[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.

[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.

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.

Cell reactions in gastric tube and colon transplants in stenoses of esophageal anastomosis.

We studied morphological and cell characteristics of stenosis of esophagogastric and esophagocolonic anastomosis. It was demonstrated that sclerogenesis in the gastric transplants is associated with hypertrophy of leiomyocytes, hyperelastosis foci, degenerative and atrophic modifications of the glands, and foveolar cell hypersecretion. In colonic transplant, collagen synthesis predominates in the esophageal anastomosis and can be associated with proliferation of blood capillaries; hyperplastic reactions of leiomyocytes and elastic fibers are minor, colonocytes exhibit high secretory activity. Differences in the cell reactions of the transplants reflect complex character of the formation of esophageal anastomosis stenosis.

Effect of esophagoplasty on structural reorganization of colon transplant.

We studied ultrastructural reorganization of the colon transplant in delayed period after esophagoplasty. It was found that during functioning of the artificial esophagus, a complex of adaptive and pathologic processes occurs in the mucosa. Focal sclerosis of the mucosa and slight epithelial degeneration with hyperplasia and hypersecretion of goblet cells were found in biopsy specimens with stenosis of the anastomosis. In case of colonopathy of the transplant, more pronounced epithelial degeneration and proliferation accompanied by abundant polymorphocellular stromal infiltration were seen. Deformation of the transplant was characterized by progressive atrophic and sclerotic reorganization of the mucosa. Goblet cells with ultrastructural signs of hypersecretion predominated in the population of epithelial cells of the colon transplant; oligomucus and poorly differentiated cell and colonocytes with signs of alteration and degenerative changes in cytoplasmic organelles were also found.

Cell reorganization in gastric transplant during esophagoplasty.

We studied peculiarities of cell reorganization of the gastric transplant during the delayed period after esophagoplasty for benign pathologies of the esophagus. Polymorphism of adaptive and pathological structural rearrangements in the mucosa of the gastric tube was observed. Degenerative and atrophic changes in epithelial structures, hypertrophy of smooth muscular components, and sclerotic reorganization of the stroma were predominating morphological phenomena. Heterogeneity of ultrastructural modifications of the epithelium reflected high secretory activity of foveal mucocytes in combination with degenerative changes in cytoplasmic organelles and impaired secretory function of fundic gland cells. Hypertrophied cells with minor ultrastructural changes, leiomyocytes with signs of biosynthesis, and degenerated smooth muscle fibers were revealed in the population of smooth muscle cells.

Ultrastructural study of cell populations in the gastric transplant after esophagoplasty.

Ultrastructural characteristics of cell populations in the gastric tube mucosa were studied after plastic surgery for benign esophageal disease. The foveolar epithelium mainly consisted of secretory active mucocytes with small changes in cytoplasmic organelles. Functionally immature parietal cells and gland cells in the epithelium of fundal glands were characterized by atrophy and degeneration. Ultrastructural features of the epithelial compartment attest to adaptive cellular hypersecretion of the mucoid against the background of impaired acid production and enzyme secretion. The stromal compartment was characterized by low pinocytotic activity of endothelial cells in blood vessels and polymorphism of smooth muscle cells. Hypertrophic leiomyocytes were shown to dominate in the population of these cells. Some cells had signs of biosynthesis and reduction of filaments. Single leiomyocytes were degenerated. The observed ultrastructural modification of epithelial and connective cells can be interpreted as structural adaptation of the gastric transplant.

Effect of esophagoplasty on the mucosa structure in the gastric transplant.

Structural modifications of the gastric tube transplant were studied during the delayed period after esophagoplasty carried out for benign diseases of the esophagus. Adaptive and pathological reactions manifesting in atrophic and sclerotic changes in the mucosa formed the basis for transplant reorganization. The leading morphological markers were degeneration and hypersecretion of the foveolar epithelium, focal atrophy of the fundal glands with foci of pyloric metaplasia, hypertrophy and fibrosis of the muscle plate, and stromal sclerosis. Abundant polymorphonuclear infiltration of the mucosa with lymphoid follicular hyperplasia were observed in H. pylori contamination of the gastric transplant.

Structural modifications of colonic transplant in plastic repair of the esophagus.

Structural changes in the colonic transplant were studied after esophagoplasty, carried out for post-burn cicatricial strictures of the esophagus. It was shown that artificial esophagus was liable to hypotony and deformation in delayed periods after reconstructive interventions. Regeneratory and adaptive reactions in the mucosa underlie its restructuring, while under pathological conditions proliferative catarrhal changes predominated in the artificial esophagus. The leading pathomorphological characteristics of the colonic transplant are epithelial degeneration, active, sometimes unbalanced proliferation, hyperplasia and hypersecretion of goblet cells, lymphoplasmacytic infiltration of the stroma paralleled by slight sclerosis. Modifications of the ultrastructural organization of cell populations in the Lieberkuhn crypts are determined by the intensity of pathological processes and are aimed at realization of the cytoprotective potential of the transplant mucosa.