[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.

[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.

Morphofunctional analysis of experimental model of esophageal achalasia in rats.

We carried out a detailed analysis of rat model of esophageal achalasia previously developed by us. Manifest morphological and functional disorders were observed in experimental achalasia: hyperplasia of the squamous epithelium, reduced number of nerve fibers, excessive growth of fibrous connective tissue in the esophageal wall, high contractile activity of the lower esophageal sphincter, and reduced motility of the longitudinal muscle layer. Changes in rat esophagus observed in experimental achalasia largely correlate with those in esophageal achalasia in humans. Hence, our experimental model can be used for the development of new methods of disease treatment.

[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.