulated intestinal obstruction should be operated immediately after making the diagnosis; treatment of adhesive intestinal obstruction should be started with conservative methods. Successful treatment, depending on the anamnesis and state of the patient, allows planned total enterolysis or conservative treatment of the peritoneal commissures. If the conservative treatment is not a success, the patients should be operated after normalization of homeostasis, and better in day time. Laparoscopic adhesiolysis in such category of patients is not indicated.

[State of cardiac activity in patients with varicose disease of the lower extremity veins].

The intracardiac characteristics were studied in 100 patients prior to a removal of varicose veins by surgical or screrotherapeutic methods using US methods. An analysis of these characteristics has shown that investigation of the diastolic function of the heart ventricles is the most demonstrative one. The function of one or two ventricles was shown to worsen with age having negative influence on the venous system of lower extremities which can cause the appearance of varicose veins or their progression thus increasing the stage of chronic venous insufficiency, the appearance of recurrent varicosity after its removal.

[Surgical prophylactics of bronchopleural fistulas after pneumonectomy].

The authors made an analysis of the results of treatment of 924 patients with non-small cell lung cancer, operated in the volume of pneumonectomy during 1990-2007 years and developed a method of complete suturing the mediastinum wound in order to isolate the bronchus stump from the free pleural cavity and prevention of the development of a bronchopleural fistula.

[Role of biological tumor markers CEA, Cyfra-21, NSE, TU M2-PK in diagnosis and treatment of lung cancer].

The authors investigated the dependence of increasing serum oncomarkers CEA, Cyfra-21, NSE, TU M2-PK on survival in 739 patients with nonsmall cell lung cancer. The tests for the determination of the content of CEA, Cyfra-21, NSE in blood serum have low sensitivity and are of little use for the diagnosis of lung cancer. The tests because of their simplicity and low cost can be used for the detection of groups of patients with preliminarily diagnosed nonsmall cell lung cancer needing additional methods of examination for more exact staging of the disease and exclusion of remote metastases and more active using adjuvant method of treatment. The use of tumor pyruvate kinase can be perspective for clinical oncopulmonology. However, due to its low specificity, further experiences are required for using this oncomarker in the group of patients with nonsmall cell lung cancer.

[View to surgical treatment of midline hernias considering their biomechanical properties].

Biomechanical parameters of the white line in health, in postoperative ventral hernias, in midline hernias and diastasis recti abdominis were studied on a special stand. It was noted that the elasticity modulus of the white line in the transverse direction is more than that in the longitudinal direction. The white line tissue strength in patients with midline hernia was 46.5% less as compared with the normal line. The greatest strength and transfer appeared with the elliptical opening stretched along the white line as compared with the round form of the opening.

[Biocenosis sparing treatment in the surgery of gastro-intestinal tract].

The authors present results of investigation of the state of microbiocenosis of the intestine and immune status of organism of 139 patients after emergency operations on the gastro-intestinal tract organs. Disbiosis and reduced indices of the immune system in the postoperative period was a cause of using biocenosis sparing treatment resulting in stabilization of microecology of the gastro-intestinal tract, higher colonization resistance and general reactivity of organism.

[Development of the method of high frequency insufflation of medical aerosol for treatment and prophylaxis of the adhesion process in the abdominal cavity].

A method of treatment of the abdominal cavity in peritonitis patients has been developed which promotes early regeneration of the peritoneum mesothelium, fibrinolysis, recovery of functions of the abdominal cavity and thus preventing formation of the adhesion process in the abdominal cavity. Effectiveness of the method was experimentally confirmed in rabbits and used in 126 patients with different forms of peritonitis. A comparison of methods of traditional treatment of peritonitis in 120 patients and that with using the developed method has shown advantages of the latter one.

[Surgical correction of isolated coarctation of the aorta in infants of the first year of life].

Long-term results of surgical treatment of isolated coarctation of the aorta were studied in infants from the first year of life till 14 years. In infants of the first year of life elimination of coarctation of the aorta with end-to-end anastomosis is more preferable than isthmoplasty of the aorta of the left subclavian artery, since risk of recoarctation is less, the subclavian artery remains preserved, the ductal tissues are completely dissected. An important condition of success of the operation with elimination of the end-to-end CA is thought to be maximal mobilization of the aorta from the surrounding tissues which leads to greater mobility, less tension in the anastomosis zone. The operations in newborns do not cause recoarctations more often than in infants from one month till one year, so the operative treatment is possible in such young age.

[Use of determination of the serum carcinoembryonic antigen in oncopulmonology].

The test for the determination of the serum carcinoembryonic antigen was found to possess low specificity and to be of little use for the diagnosis of lung cancer. The test can be used for the detection of patients with diagnosed non-small-cell cancer of the lung for more exact staging of the disease and exclusion of distant metastases as well as for more active using adjuvant methods of treatment and for the dynamic observation of the course of the disease.