[Surgical treatment of bronchopleural complications after lung resection and pleurectomy in patients with tuberculosis]. / Khirurgicheskoe lechenie bronkhoplevral'nykh oslozhnenii posle rezektsii legkogo i plevrektomii u bol'nykh tuberkulezom.

OBJECTIVE: To increase an efficiency of surgical treatment of bronchopleural complications after lung resections and pleurectomies through the development of modern indications, treatment strategies, techniques and postoperative management. MATERIAL AND METHODS: We analyzed data in 252 patients with bronchopleural complications after lung resections and pleurectomies. The study included patients who underwent treatment at the Central Research Institute of Tuberculosis for the period 2004-2010, Clinical Hospital of Phthisiopulmonology of the Sechenov First Moscow State Medical University for the period 2011-2017 and Thoracic Center of the Republic of Ingushetia for the period 2015-2019. The study included patients with postoperative pleural empyema divided into two groups: group I - 138 patients with empyema and bronchial fistula; group II - 114 patients with empyema and no bronchial fistula. In the 1st group, 1 patient had bronchial and esophageal fistulas. RESULTS: At discharge, empyema and bronchial fistula were eliminated in 245 (97.2%) patients of both groups. Overall in-hospital mortality was 1.6% (4 cases). Two (1.4%) patients died within 30 days in group I and 1 (0.9%) patient died in group II. Within 90 days after surgery, another patient died from acute cerebrovascular accident in group I. In long-term period, overall effectiveness of treatment of bronchopleural complications was 97.2% (208 out of 214 cases). CONCLUSION: The original surgical approach for bronchopleural complications considers timing of postoperative empyema, its spread and duration. This method together with minimally invasive interventions reduces mortality and ensures stable recovery after bronchopleural complications in 97.2% of patients.

[Surgical treatment of tuberculous empyema in children]. / Khirurgicheskoe lechenie tuberkuleznoi émpiemy plevry u detei.

OBJECTIVE: To analyze surgical treatment of tuberculous pleural empyema in children depending on the stage of the process. MATERIAL AND METHODS: There were 82 patients aged 4-17 years with tuberculous pleural empyema. Clinical and X-ray features of different stages of disease are described. Certain types of surgical interventions at each stage of the process are analyzed. RESULTS: In 72 children with empyema stage III 76 surgeries were performed. Postoperative complications occurred in 2 (2.6%) cases (delayed lung inflation) that required thoracocentesis with pleural drainage. There was no postoperative mortality. CONCLUSION: Complex treatment of tuberculous pleural empyema in children and adolescents with the use of modern surgical methods is followed by satisfactory outcomes in all patients. However, surgical technique, postoperative morbidity and hospital-stay depend on the stage of the process. Unfortunately, almost 90% of patients had empyema stage III. Therefore, minimally invasive surgery was not advisable and extensive, traumatic surgeries were required.

[An experience of single lung resection and pneumonectomy after contralateral lung resection in treatment of tuberculosis].

AIM: To improve the efficiency of treatment of single lung destructive tuberculosis. MATERIAL AND METHODS: 15-year experience of operations for destructive tuberculosis performed by the same surgeon including 18 resections of the single lung and 19 pneumonectomies after previous partial lung resection is presented in the article. RESULTS: Surgical management of patients with destructive tuberculosis of single lung provides positive results in more than 90% of cases. However the frequency of its application is still low according to literature data. In case of destructive tuberculosis of single lung partial resection is more frequently indicated if fibrous-cavernous tuberculosis of the upper lung (up to 4 damaged segments), persistent bacterial excretion on the background of adequate chemotherapy and pathogen's drug resistance are present.

[Repeated lung resection in patients with postoperative recurrent tuberculosis in the operated lung].

The literature data of 18 authors about surgical treatment of 1723 patients with recurrent tuberculosis are presented in the article. Also authors reported their own experience in repeated lung resection in 50 patients. Intraoperative complications were observed in 7 patients including empyema cavity dissection in 2 cases, scalping lung injury in 2 cases, peristump abscess dissection in 1 case, v. azygas injury in 1 patient and rupture of membranous part of trachea due to swollen cuff of intubation tube in 1 case. In postoperative period complications developed in 5 patients including early intrapleural bleeding in 1 case, later intrapleural bleeding in 1 case, empyema with bronchial fistula in 1 patient, residual pleural cavity in 1 patient and wound complication in 1 case. All postoperative complications were eliminated and there was no postoperative mortality. The authors concluded that although severe patients' condition, technical complexity and higher surgical risk of repeated resections compared with organ-preserving and collapsosurgical interventions satisfactory remote results and high proportion of labour rehabilitation earnestly prove advantages of repeated lung resections for recurrent tuberculosis of operated lung.

[X-ray morphometric evaluation of the location of an intercalated fragment in double fractures of the shoulder].

The Academician G.A. Ilizarov Russian Research Center "Reconstructive Traumatology and Orthopedics" treated 40 patients with double humeral fractures. On examining their X-ray films, the patients were divided into groups according to the location of an intercalated fragment. The Eletto procedure was used to estimate the levels of fractures. Comparison of the X-ray morphometric studies, the diagram of the humeral architectonics, and clinical observations revealed a relationship between the time of consolidation and the location of an intercalated fragment, which is explained by the degree of preservation of the latter's intramedullary blood flow. While treating patients with double fragments of the shoulder, it is expedient to use the Eletto index to determine the levels of the fragments.

[The first experience with video-assisted thoracoscopy used during operations in children and adolescents for pulmonary tuberculosis].

The paper first describes the experience in performing operations in 34 children and adolescents with different forms of tuberculosis of the lung and intrathoracic lymph nodes via mini-invasive access (a 4-6-cm skin cut), by applying video-assisted thoracoscopy. Practice has provided evidence that lung resections of any scope can be made in children and adolescents with pulmonary tuberculosis and nonspecific lung diseases during video-assisted thoracoscopic operations. The latter have a lot of advantages over the traditional thoracic operations; these included decreases in the duration of operations, in intraoperative and early postoperative blood and plasma losses and the duration of inpatient treatment of pulmonary tuberculosis in children and adolescents, and earlier activation.

[Outcomes of video-assisted thoracic lung resections and pneumonectomies in patients with pulmonary tuberculosis].

The paper pools some experience with 6 videothoracoscopic and 505 video-assisted thoracoscopic (VATS) resections of the lung and 105 VATS pneumonectomies. The bulk of the operations [451 (73.2%)] was made for pulmonary tuberculosis in patients aged 7 to 77 years. 81% operations by separately treating root elements, including all pneumonectomies and major lung resections, were performed. A new SOMI-80 suturing apparatus designed for mini-invasive surgery was employed to suture lung tissue in most cases. Intraoperative and postoperative complications occurred in 5 and 8 cases, respectively. The efficiency of operations for tuberculosis was 98.6%.

[Hyperbaric oxygenation in the treatment regimen using Ilizarov technique in patients with open fractures]. / Giperbaricheskaia oksigenatsiia v sisteme lecheniia po metodu Ilizarova bol'nykh s otkrytymi perelomami.

The dynamics of clinico-physiological parameters in complex treatment of patients with open fractures of the extremities using hyperbaric oxygenation was analyzed in 22 patients with severe injuries with different degree of ischemia of the extremity, and 9 patients with scanty injuries of the soft tissues. It was shown that vasospasm was observed in patients with the initially normal microcirculation after a course of HBO treatment. In patients with no or initially low capillary blood flow the microcirculation was enlarged due to vasodilatation of the arterioles. No considerable effects of the course of HBO on the main blood flow was revealed. Recommendations are given on using the HBO therapy in management of patients with severe open fractures and osteosynthesis of the injured segment by the Ilizarov methods.

[Changes of the rheologic properties of blood in patients operated upon with spleen trauma in the long-term postoperative period]. / Izmenenie reologicheskikh svoistv krovi u bol'nykh , operirovannykh pri travme selezenki, v otdalennom posleoperationnom periode.

Investigations of changed viscosity, erythrocyte deformation and aggregation indices in patients on the traumatized spleen in the long term postoperative period were carried out in 85 patients. Spleenectomy was fulfilled in 35 patients, organ saving operations in 20 patients, and autolientransplantation in 30 patients. Spleenectomy was shown to cause increased viscosity, indices of deformation and aggregation of erythrocytes. To prevent the changes of the rheologic properties organ-saving operations and autolientransplantation should be widely used.