[Treatment of tracheoesophageal fistula and consequences of severe spinal injury]. / Lechenie trakheopishchevodnogo svishcha i posledstvii tyazheloi travmy pozvonochnika.

Modern approaches to intensive care and anesthesiology make it possible to save patients with various severe traumas. Prolonged mechanical ventilation allows stabilizing the patient's status, but can result severe complications including tracheoesophageal fistula. Our patient received severe combined injury after road accident, i.e. compression-comminuted fractures of DIV, DV, DVI vertebrae with spinal cord compression, ThIII compression fracture, compression-comminuted fracture of bodies and arches ThIV, V, VI with ThVI dislocation, lower paraplegia and pelvic organ dysfunction, left-sided laryngeal paresis, brain concussion and contusion of both lungs. Mechanical ventilation has been performed for 1.5 months. The patient suffered inflammatory complications: bilateral pneumonia complicated by right-sided pleural empyema, sepsis, tracheostomy suppuration followed by cervical soft tissue abscess. Pleural drainage and debridement, as well as drainage of abscess were performed. At the same time, we diagnosed external esophageal fistula at the CVII level. Tracheoesophageal fistula closure via cervical access was carried out at the first stage. Postoperative period was uneventful. After 20 days, we performed spondylosynthesis ThI-ThVII, and decompression laminectomy ThIV-ThVI. Spine stabilization by metal elements has a beneficial effect even without spinal cord recovery regarding better conditions for neurological and social rehabilitation. Thus, treatment was performed in a highly specialized multi-field hospital by thoracic surgeons and vertebrologists. We realized the treatment plan and obtained favorable results with minimal risk of postoperative complications.

[Glial tumors of the brain: classification, present-day aspects of immunopathogenesis and immunogenetic diagnostics].

Glial tumors of the brain present a complicated problem in neurosurgery due to the peculiarities of their growth biology, their prevalence, infiltrative growth and diagnostic difficulties. The complexity of treatment, which includes surgical removal of a tumor, radiotherapy, chemotherapy, and immune correction, makes the problem even more topical. Modem classification of glial neoplasms is of no less importance, because treatment depends on the histologic structure of a tumor. Thereupon, the authors of the article pay special attention to the modem WHO classification of gliomas. As immune diagnostics and treatment are indispensable in modern neurooncology, application of neurospecific oncologic markers is being widely introduced into clinical and scientific practice in many scientific centers. However, there are no objective tests to verify the diagnosis of astrocytic glioma with reliable accuracy. Hereditary syndromes associated with glial tumors have been distinguished and are being studied. The most interesting and promising direction is research into genetic anomalies in patients with glial processes.