[Re-operations in thoracic surgery]. / Povtornye operatsii v khirurgii grudi.

AIM: To optimize the outcomes of reoperations for postoperative complications in patients with thoracic diseases and injuries. MATERIAL AND METHODS: The study enrolled 1258 patients with different thoracic diseases and injuries. Postoperatively 58 (4.6%) patients underwent re-thoracotomy and 15 (1.1%) patients - video-assisted interventions for any complications. Indications for re-operations were intrapleural bleeding, bronchial stump failure, esophagogastrostomy insufficiency, prolonged air leak through the drains due to unsealed lung parenchyma, clotted hemothorax. Postoperative complications were observed in 16 patients after re-thoracotomy (including 14 deaths), while only 1 patient died after VATS surgery. CONCLUSION: Early diagnosis and rational surgical approach are key for successful surgical treatment of early postoperative complications in thoracic surgery.

[Video-assisted surgery in the diagnosis and treatment of thoracic and abdominal injuries]. / Endovideokhirurgiya pri povrezhdeniyakh grudi i zhivota.

AIM: to prove the efficacy and safety of video-assisted techniques in diagnosis and treatment of victims with thoracic and abdominal trauma. MATERIAL AND METHODS: It was analyzed treatment of 249 patients with thoracic (n=82), abdominal (n=122) and thoracoabdominal injuries (n=35) who were divided into 2 groups depending on treatment. Control group of conventional diagnosis and treatment included 130 (52%) patients. Group 2 consisted of 119 (48%) patients in whom differentiated surgical approach combined with current technologies was applied. RESULTS: Video-assisted techniques did not reveal thoracic (n=9) and abdominal (n=7) injuries in 16 out of 103 cases. There was conversion to open surgery in 20 patients. In group 2 conventional thoracic (n=15) and abdominal (n=22) interventions were made in 37 (36%) cases while endoscopic surgery was used in other 66 (64%) patients. Postoperative complications after endoscopy were observed in 8 patients. There were 2 deaths. CONCLUSION: Rational and effective use of video-assisted surgery for thoracic and abdominal trauma significantly improves outcomes in these severe patients.

[CONTEMPORARY EPIZOOTOLOGICAL AND EPIDEMIOLOGICAL FEATURES OF BRUCELLOSIS IN THE REPUBLIC OF TAJIKISTAN].

AIM: Study epizootological and epidemiological features of brucellosis on the territory of the Republic of Tajikistan under the conditions of social-economic transformation with evaluation of width and scale of its spread, as well as reasons of the present situation. MATERIALS AND METHODS: Official statistics data, results of expert evaluations, reports, analytical material of national and international organizations, results of clinical and epidemiological analysis were used. Descriptive- evaluative epidemiologic methods, serologic studies of samples obtained from humans, animals, environmental objects between 2000 and 2013; mapping using GIS-technology, as well as statisti- cal analysis were used. Techniques of calculation of DALY-index and population infection risk parameter were used. RESULTS: Features of situation by brucellosis were detected, that lay in its wide spread among humans and agricultural animals, changes in morbidity structure, as well as char- acter of its seasonal and territorial spread, connected with predominant effect of social risk factors. CONCLUSION: Contemporary situation for brucellosis in the Republic of Tajikistan is characterized by a pronounced non-welfare and determined by acting social-economic conditions. The main factors are changes in the conditions of conducting agricultural activity against the background of high level of unemployment and external work migration.

[Modern aspects of the diagnosis and surgical treatment of perforations of chronic gastroduodenal ulcers].

Results of the complex diagnosis and surgical treatment of 180 patients with perforation of gastroduodenal ulcers were analyzed. It was shown that in pathogenesis of perforations of chronic gastroduodenal ulcers the leading place belonged to oxidizing stress. A pathogenetically grounded method of treatment of perforations of chronic gastroduodenal ulcers is an excision of the perforated ulcers in combination with vagotomy, but the method of treatment of perforations of "silent" ulcers is videolaparoscopic suture with endoscopic transgastgric chemical vagotomy.

Brucellosis control in Tajikistan using Rev 1 vaccine: change in seroprevalence in small ruminants from 2004 to 2009.

Cross-sectional serological surveys of 13,006 small ruminants were conducted in 2003 to establish baseline levels of seropositivity to brucellosis and of 12,102 again in 2009 to evaluate the efficacy of controls based on biannual conjunctival vaccination with Rev 1. Seroprevalence dropped by 80 per cent in five years in eight pilot programme districts where vaccination was generally well implemented, and the prevalence of households with evidence of infection in their animals dropped from 25.1 to 7.5 per cent. Seroprevalence was reduced by 40 per cent in 10 districts where vaccination was intermittent with low coverage during some seasons. There were no changes in 19 districts where no vaccinations were carried out. Sheep vaccinated one or more times were found to be 2.5 times more likely to be serotest positive than were non-vaccinated sheep, whereas vaccinated goats were 6.4 times more likely to be serotest positive than non-vaccinated goats.

[Prophylaxis of sutures insufficiency of the large bowel anastomoses].

The results of surgical treatment of 202 patients, for the large bowel surgical diseases, were analyzed. Basing on the analysis of the sutures insufficiency causes in the large bowel anastomoses, which have had occurred in 95 patients of control group, there were elaborated a new methods of the large bowel anastomoses formation and prophylaxis of their sutures insufficiency development in 107 patients (main group), permitting to lower the sutures insufficiency causes in the large bowel anastomoses from 13.2 to 5.6%.

[Surgical strategy for external biliary fistulas].

The authors have analyzed results of the diagnostics and treatment of 68 patients with external biliary fistulas developed after operative procedures on the liver, bile ducts and duodenum. The character of operative interventions was established to depend, first of all, on the causes of the development of biliary fistula. After different surgical procedures in the postoperative period there were 16.2% of complications with 4.4% of lethal outcomes.

[Diagnosis and treatment tactics of Caroli disease].

The results of surgical treatment of 7 patients, in whom disease of Karoly type I was diagnosed, were analyzed. Ultrasonographic examination, computeric tomography (CT) and retrograde pancreatocholangiography constitute highly informative diagnostic procedures in this disease. The choose of sugical treatment method of the patients depends on volumic cystic affection of intrahepatic biliary ducts and presence of strictured portions in them.

[Diagnosis and treatment of the bile diverting anastomosis sutures insufficiency].

The results of complex diagnosis and treatment of 64 patients, in whom bilediverting anastomoses sutures insufficiency (BDASI) had occurred, were analyzed. It was established, that dynamical ultrasonographic investigation and laparoscopy constitute the principal methods of BDASI early diagnosis. In 25 patients conservative methods of treatment were used effectively, in 34--relaparotomy was performed and in 5--videolaparoscopic interventions. Eighteen patients died.

[The programmed laparoscopic sanations for the treatment of diffuse postoperative biliary peritonitis].

Treatment results of 81 patients with the diffuse postoperative biliary peritonitis are analyzed. 34 patients were treated with the use of videolaparoscopic sanations and the rest 47 underwent traditional relaparotomy. Laparoscopic method proved to be more effective and applicable.

[Videolaparoscopic operations in diagnosis and treatment of intraperitoneal complications after operations on the liver and bile tracts].

The results of videolaparoscopic operations on 62 patients with intraperitoneal complications after operations on the liver and bile tracts were analyzed. Intraperitoneal complications were avoided in 9 cases (14.5%), postoperative bile peritonitis was diagnosed in 38 patients (61.3%), intraperitoneal bleeding was noted in 10 (16.1%) patients, and early adhesive intestinal obstruction in 10 (26.3%) patients. In 51.6% of cases the diagnostic videolaparoscopy was transformed in a curative method. Postoperative lethality was 16.1%. Mean time of stay in hospital was 2 times less and made 7.4 days.

[Early postoperative complications in echinococcosis of the liver].

Results of surgical treatment of 420 patients with echinococcosis of the liver were analyzed. Different early postoperative complications were found in 78 (18.6%) patients. It was established that their development was caused mainly by considerable pathomorphological alterations in the liver parenchyma followed by latent hepatic insufficiency as well as strategic and technical medical errors made in the preoperative period or during operations. Postoperative lethality was 13.3%.

[Postoperative oesophagogastric bleeding].

The results of complex diagnostics and treatment of 124 pflients with postoperative gastrointestinal bleedings are analysed. The results of clinic-instrumental investigations have shown that after the operations on organs of hepatopankreatobiliar zone conditioned by transitory portal hipertensy. The most efficient methods of the preventive maintenance and treatments of this complication are designed and methods, which promote the reduction an portal pressure.

[Postoperative biliary peritonitis].

An analysis of results of surgical treatment of 91 patients with postoperative biliary peritonitis has shown that frequency of postoperative biliary peritonitis depended on the volume and character of operative interventions, as well as on technical errors made at the preoperative period and during operation. The presence of latent hepatic insufficiency made for the development of polyorganic insufficiency, had negative influence on the course of the disease and might be one of the causes of high postoperative lethality (up to 23.1%) in this category of patients.

[The role of silent hepatic insufficiency in pathogenesis of postoperative biliary peritonitis].

The results of clinico-morphologic and biochemical investigations of the liver were conducted in 58 patients, in whom postoperative biliary peritonitis (PBP) was revealed. There was established, that in the basement of hepatic insufficiency formation in PBP lie the hepatocytes damage and severe portal toxaemia, caused by damaging effect of the middle mass peptides and the lipids peroxidal oxidation products.

[Diagnosis and treatment tactics of postoperative bile peritonitis].

Complex method of diagnosis and surgical treatment of 131 patients with postoperative bile peritonitis are analyzed. The main causes of peritonitis were technical and tactical medical errors and low functional reserve of liver. Laparoscopic, ultrasonic examinations and detection of endogenous intoxication degree are used for early diagnosis of this complication. Urgent relaparotomy with liquidation of peritonitis source, external drainage of bile ducts and small intestine, sanation and drainage of abdominal cavity is the main method of postoperative peritonitis treatment.

[Surgical treatment of patients with complicated forms of cholelithiasis].

An analysis of surgical treatment of 124 patients with "difficult" gallbladder has shown that in most cases (59.7%) the causes impeding surgical procedures were massive commissural processes in the gallbladder zone and stony infiltrates of the hepato-duodenal ligament with shrunken or sclerosed gallbladder as well as earlier operations on the gallbladder, a combination of echinococcosis and liver cirrhosis with acute calculous cholecystitis, cholecystodigestive fistulas, Mirizzi syndrome and intrahepatic location of the gallbladder. Videolaparoscopic operations in such cases are extremely difficult, so open laparotomic operations should be preferred.