Laparoscopic repair of a posttraumatic left-sided diaphragmatic hernia complicated by strangulation and colon obstruction.

BACKGROUND: Posttraumatic diaphragmatic hernias (PDH) are serious complications of blunt and penetrating abdominal or thoracic trauma. Traditional thoracic or abdominal operations are usually performed in these cases. METHODS: We present 2 cases of posttraumatic left-sided diaphragmatic hernia complicated by strangulation and colon obstruction. Both cases were successfully treated with laparoscopy. RESULTS: We found that laparoscopy is a safe, successful, and gentle procedure not only for diagnosis but also for treatment of complicated PDH. Strangulation and colon obstruction were not contraindications to performing laparoscopic procedures. The postoperative course and long-term follow-up (range, 12 to 30 months) were uneventful and short. We expect the same good long-term results after laparoscopic repair as after open conventional surgery. CONCLUSION: We recommend the use a minimally invasive approach to treat posttraumatic diaphragmatic hernia complicated by strangulation and colon obstruction in hemodynamically stable patients.

[Laparoscopic restoration of the colon continuity after Hartmann procedure].

Literature data and personal experience with laparoscopic restoration of the continuity of the colon after Hartmann's procedure in 19 patients allowed the authors to conclude that minimally traumatic procedures had a number of advantages over operations of wide laparotomy such as less blood loss, rapid restoration of the intestinal motility, early activation of the patients, shorter postoperative stay at hospital. They are also thought to be effective methods of treatment and prophylactics of peritoneal commissures and their complications.

[Mutation processes in the natural populations of Drosophila and Hirundo rustica from Ukrainian radiation contaminated territories].

Natural populations of Drosophila melanogaster and Hirundo rustica that reside at the territories with different levels of radioactive pollution were investigated. The levels of visible mutations, sex-linked mutations and gonad reduction of Drosophila and the rate of interphase markers of chromosomal instability in erythrocytes of birds were selected as parameters for population monitoring. The results point out to possible reverse dependence among the level of chromosomal instability of birds, the rate of lethal mutations in sex chromosome of Drosophila and the density of radioactive pollution.

Bactericidal activity of culture fluid components of Lactobacillus fermentum strain 90 TS-4 (21) clone 3, and their capacity to modulate adhesion of Candida albicans yeast-like fungi to vaginal epithelial cells.

Antagonistic activities of L. fermentum strain 90 TS-4 (21), L. casei ATCC 27216, and L. acidophilus ATCC 4356 and bactericidal activity of lactobacillus culture fluid towards E. coli strain K12, S. aureus, and S. epidermidis test cultures were studied. The bactericidal effect of L. fermentum strain 90 TS-4 (21) clone 3 culture fluid preparation (pH 6.0) on the test cultures was dose-dependent. Adhesion of C. albicans yeast-like fungi to vaginal epitheliocytes was more pronounced for strains isolated from women with asymptomatic infection than for strains isolated from women with manifest forms. L. fermentum strain 90 TS-4 (21) clone 3 culture fluid preparation modulated adhesion of yeast-like fungi only if the fungal strain was initially highly adherent.

[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.

[Effects of the association of pulmonary complications and disseminated intravascular coagulation syndrome on the viability of esophagogastric transplant in Lewis and Garlock surgical procedures]. / Vliianie na zhiznesposobnost' ézofagogastrotransplantata sochetaniia legochnykh oslozhnenii s sindromom disseminirovannogo vnutrisosudistogo svertyvaniia krovi pri vypolnenii operatsii L'iuisa i Garloka.

The influence of pulmonary complications and disseminated intravascular blood coagulation syndrome combination on esophago-transplant viability was studied while Lewis and Garlock operations conduction. Gastric necrosis have occurred in 7 (6.5%) patients after Lewis and Garlock operations conduction. In 2 of them it was a direct cause of death. Five patients died before gastric wall necrosis have developed on a background respiratory and hemocoagulation disorders occurred. The prophylaxis measures for these complications were proposed.

[Results of esophageal cancer surgical treatment in multiple primary neoplasms]. / Khirurgicheskoe lechenie pishchevoda pri pervichno-mnozhestvennykh opukholiakh.

Available are the results of surgical treatment of 11 patients with cancer of the esophagus revealed metachronously through 6 months--3 years after treatment of oro-pharyngeolaryngeal cancer (5 patients) and diagnosed synchronously with cancer of the stomach (3 patients), the lung (2 patients) and leiomyoma of the esophagus (1 patient). Radical operations on the esophagus were performed in all the patients, in synchronous tumors they were one-stage surgical intervention. Postoperative complications such as pneumonia were observed in the majority of patients, who previously underwent radiation or combined treatment for laryngeal cancer, as well as in all patients, who were operated on the esophagus and the lung in one stage. The necessity of active bronchial sanation in pre- and postoperative period of patients after treatment of laryngeal cancer and advisability of two-stage surgical treatment of synchronous tumors of the esophagus and the lung, the operation for lung cancer being performed at the second stage of treatment, are stressed in conclusion. In synchronous involvement of the esophagus and the stomach one-stage intervention on these organs is the most advisable.

[An evaluation of the immediate results of performing esophagogastroplasty]. / Otsenka neposredstvennogo rezul'tata vypolneniia ézofagogastroplastiki.

The results of oesophageal resection with one-staged oesophagogastroplasty were studied up in 108 patients. The mechanical suture failure occurred in 12 (16.4%) of 73 patients, after the manual-forming anastomosis conduction this complication did not occur. The method of the anastomosis forming using one-raw manual suture with plication by anterior gastric wall proved to be the most secure one. Application of this method together with prophylaxis of thromboembolic and respiratory disorders have permitted to reduce mortality by 2.5 times.

[The prevention and treatment of bronchial fistulae after pulmonectomy for lung cancer]. / Profilaktika i lechenie bronkhial'nykh svishchei posle pul'monéktomii po povodu raka legkogo.

Bronchial fistula was found in 5.4% of 542 lung cancer patients treated with pneumonectomy. A relationship between occurrence of fistula and laterality of lesion, extent of surgery, procedure for closing the bronchial stump and gender was established. Bronchial fistula was most common following right-side pneumonectomy which is accounted for by postoperative anatomic conditions. To prevent bronchial fistula formation, mechanical suturing of the bronchial stump supplemented by procedure after Sweet should be performed. The bronchial stump should be shielded with adjacent tissue, as suggested by the authors.

[Antiproteinase activity of alpha 2-macroglobulin]. / Antiproteinaznaia aktivnost' alpha 2-makroglobulina.

Blood serum separation by the method of gel filtration on Sephadex G-200 with the subsequent immunochemical determination of the quantitative content of basic proteolysis inhibitors permitted isolating the alpha 2-macroglobulin fraction while alpha 1-antitrypsin and alpha 1-antichymotrypsin separation was a failure. The immunochemical analysis of the antienzymic activity of the isolated inhibitors showed that 32.3 +/- 3.5% of the introduced kallikrein, 18.7 +/- 0.6% of trypsin and 14.4 +/- 4.1% of chymotrypsin were bound in the zone of alpha 2-macroglobulin. The rest of antienzymic activity was localized in the zone of alpha 1-antitrypsin and alpha 1-antichymotrypsin. After a preliminary saturation of blood serum with trypsin in the amount equivalent to its antitryptic capacity (200 micrograms/ml) the ability of alpha 2-macroglobulin to bind kallikrein and chymotrypsin lowers considerably (by 69 and 72%, respectively). In the zone of alpha 1-antitrypsin and alpha 1-antichymotrypsin a decrease in the ability to bind kallikrein and chymotrypsin amounted to 44 and 12% respectively. Thus, alpha 2-macroglobulin being bound with trypsin looses considerably its ability to bind other enzymes.

[Levels of alpha 1-antitrypsin and alpha 2-macroglobulin in blood serum and its antitryptic capacity]. / Soderzhanie al'fa 1-antitripsina i al'fa 2-makroglobulina v syvorotke krovi i ee antitripticheskaia emkost'.

Immunochemical analysis in combination with gel filtration and isoelectric focusing made it possible to state that in blood serum of healthy people 81.3 +/- 0.5% of administered trypsin is bound with alpha 1-antitrypsin and 18.7 +/- 0.6%--with alpha 2-macroglobulin. The latter is functionally heterogeneous, only 40% of it is bound with trypsin and in the formed complex the antigenic properties of trypsin and alpha 2-macroglobulin are lost. A great number of blood serum alpha 1-antitrypsin cannot fix trypsin. The content of such alpha 1-antitrypsin rises sharply with pathology available. In the immunochemical estimation of the organism inhibitory potential relative to proteolytic enzymes not only the amount of the inhibitor but also its functional activity should be taken into account. The data of immunochemical research of the blood serum isoelectrophoregrams show that the most considerable changes under conditions of pathology occur in alpha 2-macroglobulin.

[Proteolytic enzyme inhibitor and the kinin system in thyrotoxicosis]. / Sostoianie sistemy ingibitorov fermentov proteoliza i kininov pri tireotoksikoze.

Free bradykinin, kininogen, kininase, protease inhibitors of alpha 1-antitrypsin, alpha 1-antichymotrypsin, alpha 2-macroglobulin, and antitryptic volume of the blood serum were examined in 25 patients suffering from goiter with thyrotoxicosis symptoms. Activation of the kinin system and reduction in the antitryptic volume were revealed before the operation. The level of the rest inhibitors was elevated. After operative intervention these changes became more expressed. alpha 2-Macroglobulin content increased. By the moment of discharge the above parameters tended to normalization. The content of the majority of inhibitors, however, did not reach normal. This should be taken into consideration during rehabilitation of patients with thyrotoxicosis.