[Peculiarities of diagnosis and emergency surgical care in aorto-oesophageal fistula]. / Osobennosti diagnostiki i neotlozhnoi khirurgicheskoi pomoshchi pri aorto-pishchevodnom svishche.

An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.

[Features of severe surgical infections of soft tissues].

AIM: To analyze clinical and microbiological examinations in severe soft tissues infections and their significance in predictors of outcomes. MATERIAL AND METHODS: Treatment of 19 patients with severe suppurative infection and suspected non-clostridial anaerobic flora with different causes of soft tissues infection was analyzed. All patients were treated in N.V. Sklifosovskiy Research Institute of Emergency Care for the period 2010-2012. Diagnosis was based on X-ray survey, sonography and CT data. Multicomponent management included surgery, intensive therapy, proteinic and water-electrolyte balance correction, deintoxication, nutritive support and immune therapy.Microbiological diagnosis was performed using Bactec-9050, Multiscan and WalkAway-40 analyzers. Culture mediums and microanaerostats to detect aerobic and obligately-anaerobic pathogens certified in Russia were used. Of 19 patients bacteriological examination was performed in 11 patients. So 107 specimens from wounds predominantly and blood were studied. 91 strains were revealed and identified. RESULTS: 8 of 11 patients in group 1 were operated. Three patients were inoperable due to severe condition and endotoxic shock. Despite complex treatment inflammation progressed in 5 of 8 patients followed by death. The second group consisted of 8 survivors. Staphylococcus aureus played leading role. There were no significant differences related to obligately-anaerobic pathogens. Mixed populations of aerobic and facultative anaerobic pathogens were diagnosed in 45% of specimens sampled from deads that is significantly greater than from survivors (8.7%). Leading pathogens of severe suppurative infections of soft tissues were more frequent revealed in mono-culture. Early diagnosis of tissue infections caused by nonsporeforming microorganisms should be based on clinical instrumental data, microbiological and morphological examinations.

[The preoperative thoracic X-ray for tactical decisions for the thoracic injuries treatment].

Data of 379 patients with penetrating thoracic wounds were analyzed. The pathologic changes on X-ray of the thoracic cavity were registered 239 (63,1%) patients: the hemothorax was diagnosed in 44,3%, pneumothorax - in 26,8% and hemopneumothorax - in 28,9%. 154 patients had videothoracoscopic surgery and 225 patients were operated on using traditional open methods. Operative findings were compared with X-ray data. The sensitivity of plain chest radiography in diagnostics of hemothorax was 52,1%, the specificity - 92,1%. Mistakes of interpreting X-ray data in diagnosing of low-volume hemo- or pneumothorax were defined. The computed tomography of the thorax proved to be the most precise means of intrapleural injuries diagnostics. The optimal algorithm of preoperative thoracic X-ray was suggested.

[Diagnostics and treatment of pulmonary hemorrhage by the closed thoracic trauma].

Results of diagnostic and treatment of 156 patients with pulmonary hemorrhage, caused by the closed thoracic trauma, were analyzed. All patients had lung bruise, 101 of them had lung rupture. 115 (73.7%) patients demonstrated hemopneumothorax, bleeding was diagnosed in 86 (55.1%) cases and mediastinal emphysema was diagnosed in 52 (33.3%). Pulmonary hemorrhage developed more often by polytrauma of the chest, rather then by solitary lesions. Spiral computed tomography proved to be the best diagnostic means of thoracic trauma. Surgical tactics was defined mainly by the severity of intrapleural or pulmonary bleeding. Conservative treatment allowed successful recovery in the majority of patients. Only 5.1% of patients required surgery. High level of septic complications of pulmonary hemorrhage was registered/ Pneumonia developed in 28.8% and lung abscess was diagnosed in 14.1% of patients. The lethality rate was 9.6%.

[Posttraumatic pericarditis - the treatment and prophylaxis].

Results of treatment of 100 patients with posttraumatic pericarditis after stab (n=79) and blunt (n=21) thoracic trauma. Factors, leading to pericarditis onset, were primary infection, direct heart and pericardium injury (87,3%), inadequate pericardial cavity drainage (13,9%), insufficient medicamental pericarditis prophylaxis postoperatively (8,9%). Late medical recourse after blunt trauma of the thorax had led to pericarditis onset due to clotted hemothorax (23,8%), exudative pleurisy (19%) and pleural empyema (14,3%). Early diagnose and complex conservative treatment of posttraumatic pericarditis allowed recover in 78,5% (n=62) and 81% (n=17) of patients with stab and blunt thoracic trauma, respectively. Pericardial cavity drainage with intrapericardial streptokinase introduction proved to be an effective method of treatment of fibrinopurulent pericarditis.

[Diagnostics and treatment of posttraumatic septic costal osteomyelitis].

Results of treatment and diagnostics of 47 patients with posttraumatic septic costal osteomyelitis were analyzed. 26 patients had open and 21 - closed thoracic injuries. Major reasons of osteomyelitis tended to be the initial infection of the bony injury, pleural surgical revision through the initial wound and late medical help by the closed thoracic injuries. Osteomyelitis was diagnosed with the help of and X-ray examination in 14,9%, multispiral computed tomography was informative in 48,4% and scintigraphy demonstrated bone destruction and inflammation in 96,8% of cases. With no depandance from the type of an injury, the most frequent infectious agents were the Staphylococcus aureus (51,2%) and Pseudomonas aeruginosa (32,5%). Conservative treatment was successful in 26,9% after open injuries and in 42,9% of the blunt thoracic trauma. Wide costal resections were conducted in 73,1% and 52,4% of patients with open and closed injuries, respectively.

Determination of lignans in flaxseed using liquid chromatography with time-of-flight mass spectrometry.

A new method of flaxseed-derived lignan determination was developed using HPLC with high-resolution time-of-flight MS (TOF-MS), optimized, and compared to two existing methods (HPLC/MS/MS and GC/MS). The limits of detection (LODs) for HPLC/TOF-MS (0.002-0.043 pg) were comparable with those of the optimized and improved HPLC/MS/MS (0.001-0.015 pg), whereas the LODs for the optimized GC/MS were higher (0.02-3.0 pg, yet lower than reported before). Using the newly developed detection and separation methods, several key flaxseed sample preparation parameters (including extraction, hydrolysis, and sample purification) were evaluated resulting in the development of efficient protocol for lignan quantification from flaxseed hulls and embryos. The results confirmed the importance of quantification of both aglycones and unhydrolyzed glucosides in order to obtain the total lignan estimates.

[Role of spiral computed tomographic angiography in the diagnosis of aortic aneurysmal complications].

The paper considers the basic diagnostic capacities of computed tomographic angiography (CTA) in aortic aneurysmal complications. The results of emergency of CTA were analyzed In 63 patients with suspected aortic aneurysmal dissection and rupture. CTA provides complete information on the site, extent, and spread, form and sizes of an aneurismal process, on the presence of intraluminal thrombi, on the presence or absence of aortic wall dissection and rupture, on the involvement of aortic branches, and the state of adjacent tissues and organs.

Structural composition of blood erythrocytes in children with nephropathies.

Study of the structural characteristics of peripheral blood erythrocytes in the pathogenesis of nephropathies in children by means of automated recording of integral osmotic erythrograms and analysis of differential curves of hypoosmotic hemolysis showed decreased osmotic resistance of erythrocytes, which was most pronounced during renal dysfunction. A molecular model of possible modification of the erythrocyte membrane in the pathogenesis of nephropathies is proposed.