[Thoracic endometriosis and catamenial pneumothorax].

It was analyzed own experience of diagnosis and treatment of catamenial (menstrual) pneumothorax and thoracic endometriosis and literature review. It is shown that catamenial pneumothorax has specific clinical and instrumental signs allowing to establish the diagnosis before surgery. It was proposed surgical treatment including the removal of trans diaphragmatic way of pneumothorax development, removal of thoracic endometriosis and the establishment of reliable pleurodesis. It was demonstrated that this volume of surgery can be successfully implemented by using of thoracoscopic access. Relapse prevention includes hormonal therapy for the 6 months after surgery under the supervision of an obstetrician-gynecologist.

[Diagnosis and treatment of associated injuries of the pelvis].

The aim of investigation is improvement of treatment results of unstable injuries in the pelvic ring in patients with severe associated injuries. An experience of treatment of 533 patients with unstable pelvic injuries is presented. Diagnostic measures take into account the severity of the condition of the victim. Stage treatment with consecutive performing of temporary external immobilization of the pelvis and following final osteosynthesis was optimal. Replacement of external fixation for submersible osteosynthesis held in stable or terminal condition of the victim. Developed treatment of patients with pelvic injuries decreased mortality to 8.4%, number of general complications to 11.6% and number of local complications to 8.7%. Also it decreased length of hospital stay to 35.5 days and provided excellent and good functional results of treatment in 78.9% of cases.

[20 years emergency surgery of abdominal organs in Moscow].

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

[Esophageal stenting complications].

The aim of the study was to analyze esophageal stenting complications in case of cancer and benign diseases. It was investigated complications in 8 patients in terms from 7 days to 1 year after intervention. In 4 patients esophageal stenting was performed for constrictive esophageal cancer and compression with pulmonary cancer metastases into mediastinal lymphatic nodes. 2 patients had esophageal stenting for post-tracheostomy tracheo-esophageal fistula, 1 patient - for spontaneous esophageal rupture, 1 patient - for post-burn scar narrowing of esophagus and output part of the stomach. Severe patients' condition with tumor was determined by intensive esophageal bleeding in 2 cases, bilateral abscessed aspiration pneumonia, tumor bleeding, blood aspiration (1 case), posterior mediastinitis (1 case). Severe patients' condition with benign disease was associated with decompensated esophageal narrowing about proximal part of stent (1 case), increase of tracheo-esophageal fistula size complicated by aspiration pneumonia (1 case), stent migration into stomach with recurrence of esophago-mediastino-pleural fistula and pleural empyema (1 case), decompensated narrowing of esophagus and output part of the stomach (1 case). Patients with cancer died. And patients with benign diseases underwent multi-stage surgical treatment and recovered. Stenting is palliative method for patients with esophageal cancer. Patients after stenting should be under outpatient observation for early diagnosis of possible complications. Esophageal stenting in patients with benign diseases should be performed only by life-saving indications, in case of inability of other treatment and for the minimum necessary period.

[Diagnostics and treatment of traumatic retroperitoneal bleedings].

Treatment results of 403 patients with the closed abdominal trauma, complicated by the retroperitoneal bleeding, was performed. Two types of echographic and CT picture of the retroperitoneal bleeding were distinguished - with clot formation and of impregnation type. The diagnostic and treatment algorithm was suggested. The use of the least allowed the location of the bleeding source in 40% of the operated patients and in 100% of those, who were treated conservatively. The indications to the retroperitoneal surgical revision were set basing on the information about the bleeding source or the localization and spreading of the hematoma. The use of the algorithm was successful in 98.9-100% of cases.

[Diagnostics and treatment of renal injury after closed abdominal trauma].

The 10-year experience of treatment of closed isolated and combined abdominal trauma and renal injury included data of 117 cases. The diagnose was made basing on the clinical analysis, ultrasound investigation and computed tomography. 61 patients were operated on, though only 6 of them on the reason of the renal injury. The rest 55 were operated on the reason of accompanying spleen injury, urinary bladder of diaphragm rupture. 56 patients with renal injury were treated conservatively, of them 55 - successfully. The study showed, that the computed tomography provided the complete information about the severity of the renal trauma and bleeding, defining the indication to surgery. Authors worked out the indications for the visual intraoperative kidney revision, if the severity of the injury had been not assessed before. Nevertheless, the conservative therapy proved to be effective in 98.2% of patients with kidney trauma stage I-IV.

[The changes of intraabdominal pressure in patients with retroperitoneal bleeding].

The linear dependence of the intraabdominal pressure and the volume of retroperitoneal bleeding was revealed in 34 patients with the aortic aneurism rupture. In patients with the blunt abdominal trauma, treated conservatively and laparotomized (each group consisted of 26 patients), the intraabdominal pressure is higher in the operated group during the first day after the operation. The main factors of the intraabdominal hypertension seem to be shock and massive infusion and transfusion therapy.

[Computed tomography in diagnostics and treatment of traumatic retroperitoneal hemorrhage].

Causes of retroperitoneal bleeding (RB) were specified basing on retrospective analysis of 60 observations of closed abdominal injury. Two types of RB, with formation of blood packets and "impregnation", were marked out each having their computer tomography singes, changing during treatment. Contrast-enhanced computer tomography enabled to detect persisting bleeding from kidney or spleen, set indications for urgent laparotomy and reveal traumatic renal artery thrombosis even in the absence of hemoperitoneum.

[Complications of the traumatic retroperitoneal bleedings].

To analyze treatment results of patients with retroperitoneal bleedings (RP), they were divided in 3 groups. The first group (n=75) consisted of patients with extensive RP, the second group (n=284) was formed by patients with localized RP. The control group consisted of 77 patients with blunt abdominal trauma without signs of RP. The most frequent RP localization was as follows: lateral right, extended, lateral left, pelvic, combined, inferomedial and anteromedial. Mild trauma of kidney and pelvic bones' fracture were the major causes of localized RP. Severe renal trauma and pelvic fractures led to extensive RP. Significant risk factors of complicated course of the disease were identified. These were pneumonia, septic tracheobronchitis, acute respiratory and renal insufficiency.

[Intraabdominal pressure alterations in ruptured abdominal aortic aneurysms].

The authors investigated the dependence of intraabdominal pressure on the volume of a retroperitoneal haematoma. The study included a total of thirty-four patients in whom elevation of intraabdominal pressure had solely been caused by haemorrhage into the retroperitoneal space. The volume of the retroperitoneal haematoma was calculated based on the findings of spiral computed tomography, whereas intraabdominal pressure was measured using the methods suggested by Sugrue M. and Kron I. L. The statistical analysis showed a moderate positive correlation between the retroperitoneal haematoma volume and the level of intraabdominal pressure. With the volume of the retroperitoneal haematoma approximating to 2,000 ml, intraperitoneal pressure was at the upper limit of the norm. Of the patients examined, none turned out to have developed the high intraperitoneal pressure syndrome.

[Adrenal injury in blunt abdominal trauma].

10 patients with adrenal damage were observed during 2.5 years. It amounted 0.93% of all patients with closed abdominal injuries. The right adrenal gland was traumatized in all cases evidently due to it's compression between right lobe of liver and vertebral column. Adrenal damage is observed quite often in combination with injuries of right liver lobe, right kidney and retroperitoneal hematoma formation. 5 patients underwent laparotomy on account of intra-abdominal bleeding, but adrenal damage was never revealed. Ultrasound and tomographic semiotics of adrenal damage was worked out, which allowed ascertaining diagnosis in 80% on application of ultrasound study and in 100% at computer tomography. Injury of one adrenal gland was not accompanied by adrenal failure and did not require hormonal replacement therapy.

[Diagnostics and treatment of abdominal injuries with retroperitoneal organs involvement].

The results of treatment of 66 patients with non-gunshot abdominal injuries, involving retroperitoneal organs, are described. Preoperative clinical and ultrasound investigations are not accurate enough to diagnose retroperitoneal lesions, which were diagnosed intraoperatively in 57,6% of patients. In 97% retroperitoneal haematoma was located 2-10 sm from the posterior parietal peritoneum. In case of aorta injury, postcava or renal injury grade IV, retroperitoneal haematoma is large and bulging, though absence of these signgns does not exclude serious injuries of retroperitoneal organs and structures. Retroperitoneal cavity revision by the dissection of the wound canal can provoke further bleeding, so it should be performed only after visualization and cross-clamping the afferent vessel.

[Diagnosis and treatment of simultaneous injuries of the thorax and abdomen]. / Diagnostika i lechenie odnovremennykh ranenii grudi i zhivota.

Results of examinations and treatment of 167 patients with simultaneous injuries of the thorax and abdomen are presented. It is demonstrated that x-ray and ultrasonic examinations help make choice on right surgical policy. All the patients were divided into two groups. Study group (137 patients) was treated according to proposed curative algorithm. The rest 30 patients were included into control group. Volume of intra-surgical hemorrhage and time of surgery were greater in the control group compared with the study group. Proposed algorithm permitted to reduce number of postoperative complications from 46.7 to 21.2%, and lethality -- from 13.3 to 4.1%.