[Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations]. / Effektivnost' endoskopicheskoi vakuumnoi terapii v kompleksnom minimal'no invazivnom lechenii perforatsii pishchevoda.

OBJECTIVE: To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS: The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS: Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION: EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.

[Endoscopic treatment of bronchial complications after lung transplantation]. / Endoskopicheskoe lechenie bronkhial'nykh oslozhnenii posle transplantatsii legkikh.

OBJECTIVE: To analyze the incidence and structure of bronchial complications following lung transplantation and evaluate an effectiveness of endoscopic treatment of these events. MATERIAL AND METHODS: The study enrolled 50 patients after bilateral lung transplantation (24 men and 26 women). Mean age of patients was 35.4±5 (19; 61) years. Ischemia of bronchial mucous membrane of the transplant was intraoperatively and postoperatively analyzed. We also assessed severity and prevalence of anastomotic and non-anastomotic cicatricial bronchial stenoses. RESULTS: All patients after lung transplantation were diagnosed with bronchial complications, i.e. ischemia of bronchial mucous membrane of the transplant. In 76% of patients, these complications did not require endoscopic treatment. Surgical and endoscopic treatment was required in 24% of cases. Three patients (6%) underwent intraoperative correction of bronchial anastomosis. Bronchial suture failure was diagnosed in 3 patients (6%), cicatricial bronchial stenosis - in 6 (12%) cases. Endoscopic stenting was effective for recovery of bronchial patency with complete epithelialization of mucous membrane. Stenting of lobar bronchus with application of mitomycin C was effective in patients with non-anastomotic stenoses type III after lung transplantation. CONCLUSION: Major bronchial complications occurred in 24% of patients after lung transplantation. Endoscopic treatment of bronchial complications using a self-fixing silicone endoprosthesis after lung transplantation was effective in all patients with anastomotic and non-anastomotic cicatricial strictures. Mitomycin C prevented excessive growth of granulation and scar tissue.

[Difficulties of differential diagnosis and treatment of achalasia cardia after previous hiatal hernia repair]. / Trudnosti differentsial'noi diagnostiki i lecheniia akhalazii kardii u patsientki, ranee operirovannoi po povodu gryzhi pishchevodnogo otverstiia diafragmy.

Esophagocardiomyotomy followed by anterior fundoplication is a standard treatment of achalasia cardia, whereas cruroraphy with complete or partial posterior fundoplication is carried out for hiatal hernia and gastroesophageal reflux disease. The most common postoperative complications of hiatal hernia repair are dysphagia due to malformed cuff, phenomenon of 'telescope' and slow gastric emptying syndrome. Recurrent hiatal hernia is observed in 3-15% of cases. Currently, there are a lot of reports devoted to redo antireflux procedures in patients with hiatal hernia. The goal of the study is to demonstrate difficulties of diagnosis and treatment in a patient with achalasia cardia after previous hiatal hernia repair.

[Esophageal achalasia]. / Akhalaziia kardii.

Prevalence, clinical manifestations and of modern classifications of achalasia are reviewed in the article. Diagnosis and treatment of this pathology were analyzed by using of 58 references.

[The features of diagnosis and treatment of traumatic and non-traumatic pulmonary bleeding]. / Osobennosti diagnostiki i lecheniia legochnogo krovotecheniia travmaticheskoi i netravmaticheskoi étiologii.

AIM: To analyze an efficacy of differentiated approach for pulmonary bleeding of different etiology and severity. MATERIAL AND METHODS: The study included 134 cases of pulmonary bleeding for the period 2006-2015 including 53 patients with traumatic and 81 with non-traumatic etiology. Men/women ratio was 2.7:1, mean age was 43 years. Comparative retrospective analysis of X-ray and CT data in diagnosis of bleeding source was performed. Bronchoscopy was used to confirm these data. There were 43 endovascular examinations including 40 cases of bronchial arteriography (BAG). RESULTS AND DISCUSSION: X-ray and CT-signs of bleeding source were detected more often in case of traumatic pulmonary bleeding (62.3% and 93%) compared with non-traumatic (27.2 and 54%; p<0.05). Bronchoscopy revealed ongoing pulmonary bleeding in 40 (30%) patients, completed - in 94 (70%) patients. Indirect angiographic signs were the most frequent for pulmonary bleeding origin: hypervascularization (32.6%), bronchial-pulmonary shunts (23.2%) and bronchial artery dilatation (20.9%). 17 patients with ongoing bleeding underwent bronchial obstruction with adequate hemostasis in all cases. Endovascular interventions included bronchial arteries embolization (EBA) (33), occlusion of intercostal arteries (3) and segmental branches of low-lobar pulmonary artery (1), aortic stenting (1). Early efficacy of EBA was 97% with 2 month recurrence of pulmonary bleeding near 12.5%. Ongoing traumatic pulmonary bleeding was an indication for emergency thoracotomy in 18.9% compared with 12.3% for non-traumatic bleeding when surgery was made after endoscopic and endovascular hemostasis. CONCLUSION: Differentiated approach depending on etiology and severity of pulmonary bleeding improves outcomes and reduces the number of operations for ongoing severe bleeding.

[Enteral tube feeding in adult patients with cystic fibrosis and respiratory failure]. / Énteral'noe zondovoe pitanie u vzroslykh bol'nykh mukovistsidozom s dykhatel'noi nedostatochnost'iu.

AIM: To evaluate the efficiency of nocturnal hyperalimentation in adult patients with cystic fibrosis (CF) and respiratory failure. SUBJECTS AND METHODS: The investigation enrolled 17 patients older than 18 years (mean age, 25.6±4.2 years) diagnosed with very severe CF (forced expiratory volume in one second (FEV1), < 30%; body mass index (BMI), < 18.5 kg/m2); all the patients were on the waiting list for lung transplantation. Nutritional status and pulmonary function parameters, such as body weight, height, BMI, and FEV1, were measured at baseline, before and 6 and 9 months after tube feeding. RESULTS: The study group showed a considerable increase in body weight and BMI after 6 and 9 months. The change in lung function was statistically insignificant. Lung transplantation was successfully conducted in 5 patients; 4 died while on the waiting list; the cause of death was respiratory failure. CONCLUSION: Supplemental PEG tube feeding improves the nutritional status (BMI, body weight) of patients with very severe CF.

[Absence of postoperative pulmonary impermeability in patients with spontaneous pneumothorax]. / Posleoperatsionnaya negermetichnost' legkogo u patsientov so spontannym pnevmotoraksom.

AIM: to improve treatment of patients with spontaneous pneumothorax who had not postoperative pulmonary impermeability. MATERIAL AND METHODS: 87 patients with spontaneous pneumothorax underwent videothoracoscopy (VTS), lung resection supplemented by pleurodesis (parietal pleurectomy or pleural abrasion). Absence of pulmonary impermeability was observed in 5 (5.7%) patients. RESULTS AND DISCUSSION: Re-operation was performed in 2 patients (Vanderschuren 2 and 3) namely re-thoracoscopy and thoracotomy with additional ligation of air origins. Drainage tubes were removed in 4 and 17 days postoperatively in patient without/with emphysema respectively. In patient (Vanderschuren 1) who underwent thoracoscopic resection and parietal pleural abrasion valve bronchoblocation was performed in 9 days after VTS due to persistent pneumothorax. Pleural drainage tube was removed in 13 days (emphysema) after bronchial valve deployment. 2 patients (Vanderschuren 4) had heterogeneous pulmonary emphysema. One of them underwent video-assisted mini-thoracotomy, lung resection with reinforcement of seams with synthetic material. In other observation conversion to thoracotomy followed by atypical resection of bullous emphysema and manual suturing of lung was applied. In both cases bronchoblocation was performed intraoperatively with good results. Drainage tubes were removed in 13 and 17 days respectively. There were no complications. CONCLUSION: Intraoperative endoscopic bronchoblocation is advisable if air leakage is considerable in operating theater and complicates lung smoothing. Such approach reduces hospital-stay and improves outcomes.

[The effectiveness of the valve bronchial occlusion in case of bronchopleural fistulas].

The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

[Treatment of septic complications of thoracic injuries].

Treatment results of 77 patients with suppurative lung complications after injuries (n=22) and closed thoracic trauma (n=55) were analyzed. It was registered, that purulent process in lung was typical for the cases with direct primary lung tissue injury: 72.7% of patients with penetrating thoracic injuries and 83.6% of patients with closed chest trauma. Complex conservative treatment with adequate bronchial and transthoracic drainage proved to be the most effective modalities during the acute suppurative phase. Gram-negative flora proved to be the cause of chronic forms of suppuration. The overall chronisation rate of the lung abscess was 4.5% after penetrating thoracic injuries and 10.9% of patients with closed chest trauma.

[Diagnostics, treatment and expert evaluation of air crew members with polypoid growth in the gallbladder].

The article discusses results of diagnosing and treatment of various forms of gallbladder polypoid growth (GBPG) in air crew members in the past 10 yr. period. Growth of polyps was detected in 12.1% of pilots with gallbladder pathologies. Timely and correct diagnostics with the use of radiologic visualization may prevent unwarranted surgery of the hepatobilizry system and thus extend the flying longevity. Ultrasound Doppler investigation is particularly effective in diagnosing early GBPG. High quality of visual differentiation attainable with these techniques made it possible to diagnose the nonneoplastic nature of GBPG in 75% of cases that did not require operational treatment. In most cases the authors' diagnostic and treatment algorithm reduced the amount of surgical activity and prolonged ace careers.

[Changes in the hepatobiliary system in juvenile rheumatoid arthritis]. / Izmeneniia gepatobiliarnoi sistemy pri iuvenil'nom revmatoidnom artrite.

The authors submit the results of echographic investigation of 42 children aged from 4 to 15 years old with juvenile rheumatoid arthritis (JRA). All the patients were distributed into three groups. Signs of affection of the hepatobiliary system were revealed in 60% of the patients, predominantly with the articular form of the disease and in 78.5% of the children with the articular -visceral form. The most grave changes were noted in the group of patients with JRA complicated by secondary amyloidosis (100%). The data obtained are compared with the clinico-laboratory indices, the form of the disease, peculiarity of therapy as a result of which a relationship between the mentioned signs and the character of JRA lesions is established. A high informativeness of the echographic method especially in the diagnosis of secondary amylosis is confirmed.