[ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY BETA-LACTAM ANTIBIOTICS].

We report a case of iatrogenic lesion of the lungs in a 61 year old patient following simultaneous subtotal resection and plastic surgery of esophagus using a gastric stem with the removed cardial portion along with subtotal mediastinal lympho-dissection for the treatment of 2 x 1 cm T2NoMO tumour in the middle third of esophagus. The patient's medical history contained no evidence of previous pulmonary pathology, preoperative chest X-ray study revealed neither focal nor infiltrative changes in the lungs. On day 5 after extensive surgical intervention with the use of a parenteral beta-lactam antibiotic, the patient developed acute respiratory distress the symptoms of which increased wavelike during the next 4.5 weeks in association with subfebrility, leukocytosis, enhanced ESR and large shaded areas in the lungs. These conditions were regarded as signs of pneumonia that required the application of increasingly more powerful beta-lactam antibiotics. All these symptoms became less apparent and completely disappeared within 2 days and 1 week respectively after withdrawal of the antibiotics and prescription of parenteral prednisolone. It confirmed the iatrogenic origin of lung lesions regarded by the authors as recurring acute respiratory distress syndrome caused by beta-lactam antibiotics.

[Esophagoplasty in combined scarry lesions of the esophagus, laryngopharynx and the trachea in children].

The experience of plasty of the pharynx and esophagus with graft of the free small intestine segment was presented in 12 children after burn stricture by the potassium permanganate. The technical aspects of operation using methods of the reconstructive vascular surgery were described. Good short-term result was obtained in all the patients. The long-term results were investigated during 15 years. It was observed, that the graft diverticulum developed by 4-7 years in 3 patients, whom repeated operation should be performed. According to the authors, the regional plasty of the esophagus by free revasculizated small intestine graft was really effective surgical supply and could be considered as the method of choice in limited scarry lesions of the pharynx and cervical esophagus, but the method should be improved.

[Repeated plasty of the esophagus in children with the application of transplant from the ileum].

The authors give topographic-anatomical substantiation of a possibility to employ the ileum for esophageal replacement and describe a technique of forming such transplant. Their clinical experience includes 9 operated children. Earlier they had endured from 1 to 4 attempts of esophageal replacements by different traditional methods. In all children operated upon good results were obtained. It allows the ileum to be included in the arsenal of possible methods of esophageal replacement and considering it as an alternate variant in nonstandard situations.

[Specific formation of esophageal autotransplant in the compromized and resected stomach].

An experience with 60 operated patients allows introduction of accuracy in the idea of possibility to use the compromised with different diseases and surgical procedures stomach in plasty of the esophagus. Technical specific features of forming the transplant are developed. Practicability of esophageal plasty with the small bowel using the loop of the bowel involved in digestive anastomoses is shown. In nonstandard situations the success of surgery is determined by an individual choice of plastic material, using reconstructive vascular surgery and rational method of placing the transplant.

[Esophagoplasty in non-standard situations: an analysis of 130 observations].

An experience with 130 esophagoplastics in non-standard situations has been analyzed. In all patients there was defectiveness of one or several organs--potential donors, in 48 observations the operation being repeated. Decision on the plastic material had to be individual and required systematized approach: in 87 patients the jejunum was used, in 26 patients--stomach, in 9--colon and in 8--ileum. In 69 cases plasty was followed by surgical reconstruction and different variants of revascularization of the shifted or free intestinal transplant with using microsurgical technique. The transplant was located in the posterior mediastinum (56), antethoracally (40), retrosternally (23) or on the neck (11). Complete clinical effect was obtained in 125 patients (96.1%), plasty was not completed in 2 (1.6%), 3 patients died (2.3%). The authors are discussing the ways of achieving and conditions of success of plasty of the esophagus in non-standard situations.

[Esophagoplasty in patients with the "waning" stomach or without the stomach]. / Ezofagoplastika pri "ushcherbnom" zheludke ili ego otsutstvii.

An experience with 48 intrathoracic esophagoplasties in patients with "waning" stomach or its absence is generalized. The results obtained show that scarry-ulcerous damages of the pyloroduodenal and cardioesophageal portions, local surgical procedures, gastrostomy included, are not considered as deterrent factors for using the stomach as the plasty material for esophagoplasty. For the resected stomach or its absence the small intestine should be preferred in the formation of the anastomosis within the limits of the thoracic cavity and large intestine--when putting anastomosis on the neck. A complete clinical effect was obtained in 45 patients. Three patients died (6.25%).

[Intrathoracic esophagogastroanastomosis: a problem and ways for its solution]. / Vnutrigrudnoi ézofagogastroanastomoz--problema i puti ee resheniia.

The investigation has shown that the due level of blood supply of the wound surfaces of the organs being sutured, the obligatory absence of a strain, perfect technique of the proper manual putting the end-to-end type anastomosis and the rational placing of the transplant in the posterior mediastinum with a strictly vertical rectilinear orientation, without bends and rotation, allowed to get a smooth course in 98.8% of the operated patients. Incompetent sutures took place in 1.2% of cases. It was also shown that the anastomosis of choice might be an invagination variant of the applying of it having not only high degree of reliability, but also the marked antireflux properties. The dynamic endoscopic control with the correction of forming anastomosis during 2-3 months allowed minimization of possibility of the development of scary stenosis. The results obtained suggest that the problems of intrathoracic esophageal anastomosis in clinic have been solved.

[Possible complications of lymph node dissection in esophagus cancer and ways to prevent them]. / Vozmozhnye oslozhneniia limfodissektsii pri rake pishchevoda i puti ikh profilaktiki.

The experiences with surgical treatment of esophagus cancer show that performing lymphodissection makes the operation more laborious and potentially results in the development of severe complications such as an injured recurrent nerve, chylothorax, higher risk of bleeding etc. Using their clinical experiences including 80 patients of the group of investigation and 194 patients of the control group, the authors describe methodological aspects of optimization of the operative intervention, possible complications and ways for their prevention. At the same time, the results of the treatment show that it is possible to avoid severe consequences of lymphodissection by means of adequate and purposeful prophylactics and timely elimination. The worked through links of the whole chain of the surgical intervention allow minimization of the potential negative phenomena of lymphodissection and so it can be considered as an integral part of the operation for esophageal cancer.

[Carcinoma of the major duodenal papilla]. / Rak bol'shogo sosochka dvenadtsatiperstnoi kishki.

An experience with treatment of 62 patients with carcinoma of the major duodenal papilla during the period of 1989-1999 is generalized. Mean age of the patients was 62.4. Most of the patients admitted (85%) had jaundice. The most informative method of examination was FGDS, its sensitivity was 84%. All the patients were operated on. Transduodenal papillectomies (TDPE) were performed in 10 patients, pancreatoduodenal resection (PDR) in different modifications--in 42 patients, in 2 of them for recurrent carcinoma after TDPE, biliodigestive anastomoses--in 13 patients. Resectability was 80%, postoperative lethality--0%. Postoperative complications after PDR developed in 21% of the patients. Recurrent tumors after TDPE appeared in half of the patients. The actuarial five year survival after PDR was 50.6%. PDR is considered to be the operation of choice for cancer of the major duodenal papilla.

[Methodological aspects of surgery of esophageal cancer]. / Metodicheskie aspekty khirurgii raka pishchevoda.

Based on many years of clinical experiences including more than 400 patients operated on for carcinoma of the thoracic portion of the esophagus the author describes the methodological aspects of the succession of operation stages and rational modes of mobilization of the malignant area guided by the principles of observation of the maximum degree of ablastic character of the intervention and getting higher radicalism of it.

[Long-term outcome of surgical treatment of patients with esophageal cancer]. / Otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh rakom pishchevoda.

Under study were the results of surgical treatment of 185 patients with esophageal carcinoma. One-year survival was 75.4%, 2-year survival was 49.6%, 3-year--43.4%, and 4-year survival--33.3%. Among the patients with tumors with the invasion degree T1, T2, T3 and having no metastases to the regional lymph nodes the resection of the esophagus in combination with the extended lympho dissection resulted in 4-year survival in more than 50% of the patients operated upon. In patients with tumors T3N1, T4N1 and especially with the simultaneous involvement of several lymph collectors the 4-year survival was 21.4%. The operative intervention at this stage of the disease should be considered as a palliative means in the greater part of the patients.

[Zenker's diverticulum]. / Divertikul Tsenkera.

An experience with treatment of 14 women and 15 men aged from 41 to 83 years with Zenker's diverticulum was analyzed. Most liable to the disease were people at the age from 50 to 70 years. The average duration of the disease was 3-4 years. All the patients were subjected to improved surgical interventions: resection of the diverticulum (11 patients), operations under the control of the endoscopic technique (18 patients). Resections of the diverticulum were combined with cryopharyngeal myotomy. No complications were noted. There were no lethal outcomes. So, wider indications to operative treatment in patients with Zenker's diverticulum, endoscopic methods used at all stages of treatment as well as improved methods of performing the operation enabled the authors to obtain good immediate and long-term results.

[Functional risk factors of esophageal resection with one-stage intrathoracic esophagogastroplasty]. / Funktsional'nye faktory riska rezektsii pishchevoda s odnoétaphoi vnutrigrudnoi ézofagogastroplastikoi.

Functional values of cardiorespiratory complex influencing the survival after resection of the esophagus with one-stage intrathoracic esophagoplasty were examined in 94 cases. Risk factors of postoperative lethality were revealed, among which changes of cardiovascular system predominated over disturbances of function of external respiration. Among parameters of hemodynamics assessed by integral rheography with computer processing of the curve, variability of blood stroke volume at rest and its dynamics after exercise fest showed high significance.

[Lymph node dissection in esophageal cancer]. / Limfodissektsiia pri rake pishchevoda.

Results of surgical treatment of 70 patients with carcinoma of the thoracic part of the oesophagus were analyzed. The extended two-levels (intraabdominal and intrathoracic) lymphodissection is the necessary part of the operation. Postoperative lethality was 2.9%, one year and 2 years survival was 85.8 and 69% correspondingly. The data obtained show that it is expedient to introduce the extended two-levels lymphodissection into clinical practice.

[The clinical assessment of central hemodynamics in patients over 70 undergoing the surgical treatment of calculous cholecystitis]. / Klinicheskaia otsenka tsentral'noi gemodinamiki u bol'nykh starshe 70 let pri khirurgicheskom lechenii kal'kuleznogo kholetsistita.

An analysis of the initial type of central hemodynamics and the postoperative period in 177 patients aged older than 70 years having calculous cholecystitis has shown that surgical treatment of patients with the normo- and hyperdynamic types of circulation even with concomitant diseases can give positive results. The least favourable regimen of blood circulation proved to be the hypodynamic type characteristic of patients with pronounced disturbances of homeostasis and/or with recent myocardial infarction.