[The role of plasmapheresis in prevention of complications after thoracoscopic thymectomy in patients with myasthenia combined with thymic hyperplasia]. / Rol' plazmafereza v profilaktike oslozhnenii videotorakoskopicheskoi timektomii u patsientov s miasteniei v sochetanii s giperplaziei vilochkovoi zhelezy.

Surgical indications for thymectomy include thymus tumour of different genesis as well as myasthenia. Minimally invasive methods such as thorascopy and robot-assisted thymectomy have been widely used lately as well as standard surgical methods namely sternotomy and thoracotomy. Regardless the type of access in myasthenia patients specific crisis conditions of respiratory failure can appear in postoperative period that usually requires mechanical ventilation. This study was aimed to estimate the efficacy of pre- and postoperative plasmapheresis in prevention of specific myasthenia-associated complications.

[The program of accelerated rehabilitation after esophagoplasty (fast track surgery) in esophageal cancer surgery].

Esophagectomy with simultaneous plasty in patient with esophageal cancer is still associated with a high incidence of postoperative complications and long-stay patient in the clinic. The purpose of our report is to inform the use of the program of accelerated rehabilitation after esophagectomy in a prospective study of 13 patients during the period from 2010 to 2011 year and the role of the anesthesiologist in its implementation. Methods aimed at the preoperative examination, minimally invasive surgery, thoracic epidural anesthesia/analgesia with local anesthetics as a component of anesthesia and postoperative analgesia, early extubation and mobilization of the patient with the implementation of breathing exercises, early enteral feeding, and the planned short postoperative stay in resuscitation and hospital were used. Postoperative complications were observed in 3 (23/1%) patients: one patient (7/7%) had right-side pneumonia, two patients (15/4%) had right-side pneumothorax requiring emergency re drainage. The average intensive care stay was 2 (1-4) days, postoperative hospital stay--9 (7-12) days. Further monitoring of the patients did not show any long-term complications. The results confirm that it is possible to optimize the healing perioperative process in patients after esophagectomy with simultaneous plasty by using of accelerated rehabilitation program without the risk of increasing the frequency of postoperative complications. it will provide the reduction of length of hospital stay. In view of multifaceted and controversial issue the following researches in this direction are necessary.

[Surgery for cardio-esophageal cancer].

The experience of surgery of 369 patients with cardio-esophageal cancer treated in the Kazan Republic Clinical Oncology Center is presented. The patients are divided into 3 groups respective of the type of adenocarcinoma (classification by J.R. Siewert). Thus, the first group consists of 45 (12.1%) patients, the second--172 (46.6%) and the third--152 (41.3%) patients. Each group is divided into subgroups according to the performed operation: transhiatal esophagoplasty with esophagogastroanastomosis on the neck, transthoracal esophagoplasty (operations by Lewis and Gerlock) with intrapleural esophadogastroanastomosis and gastrectomies with high resection of esophagus. High productivity of the differentiated approach to surgical treatment of cardio-esophageal cancer depending on the type of adenocarcinoma is shown. Such approach allows the surgical treatment to be more radical, to reduce quantity of the early and remote complications and to raise the survival. So, it is revealed that performance of transhiatal and transthoracal esophagoplasty is possible in cases of type I adenocarcinoma. Gastrectomies in cases of type II adenocarcimoma are of poor prognosis.

[SOME ASPECTS OF DIAGNOSIS AND COMPREHENSIVE TREATMENT OF BARRETT'S ESOPHAGUS].

OBJECTIVE: Assess the value of routine endoscopy in the diagnosis of Barrett's esophagus (BE) in patients with gastroesophageal reflux disease (GERD) and to show the feasibility of a comprehensive treatment algorithm that includes antireflux surgery as an essential component. MATERIALS AND METHODS: The study was conducted on a sample of 171 patients with Barrett's esophagus who underwent antireflux surgery. In evaluating the operating characteristics of endoscopy were recruited another 675 patients with GERD without BE. On the diagnostic phase was used endoscopy with double chromoscopy and biopsy followed by histological examination. At the stage of treatment, patients received conservative therapy by PPl after which underwent antireflux surgery and argon-plasma coagulation (in some cases). RESULTS: Endoscopy of the esophagus with a double chromoscopy in identification BE in patients with GERD, has a moderate sensitivity (71.9%, 95% Cl 64.6%-78.5%) and high specificity (100%, 95% Cl 99.5%-100%). A comprehensive treatment approach that includes antireflux surgery as an essential component has allowed to achieve excellent and satisfactory immediate results of treatment in 88.9% of patients (95% Cl 83.2%-93.2%). Excellent and satisfactory long-term results were achieved in 89.5 % of patients (95% Cl 83.9%-93.6 %). CONCLUSION: The results indicate the need for biopsy and histological examination in all patients with GERD, who has no suspicion of BE according to endoscopy, and prove high efficiency of complex treatment algorithm that includes antireflux surgery as an essential component.

[The ruptures of the trachea with the intubation tube in patients with esophagus cancer].

Postintubation tracheal ruptures is a rare but serious complication with high risk for the patient's life. The preliminary diagnosis is usually made after occurrence of subcutaneous emphysema, blood spitting, respiratory insufficiency, pneumothorax and/or pneumomediastinum. The suspected rupture of the trachea should be verified by fiber-optic bronchoscopy. The decision about necessity of surgical or conservative treatment is based on the compilation of clinical, radiologic and endoscopic data. We present 9 cases (7 women and 2 men) of postintubation tracheal ruptures, occurred during the esophageal (6), lung (2) and mammary gland (1) surgery.

[Thymectomy and antibodies to acetylcholine receptors (AChR) in patients with myasthenia gravis in the early postoperative period].

Thymectomy and removal of the hyperplastic thymus have been performed in 21 patients with myasthenia. In 14 patients, thymectomy is performed through thoracoscopic access (TA), while in 7 cases through thoracotomic access (TT). The serum levels of antibodies to acetylcholine receptors (AChR) determined before and after surgery were increased in both groups of patients. Thus, thymectomy, regardless of the degree of clinical improvement in early post operative period, significantly increases the level of anti-AChR antibodies in the serum of patients in the early postoperative period compared to baseline. These changes may reflect the immune response to a stressful situation related to the traumatic surgery. It should be noted that the level of anti-AChR antibodies was significantly higher in a group of TT that may be related with a larger volume of the removed tissue.

[An integrated approach to diagnosis and treatment of Barrett's esophagus].

Barrett's oesophagus is a condition when the oesophagus adenocarcinoma risk increases. There are different ways of diagnostic and treatment for this disease abroad and our country. We offer a complex method for Barrett's oesophagus treatment. Our method reveals Barrett's oesophagus effectively. We also take antireflux treatment and Barrett's epithelium elimination using miniinvasive surgery with drugs therapy. We have experience of curing 48 patients from Barrett's oesophagus. Considering obtained results our tactic for clinical practice is recommended.

[Endoscopic diagnosis and complex treatment of Barrett's esophagus complicated by hernia of esophageal foramen of the diaphragm].

A protocol is suggested of complex diagnosis and treatment of Barrett's esophagus using sparing endoscopic removal of Barrett's epithelium in combination with surgery and medicinal antireflux therapy. Eighty-three patients were diagnosed and treated for hernia of esophageal foramen of the diaphragm and gastro-esophageal reflux complicated by Barrett's esophagus. Ninety-two percent of patients receiving our four-component treatment were cured; no recurrent esophageal adenocarcinoma was reported during the 56.7 +/- 2.4 month follow-up. Conversely, in patients receiving three-component treatment, efficacy was 56%; esophageal adenocarcinoma was reported in 3 (12%).

[Laparoscopic surgeries in the treatment of hiatal hernias]. / Laparoskopicheskie operatsii v lechenii gryzh pishchevodnogo otverstiia diafragmy.

Immediate and long-term results of treatment of 132 patients with hiatal hernias are analyzed. Indications for surgery are determined. Complications during and after laparoscopic antireflux surgeries are analyzed.

[Diagnosis and treatment of breast cancer with central and medial localization using video-assisted thoracoscopic parasternal lymphadenectomy]. / Diagnostika i lechenie raka molochnoi zhelezy tsentral'noi i medial'noi lokalizatsii s ispol'zovaniem videotorakoskopii.

Since extended mastectomy after Urban involves an unjustifiably high level of trauma, this method has limited application. We have evolved a procedure of video-assisted thoracoscopic parasternal lymphadenectomy (VATPL). On completion of the experimental part using cadavers to work out the rationale for extent of surgery, clinical trials started. A total of 120 operations in patients aged 27-73 were performed (left-sided--64, right-sided--56), with the number of lymph nodes removed in each case ranging 1-10. Metastases were detected in 23 (19.2%), isolated lesions (metastases to parasternal lymph nodes alone)--6 (5.0%). With volume of removed tissue being identical, the findings on level of pain, amount of narcotic analgetics, hospital stay duration, intra- and postoperative complication incidence and cardiointervalography and pneumotachometry for VATPL patients were significantly better than for those treated by traditional (open-chest) procedure. It is concluded that VATPL is a highly effective and low-traumatizing diagnostic method. It may be recommended as an operation of choice for parasternal lymph collector involvement of central or medial localization.

[Stereotaxic biopsy of non-palpable breast neoplasms with the ABBI system (USSC)]. / Stereotakticheskaia biopsiia nepal'piruemykh obrazovanii molochnoi zhelezy s primeneniem ABBI system (USSC).

The study was concerned with application of the stereotactic automated surgical biopsy breast with the ABBI (USSC) device for verification of non-palpable breast lumps. It included 13 females, aged 34-72 (mean age--54) and lasted 6 months (1999). Microcalcinates were detected in 3 (22.8%), local cordlike tissue structures--3 (22.8%), focal shadows--7 (53.2%). Lesion size: (5 mm (16%), 5.1-10 mm (25%) and 10.1-20 mm (59%). Malignancy was diagnosed in 3 cases (22.8%), dia. 7-10 mm; atypical ductal hyperplasia--2 (8.3%), and miscellaneous benign pathology--53.2%. Adequate removal of lesions was histologically confirmed in all cases. The procedure was carried out with ambulatory monitoring, under local anesthesia, and lasted 1.5 hrs. No complications were reported. The cosmetic results were good; no analgetics were dispensed. The ABBI system proved an effective means of stereotactic surgical biopsy of the breast because it removed the entire radiologically-suspicious site as a complete tissue preparation. It provided all histological data without crushing or segmenting the preparation. Since tissue texture and, particularly, the preparation edges remained intact, the latter could be examined too, if needed. All this ruled out inaccurate interpretation, repeat biopsy and unjustified lumpectomies.

[Biopsy of non-palpable tumors of the breast]. / Biopsiia nepal'piruemykh obrazovanii molochnoi zhelezy.

14 biopsies were performed in patients with non-palpable tumors of the breast with stereotaxic automated system (ABBI) and disposable "pistol-needle" ("Auto-Suture") whose needle-harpoon penetrates into pathologic focus under local anesthesia (four fold digital stereotaxic control guarantees the precision of biopsy). Non-palpable breast cancer in the tissue areas of 4, 7 and 11 mm in horizontal section was diagnosed in 3 patients. Biopsy was performed outpatiently, there were no complications. The procedure is like a diagnostic sectoral resection of the breast.

[Parasternal lymph node excision in breast cancer]. / Parasternal'naia limfadenéktomiia pri rake molochnoi zhelezy.

Comparative analysis of the results of videothoracoscopic parasternal lymphadenectomy and standard mastectomy by Urban--Holdin is presented. In November 1995 to December 1999 205 videothoracoscopic parasternal lymphadenectomies were performed (96--on the left, 104--on the right). Central and medial location of breast cancer was indication for this operation. Age of the patients ranged from 23 to 73 years. Surgery was performed under intravenous anesthesia in the conditions of artificial lung ventilation with separate lung intubation. Mastectomy was performed as the first stage. Further, thoracoports were introduced into pleural cavity in the 5th intercostal space along medioclavicular and mediaxillar lines and in the 4th intercostal space along anterior axillar line. Parietal pleurotemy was performed parallely to internal thoracic vessels, parasternal fat and lymph nodes were removed en-block. Parasternal lymph nodes were involved in 40 (19.5%) patients. The spirometry, cardiomonitoring which were used pre-, intra-, postoperatively demonstrated that parasternal thoracoscopic lymphadenectomy is less traumatic and effective as diagnostic method than mastectomy by Urban--Holdin. Parasternal thoracoscopic lymphadenectomy can be recommended as a method of choice in medial and central breast cancer.

Thoracoscopic surgery in the management of mediastinal masses. Indications, complications, limitations.

BACKGROUND: In recent times thoracoscopy has been used for diagnoses and treatment of mediastinal masses. This study is a preliminary review of indications, complications, and limitations in this field of surgery. METHODS: Twenty-eight patients with mediastinal masses were operated in the Clinical Oncological Centre, Kazan. Twenty-two of them had anterior mediastinal growths; six had posterior mediastinal tumors. Thoracoscopy was diagnostic in 14 cases; it was therapeutic in 14 cases. RESULTS: The definite diagnosis was achieved in all patients. In cases of benign lesions the operations were successfully completed thoracoscopically. All patients underwent a postoperative period with low pain and short postoperative time. CONCLUSIONS: Video-assisted thoracoscopy is indicated in cases of mediastinal masses, both for diagnosis and treatment. It has significant advantages compared to normal thoracoscopy and mediastinoscopy.

[Prognosis of lung cancer incidence in the Moldavian SSR]. / Verifikatsiia prognoza zabolevaemosti rakom legkogo v Moldawskoi SSR.

A correlation is given between the actual figures of lung cancer incidence in the Moldavian SSR and those prognosticated for the peiod of 1972--77. The former were found to coincide with the latter. Based on some additional observations the rate of lung and stomach cancer incidence has been prognosticated till 2000.