[Surgical management of tracheal anastomosis failure and risk of arterial bleeding]. / O khirurgicheskoi taktike pri nesostoyatel'nosti trakheal'nogo anastomoza i ugroze arrozionnogo krovotecheniya.

OBJECTIVE: To determine the optimal algorithm for tracheal anastomotic insufficiency and prevention of arterial bleeding. MATERIAL AND METHODS: We present 2 patients with defects of tracheal anastomosis after tracheal resection and divergence of tracheal edges. We primarily analyzed appropriate emergency care and prevention of subsequent severe complications such as arterial bleeding and respiratory insufficiency. CONCLUSION: Tracheostomy may be preferable for complete late tracheal anastomotic insufficiency to restore breathing. However, surgery should be accompanied by prevention of arterial bleeding. Isolation of damaged area, particularly tracheostomy tube, from the mediastinum by well-vascularized tissues can prevent bleeding from major vessels (for example, innominate artery). Follow-up is unreasonable due to worsening of clinical situation, risk of hemorrhagic complications and fatal outcomes. General satisfactory clinical status of the patient is not of matter. Repeated tracheal anastomosis is justified only for early insufficiency, i.e. within 2-3 days when postoperative inflammation is mild.

[Argon-laser ablation is a new method of airways recanalization for tumoral stenosis]. / Novyi metod rekanalizatsii dykhatel'nykh putei pri opukholevykh stenozakh: argonolazernaya ablyatsiya.

AIM: To develop the new method of laser recanalization of airways for tumoral stenosis. MATERIAL AND METHODS: It is proposed to conduct laser effect in the gas environment that does not support combustion (argon). Also the device for these AIM: is suggested. The method is called argon-laser ablation (ALA). A comparison of ALA and conventional high-energy laser exposure (LPD) was performed. RESULTS: ALA and LPD were used in 46 patients and 17 patients with non-small cell lung cancer. The duration of endobronchial operations and incidence of complications were significantly higher in group 2. The incidence of complete remission was significantly higher in group 1. CONCLUSION: Endobronchial argon-laser ablation of tracheal and bronchial tumors removes exophytic tumoral component in more favorable conditions compared with conventional high-energy laser exposure. Also it significantly increases an efficiency and reduces the frequency of complications.

[Criteria of functional operability and indications for intraoperative volumetric monitoring of patients during extensive surgical procedures on the lung]. / Kriterii funktsional'noi operabel'nosti i pokazaniia k intraoperatsionnomu voliumetricheskomu monitoringu u bol'nykh pri obshirnykh operativnykh vmeshatel'stvakh na legkikh.

The investigation included 32 patients after extensive operative interventions on the lungs: pneumonectomy with circular resection of the trachea bifurcation and different kinds of combined pneumonectomies. Methods of Doppler echocardiography and thermal dilution were used for studying the parameters of lesser circulation before, during and after operation. Patients with the initially impaired hemodynamics had more pronounced functional changes after surgical procedures. The shift limits of the main ultrasonic indices of the right ventricle function were determined in order to form a group of the higher prognostic risk.

[Transcranial electric stimulation in anesthesiological support in emergency operations in patients with hypovolemia]. / Primenenie transkranial'noi élektrostimuliatsii pri anesteziologicheskom obespechenii ékstrennykh khirurgicheskikh operatsii u bol'nykh s gipovolemiei.

Hemodynamics was studied in 60 patients with pronounced initial hypovolemia, urgently operated on for acute gastrointestinal disease under conditions of 4 anesthesia. In contrast to traditional anesthesia, transcranial electric stimulation (TCES) as a component of anesthesia stabilized hemodynamics without increasing the rate and volume of intraoperative infusion therapy. This makes total anesthesia with TCES preferable in urgent operations, particularly in cases when hypovolemia cannot be properly corrected before surgery.

[Mycotic aneurysms of the thoraco-abdominal part of the aorta]. / Mikoticheskie anevrizmy torakoabdominal'nogo otdela aorty.

Mycotoc aneurysms (MA)--a rare and extremely dangerous lesion of the aorta. CT, MRA and aortography were used to diagnose MA of the thoracoabdominal areas in 2 men of 64 and 67 years of age. The clinical picture included: fever with shivering with the temperature 38-39 degrees C and increasing pains in the inferiothoracic and lumbar areas of the spine. Hemoculture was positive in 1 patient only. The patients were operated on. Shunting of the aorta from the inferiothoracic to infrarenal segments was performed in one patient with the exclusion of the involved portion and resection of MA. Metalloosteosynthesis of the spine due to destruction of LI-LII and compression of the spine were performed in the second patient followed by analogous shunting of the aorta and visceral arteries with the resection of the aneurysm. To prevent infection of the prostheses the shunts were wrapped up with a piece of the greater omentum. One patient died two months later from recurrent sepsis. The other one is alive, within 28 months the shunts are patent, there are no signs of a reinfection.

[Use of gelofusin in the clinics of the St. Petersburg's I.P. Pavlov State Medical University]. / Primenenie preparata "Gelofuzin" v klinikakh Sankt-Peterburgskogo gosudarstvennogo meditsinskogo universiteta im. akad. I.P. Pavlova.

The authors analyze the results of using blood substitute made on the basis of gelatin and give a comparative characteristic of different colloid blood substitutes on the basis of dextran, gelatin, starch and polyethylene glycol. Advantages of Gelafusin are shown.

[High-frequency pulmonary ventilation in general surgical and intrathoracic surgical interventions]. / Vysokochastotnaia ventiliatsiia legkikh pri obshchekhirurgicheskikh i vnutrigrudnykh operativnykh vmeshatel'stvakh.

Various types of high-frequency and conventional controlled lung ventilation, as part of anesthesiological management during surgery have been comparatively assessed. The study was conducted on 239 patients. The study of gas exchange, mechanical properties and pulmonary hemodynamics revealed no data indicating the clinically significant advantages of high frequency ventilation regimens. When high-frequency ventilation was used there was a close relationship between bronchial patency and ventilation efficacy. The authors come to a conclusion that high-frequency ventilation regimens cannot be considered nowadays as an alternative to conventional controlled lung ventilation.

[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]. / Postpnevmonéktomicheskii sindrom: nekotorye novye anesteziologicheskie i patofiziologicheskie aspekty problemy.

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.