[Thoracoscopic resection of recurrent atypically located parathyroid adenoma of anterior mediastinum in a patient with hyperparathyroidism undergoing renal replacement therapy]. / Torakoskopicheskoe udalenie retsidivnoi atipichno raspolozhennoi adenomy okoloshchitovidnoi zhelezy perednego sredosteniya u patsientki s giperparatireozom, nakhodyashcheisya na zamestitel'noi pochechnoi terapii.

We present successful surgical treatment of a patient with chronic kidney disease (CKD) and hyperparathyroidism undergoing renal replacement therapy. At baseline, parathyroidectomy via cervical access was performed for parathyroid adenomas. After 6 years, clinical and laboratory relapse of disease required thoracoscopic resection of atypically located anterior mediastinal adenoma. This case demonstrates that this disease is one of the most difficult in modern medicine requiring a special approach in diagnosis and treatment. Patients with CKD and hyperparathyroidism need for follow-up, control of total and ionized serum calcium, inorganic phosphorus and parathormone, osteodensitometry, ultrasound and scintigraphy of thyroid and parathyroid glands, and, if necessary, CT or MRI of the neck and chest organs.

[Combined surgeries for secondary chest wall lesions]. / Kombinirovannye operatsii pri vtorichnom porazhenii grudnoi stenki.

The authors present treatment of rhabdomyosarcoma of the gluteal region with secondary lesion of the lung and chest wall. Features of chest wall defect closure are analyzed.

[Chest wall repair after extensive resections]. / Rezul'taty vosstanovleniya karkasa grudnoi stenki posle obshirnykh rezektsii.

OBJECTIVE: To analyze the outcomes after different methods of post-resection chest wall defect reconstruction. MATERIAL AND METHODS: The study included 41 patients aged 22-73 years who underwent chest wall repair with local tissues and synthetic materials. Twelve (29.3±7.1%) patients had sarcoma, 9 (21.9±5.9%) - non-small cell lung cancer (NSCLC) with invasion of the chest, 9 (21.9±5.9%) - metastatic lesions, 8 (19.5±6.2%) - benign tumors, 2 (4.8±3.4%) - breast cancer with invasion of the chest wall, 1 (2.4±2.4%) - desmoid tumor. Seven patients were diagnosed with T3N0M0, 1 - T3N2M0, 1 - T2N0M1b (oss). Among patients with NSCLC with invasion into the chest wall, squamous cell cancer was verified in 4 (44.4±16.6%) patients, adenocarcinoma - in 4 (44.4±16.6%), neuroendocrine tumor - in 1 (11.2±10.5%) patient. Stages of surgeries are presented. RESULTS: We analyzed treatment outcomes in 41 patients. Five (12.2%) patients had seroma, hemothorax, thoracopleural fistula, subcutaneous emphysema and fatal asystole. There were no postoperative complications associated with paradoxical breathing. CONCLUSION: Accurate morphological verification prior to treatment is valuable to determine the stages of combined treatment of chest wall tumors. Chest wall defect closure with own tissues and synthetic materials is necessary after extensive resections. A multidisciplinary approach involving thoracic and plastic surgeons is needed.

[Surgical management of tracheal anastomosis failure and risk of arterial bleeding]. / O khirurgicheskoi taktike pri nesostoyatel'nosti trakheal'nogo anastomoza i ugroze arrozionnogo krovotecheniya.

OBJECTIVE: To determine the optimal algorithm for tracheal anastomotic insufficiency and prevention of arterial bleeding. MATERIAL AND METHODS: We present 2 patients with defects of tracheal anastomosis after tracheal resection and divergence of tracheal edges. We primarily analyzed appropriate emergency care and prevention of subsequent severe complications such as arterial bleeding and respiratory insufficiency. CONCLUSION: Tracheostomy may be preferable for complete late tracheal anastomotic insufficiency to restore breathing. However, surgery should be accompanied by prevention of arterial bleeding. Isolation of damaged area, particularly tracheostomy tube, from the mediastinum by well-vascularized tissues can prevent bleeding from major vessels (for example, innominate artery). Follow-up is unreasonable due to worsening of clinical situation, risk of hemorrhagic complications and fatal outcomes. General satisfactory clinical status of the patient is not of matter. Repeated tracheal anastomosis is justified only for early insufficiency, i.e. within 2-3 days when postoperative inflammation is mild.

[Safe thyroidectomy for thyroid and parathyroid diseases]. / Puti osvoeniya bezopasnoi tekhniki tireoidektomii pri zabolevaniyakh shchitovidnoi i okoloshchitovidnykh zhelez.

OBJECTIVE: To offer the ways for safe thyroidectomy aimed at prevention of damage of recurrent laryngeal nerve in patients with thyroid and parathyroid diseases. MATERIAL AND METHODS: We analyzed postoperative outcomes after thyroidectomy in 342 patients aged 20-80 years. Topography of recurrent laryngeal nerves was studied on 20 laryngeal-tracheal complexes of deceased patients. Technique of visualization of various segments of recurrent laryngeal nerve was worked out. RESULTS AND DISCUSSION: Thyroidectomy was performed in 342 patients with thyroid and parathyroid diseases. Thyroidectomy was performed in accordance with recommendations described by F.W. Lahey, W.B. Hoover (1938) and H. Malcolm, M.D. Wheeler (1998). Location of recurrent laryngeal nerve varied in patients with nodular, retrosternal goiter and parathyroid gland adenoma. Comparison of intraoperative and morphological data on recurrent laryngeal nerve visualization showed possible risks of its damage during manipulations on thyroid gland, esophagus and trachea. Our study confirmed the need for visualization and mobilization of recurrent laryngeal nerve in all procedures on thyroid and parathyroid glands. Introduction of the described technique of thyroidectomy and training sessions for recurrent laryngeal nerve mobilization on laryngeal-tracheal complexes reduced postoperative incidence of phonation disorders from 21.6% to 0.98%. CONCLUSION: Thyroidectomy may be a safe procedure if surgeons are familiar with the details of surgical technique and prevent damage to adjacent structures.

[Life-threatening complications following endoscopic recanalization of cicatricial tracheal stenosis]. / Zhizneugrozhayushchie oslozhneniya pri endoskopicheskoi rekanalizatsii rubtsovykh stenozov trakhei.

The authors report an attempt of tracheal stenosis bougienage complicated by tracheal rupture. Particularities of diagnosis and treatment of patients with cicatricial stenoses of breathing pathways are analyzed.

[Surgical treatment of combined neck injury]. / Khirurgicheskoe lechenie mnozhestvennykh povrezhdenii shei.

The authors report acute neck injury followed by damage to larynx, trachea and pharynx. Features of treatment of this lesion are analyzed.

[Features and choice of surgical strategy in patients with gastrointestinal fistulas]. / Osobennosti taktiki i vybora sposoba khirurgicheskogo lecheniya patsientov so svishchami zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the features and choice of surgical strategy in patients with gastrointestinal fistula based on classification of their types. MATERIAL AND METHODS: There were 398 patients with gastrointestinal fistula. Fistula type 1 was found in 126 (31.7%) cases, type 2 - 38 (9.6%) cases, type 3 - 73 (18.3%) cases, type 4 - 26 (6.5%) patients, type 5 - 135 (33.9%) cases. One-stage and two-stage treatment was applied in patients with fistula type 1, two-stage treatment only - for fistula type 2. In patients with fistula type 3, treatment strategy depended on timing of fistula formation, its level and amount of intestinal chymus loss. In case of fistula type 4, radical treatment is difficult. However, surgery is safer when adhesions between intestinal loops are not yet dense enough. Indeed, dissection is associated with less risk of their damage. Reconstructive procedures were applied for fistula type 5 depending on its localization. RESULTS: The causes of gastrointestinal fistula were complications after surgery for acute ileus in 73 patients (17 ones died), blunt abdominal trauma in 81 (8), open abdominal trauma with cold weapons in 39 (6) and firearms in 11 cases (2), mesenteric thrombosis in 33 patients (8), pancreatic necrosis in 25 cases (9), abdominal hernia in 15 cases (4), acute appendicitis in 40 patients (3), colonic diverticulosis in 24 patients (1), urological diseases in 5 cases, colon perforation by a foreign body in 3 cases, colonoscopy in 5 patients, Hirschsprung's disease in 2 patients, Crohn's disease in 11 cases (3), colon polyps in 4 patients, intestinal tuberculosis in 1 case (1), small bowel resection for obesity in 1 patient and gynecological diseases in 25 patients (2). Fistulas type 1 and 4 were followed by the highest postoperative mortality since these interventions are associated with the most severe changes in abdominal cavity. Low mortality was observed in patients with fistula type 5, no abdominal inflammation and normalized intestinal passage. The overall mortality in patients with gastrointestinal fistulas was 16.1%. CONCLUSION: Treatment strategy in patients with gastrointestinal fistula primarily depends on the type of fistula that requires emergency, urgent, delayed or reconstructive surgery. Staged approach in patients with gastrointestinal fistulas can improve treatment outcomes.

[Thoracoabdominal hernia after treatment of chronic sterno-mediastinitis]. / Torakoabdominal'nye gryzhi posle lecheniia bol'nykh khronicheskim sternomediastinitom.

AIM: To analyze clinical course and develop surgical technique for thoracoabdominal hernia in patients after previous sterno-mediastinitis. MATERIAL AND METHODS: There were 7 (20%) patients aged 53-69 years with thoracoabdominal hernia after previous cardiac surgery followed by postoperative sterno-mediastinitis. Thoracoomentoplasty was used for treatment of this complication. There were 2 males and 5 females. RESULTS: All patients underwent surgery aimed at translocation of the organs from mediastinum to abdominal cavity, restoring normal anatomical location of stomach, transverse colon and large omentum, stabilizing the thorax and closing the defects in the diaphragm and anterior abdominal wall. CONCLUSION: Surgical indications are justified by stomach and transverse colon dysfunction due to their displacement to the mediastinum with threat of strangulation, cardiac compression by hernial sac, as well as chest instability. Combined approach allows to achieve recovery in all patients.

[Prospects of combined anterior prosthetic hernia repair in treatment of large and giant ventral hernias]. / Peredniaia proteziruiushchaia gernioplastika kombinirovannym sposobom pri bol'shikh i gigantskikh ventral'nykh gryzhakh.

AIM: To evaluate clinical efficacy of combined anterior prosthetic hernia repair in treatment of large and giant ventral hernias. MATERIAL AND METHODS: Patients with large and giant hernias have been analyzed. In the main group (n=675) combined methods of hernia gates repair were applied, in control group (n=257) - stretching repair including prosthesis deployment. Surgeons (n=22) were interviewed for learning curve, safety, limitations and reliability of combined methods. RESULTS: Combined method of hernia repair in patients with large and giant hernias reduces overall postoperative morbidity (p<0.001), wound complications (p<0.05) and incidence of recurrent hernia (p<0.001). Questionnaire data showed the possibility of learning for the method by the most of surgeons to treat these patients. As a result, some practical recommendations are presented for successful procedures and satisfactory results of treatment.

[Ribs osteosynthesis in patients with isolated and combined chest trauma]. / Osteosintez reber u postradavshikh s izolirovannoi i sochetannoi travmoi grudi (s kommentariem).

INTRODUCTION: Rapid methods of costal fractures fixation using special costal plates are becoming more common. AIM: To evaluate the efficacy of ribs osteosynthesis in patients with isolated and combined chest trauma. MATERIAL AND METHODS: It is presented an experience of surgical treatment of patients with costal fractures in case of isolated (30) and combined (29) chest injury. System for ribs osteosynthesis was used predominantly in surgical tactics. RESULTS: Immediate surgical results were analyzed. Most patients had increase of blood gas parameters, oxygenation in the postoperative period. In case of isolated chest injury mean duration of mechanical ventilation was 1.3±1.1, incidence of complications - 3.3%, mortality rate - 0%. In group of combined injuries those indexes were 4.6±3.05, 13.8% and 13.8% respectively. CONCLUSION: The method of ribs osteosynthesis in patients with isolated and combined chest trauma showed high efficiency.