[Treatment of a patient with giant solitary fibrous tumor of the left hip]. / Lechenie patsientki s gigantskoi gemangioperitsitomoi.

The authors report surgical treatment of a 59-year-old female with a giant solitary-fibrous tumor of the left hip. Previous excision of hip hemangioma was performed in 2016. Recurrent tumor with fast growth has occurred since 2018. The neoplasm consisted of 2 tumors connected by vascular structures. CT revealed soft tissue neoplasms in the upper third of the left thigh (anterior, medial and dorsal regions). Large tumors with an isthmus along the inner surface had tuberous contours and internal septa. The last ones and walls accumulated contrast agent. No structural damage to femoral muscles was observed. The patient underwent resection of tumor and vascular ligation (great saphenous vein and its tributaries along the anterior surface, arteries from the deep femoral artery system along the posterior surface of tumor). There were no early postoperative complications. There are no complaints within 6 month after surgery. There is no lower limb dysfunction.

[Diagnostic and treatment of foreign bodies of the upper digestive tract]. / Inorodnye tela verkhnikh otdelov zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the results of diagnosis and treatment of foreign bodies of the upper gastrointestinal tract. MATERIAL AND METHODS: There were 1187 patients aged 15-99 years with suspected foreign body of the upper gastrointestinal tract. In 536 patients (266 men, 270 women), foreign bodies were detected. Ingestion of a foreign body was more common in patients aged 46-65 years. In 516 patients, foreign bodies were detected in the esophagus (pharyngo-esophageal junction - 25, upper third of the esophagus - 426, middle third of the esophagus - 34, lower third of the esophagus - 21, esophageal-gastric junction - 10). Four patients admitted with esophageal wall perforation. In 3 cases, foreign bodies were localized in the throat, 15 patients - in the stomach, 2 patients - in the duodenum. RESULTS: In most cases, foreign bodies were organic (n=506). Removal was successful in 530 cases. In 4 patients with esophageal wall perforation and mediastinitis, removal was performed intraoperatively. Flexible endoscope was used in 500 cases. In 86 patients, foreign bode was displaced in the stomach using flexible endoscopy. Foreign body removing wasn't successful in 4 cases. In 2 patients, extraction was followed by esophageal wall damage. In 4 patients, esophagotomy was applied to extract foreign body. Suturing the esophageal wall defect was carried out in 2 cases. Abrasion and erosive esophagitis were the most common injuries of esophageal mucosa. Esophageal diseases were detected in 75 cases after foreign body removal (67 cases - benign esophageal diseases). One patient died from bedsore of innominate artery complicated by acute hemorrhage. CONCLUSION: Foreign bodies of the upper gastrointestinal tract are observed in 45% of patients at admission. Neck and chest X-ray examination is obligatory before endoscopy. Flexible endoscopy is a gold standard for diagnosis and extraction of foreign bodies. Repeated endoscopy after foreign body extraction should be mandatory. It is necessary to visualize complications associated with foreign body and identify esophageal diseases.

[Endoscopic bronchial valve treatment of bronchopleural fistala and air leakage]. / Endoskopicheskaya klapannaya bronkhoblokatsiya pri lechenii bronkhoplevral'nykh svishchei i utechki vozdukha.

OBJECTIVE: To evaluate an effectiveness of endobronchial valve treatment of patients with bronchopleural fistulas and prolonged air leakage. MATERIAL AND METHODS: Endobronchial valve treatment was analyzed in 115 patients with bronchopleural fistulas or postoperative air leakage. All patients were divided into 5 groups depending on disease: bullous emphysema, acute purulent lung diseases, chronic purulent lung and pleural diseases, bullous emphysema complicated by pneumothorax with failed pleural cavity, other lung diseases associated with prolonged postoperative air leakage. RESULTS: Endobronchial valve treatment was effective in more than 70% patients. There were no intraoperative and postoperative complications. CONCLUSION: Endobronchial valve treatment is a highly effective minimally invasive method for treating patients with bronchopleural fistulas and postoperative air leakage.

[Diagnostics and treatment of patients with giant leiomyoma of the esophagus]. / Diagnostika i lechenie bol'nykh s gigantskoi leiomiomoi pishchevoda.

Diagnostics and surgical treatment of 2 patients with giant esophageal leiomyoma are reported. The diagnosis was confirmed by chest computed tomography, MRI of the mediastinum, endoscopic ultrasound. Resection of tumor with mucosa suturing and Nissen fundoplication was performed in 1 case. There were no intraoperative complications. Postoperative partial failure of the seams of the esophageal wall occurred in 1 case. Drainage of posterior mediastinum was performed. Treatment resulted closure of the esophageal wall defect. Control postoperative examination confirmed patent esophagus and preserved passage through the esophagus. Multidisciplinary approach to diagnosis and treatment of these patients results favorable outcomes.

[Treatment of patient with echinococcosis of lungs and mediastinum]. / Lechenie patsienta s ékhinokokkozom legkikh i sredosteniia.

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.

[Esophageal cancer after chemical burn]. / Rak pishchevoda posle khimicheskogo ozhoga.

AIM: To analyze patients with chemical burn of esophagus followed by cancer. MATERIAL AND METHODS: Since 2010 till 2017 esophageal cancer has been diagnosed in 4 patients with esophageal cicatrical stenosis after previous chemical burn. Cervical segment of the esophagus was involved in 1 case. RESULTS: Resectable tumor was observed only in 1 patient. In 3 cases stenting was performed (palliative intervention in 2 patients and as preoperative stage in 1 case). Stomach probe for feeding was deployed in 1 observation. CONCLUSION: Patients after previous chemical burn of the esophagus and esophagoplasty should be under follow-up for timely diagnosis and treatment of esophageal malignancies.

TRA.NSTHORACIC PUNCTURE BIOPSY IN DIAGNOSTICS OF FOCAL LESIONS OF THE LUNG.

The transthoracic puncture biopsy was performed under surveillance of X-ray computed tomography in order to verify diagnoses in 80 patients with lung tumors. This procedure allowed verification of diagnosis and choice of treatment strategy in 95% of cases. The complications obtained as result of intervention didn't bring severe character and were arrested in term of two days.

MEDIASTINOSCOPY IN SURGERY OF BENIGN DISEASES OF ESOPHAGUS AND CARDIAC ORIFICE.

An article presents the results of application of mediatinoscopy in extirpation of the esophagus and cardiac orifice. The comparative assessment was made in group of patients who underwent the standard surgery. An application of mediastinoscopy for excretion and extirpation of the esophagus allowed doctors to cut down the duration of intervention on 40,15%. The volume of intraoperative loss of blood was reduced on 45,52% and the rate of intraoperative complications decreased on more than 45% compared with standard surgery. There was noted the reduction of the rate of postoperative complications more than 30% and the course of postoperative period was smooth. These factors shortened hospital stay and time the patients should be in resuscitation department.

COMPARATIVE ASSESSMENT OF THORACOSCOPY AND DESTRUCTION OF PULMONARY BULLAS COMBINED WITH PLEURODESIS AND PLEURECTOMY.

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren't statistically differentiated in patient's groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient's group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis.

DIAGNOSTICS AND TREATMENT OF PATIENTS WITH TOOL ESOPHAGEAL PERFORATION.

The article presents an experience of diagnostics and treatment in 21 patients with esophageal perforation at the period from 1995 to 2015. The perforation was often (13 patients) the complication of interventional surgery which was directed to reconstruction of esophagus passing (scarry stricture of the esophagus, esophageal cancer, achalasia of esophagus). There was noted an esophageal rupture of lower third part of esophagus in 14 cases. These complications were diagnosed in all cases and the patients underwent an operation. There was performed the opening and drainage of the mediastinum in order to prevent mediastinitis. Complications had one patient in postoperative period. There wasn't observed lethal outcome.

LEVEL OF THE GUALITY OF LIFE OF THE PATIENTS AFTER ESOPHAGOPLASTY ON THE BASIS OF GASTROINTESTINAL INDEX ASSESSMENT.

The article presents the interview results of 55 patients after esophagoplasty (30 cases - after esophagogastroplasty, 25 cases - after esophagoplasty) using questionnaire GIQLI. The authors came to conclusions about advantages of extirpation of esophagus with esopagogastroplasty compared with subtotal shunt esophagocoloplasty because of high rate of gastrointestinal index of the quality of life and their components in patients after esophagogastroplasty compared with results of patients after esophagoplasty. There was noted an expessed growth in the scales and rise of gastrointestinal index in patients who underwent esophagogastroplasty after 3 years of follow-up.

[Robot-assisted cystprostatectomy for urinary bladder cancer (the first experience)].

The article reports a case of a robot-assisted cystprostatectomy in a 36 y.o. patient with a malignant bladder neoplasm (highly differentiated infiltrative urothelial bladder cancer, Gr 2, invading the bladder wall mucosa, the multicentric growth type, with the focal tumor growth in the urethral mucosa and prostate). The ileal neobladder was constructed using intracorporeal access. Operating time was 6 hours, intraoperative blood loss was 150 ml. There was no intra - or postoperative complications. Voiding function was restored at day 10 postoperatively.