[Diagnostic and treatment of foreign bodies of the upper digestive tract]. / Inorodnye tela verkhnikh otdelov zheludochno-kishechnogo trakta.

OBJECTIVE: To evaluate the results of diagnosis and treatment of foreign bodies of the upper gastrointestinal tract. MATERIAL AND METHODS: There were 1187 patients aged 15-99 years with suspected foreign body of the upper gastrointestinal tract. In 536 patients (266 men, 270 women), foreign bodies were detected. Ingestion of a foreign body was more common in patients aged 46-65 years. In 516 patients, foreign bodies were detected in the esophagus (pharyngo-esophageal junction - 25, upper third of the esophagus - 426, middle third of the esophagus - 34, lower third of the esophagus - 21, esophageal-gastric junction - 10). Four patients admitted with esophageal wall perforation. In 3 cases, foreign bodies were localized in the throat, 15 patients - in the stomach, 2 patients - in the duodenum. RESULTS: In most cases, foreign bodies were organic (n=506). Removal was successful in 530 cases. In 4 patients with esophageal wall perforation and mediastinitis, removal was performed intraoperatively. Flexible endoscope was used in 500 cases. In 86 patients, foreign bode was displaced in the stomach using flexible endoscopy. Foreign body removing wasn't successful in 4 cases. In 2 patients, extraction was followed by esophageal wall damage. In 4 patients, esophagotomy was applied to extract foreign body. Suturing the esophageal wall defect was carried out in 2 cases. Abrasion and erosive esophagitis were the most common injuries of esophageal mucosa. Esophageal diseases were detected in 75 cases after foreign body removal (67 cases - benign esophageal diseases). One patient died from bedsore of innominate artery complicated by acute hemorrhage. CONCLUSION: Foreign bodies of the upper gastrointestinal tract are observed in 45% of patients at admission. Neck and chest X-ray examination is obligatory before endoscopy. Flexible endoscopy is a gold standard for diagnosis and extraction of foreign bodies. Repeated endoscopy after foreign body extraction should be mandatory. It is necessary to visualize complications associated with foreign body and identify esophageal diseases.

[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.

[Treatment of patient with echinococcosis of lungs and mediastinum]. / Lechenie patsienta s ékhinokokkozom legkikh i sredosteniia.

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.

[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.

Ultrastructure of Cardiomyocytes and Blood Capillary Endotheliocytes in the Myocardium under Conditions of Experimental Mechanical Injury to the Heart.

We studied ultrastructural changes in cardiomyocytes and blood capillary endotheliocytes in the ventricular myocardium in response to mechanical injury of the heart of varying severity in Wistar rats. Acute alterative changes in cardiomyocyte and endotheliocyte ultrastructure indicate impairment of the energy-producing, contractile, and protein-synthesizing functions of the cells after mechanical injury. These disorders play the key role in the development of acute contractile insufficiency of the myocardium in mechanical injury to the heart.

Morphological Characteristics of the Cartilaginous Tissue of Human Auricle in Different Age Periods.

A complex morphological study of the auricle to determine the human age was performed by evaluating the metric sizes between fixed points in each auricle with axial guidelines. The auricular elastic cartilage in different age periods was characterized by thickening of the cartilaginous plate, different mature and immature cartilage zone ratio, variations in the volume density of the intercellular substance and elastic fibers, and change in the numerical density of individual chondrocytes and isogroups. Aggrecan content in the cartilage was shown to increase in different age periods. Age-related structural changes in the auricular cartilage expand the possibilities of forensic medical examination and hold much promise for the identification of personality.

TRA.NSTHORACIC PUNCTURE BIOPSY IN DIAGNOSTICS OF FOCAL LESIONS OF THE LUNG.

The transthoracic puncture biopsy was performed under surveillance of X-ray computed tomography in order to verify diagnoses in 80 patients with lung tumors. This procedure allowed verification of diagnosis and choice of treatment strategy in 95% of cases. The complications obtained as result of intervention didn't bring severe character and were arrested in term of two days.

MEDIASTINOSCOPY IN SURGERY OF BENIGN DISEASES OF ESOPHAGUS AND CARDIAC ORIFICE.

An article presents the results of application of mediatinoscopy in extirpation of the esophagus and cardiac orifice. The comparative assessment was made in group of patients who underwent the standard surgery. An application of mediastinoscopy for excretion and extirpation of the esophagus allowed doctors to cut down the duration of intervention on 40,15%. The volume of intraoperative loss of blood was reduced on 45,52% and the rate of intraoperative complications decreased on more than 45% compared with standard surgery. There was noted the reduction of the rate of postoperative complications more than 30% and the course of postoperative period was smooth. These factors shortened hospital stay and time the patients should be in resuscitation department.

COMPARATIVE ASSESSMENT OF THORACOSCOPY AND DESTRUCTION OF PULMONARY BULLAS COMBINED WITH PLEURODESIS AND PLEURECTOMY.

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren't statistically differentiated in patient's groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient's group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis.

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.

[DIAGNOSTICS AND TREATMENT OF BOERHAAVE'S SYNDROME].

The article presents the results of diagnostics and treatment of 12 patients with Boerhaave's syndrome (men--9, women-- 3). The age of the patients was 19-68 years old. The prescription of spontaneous rupture of the oesophagus was 7 h-2 days from moment of the rupture to hospital admission. General aspects of disease were noted in 10 patients, though only 5 patients were directed to the hospital with suspicion on Boerhaave's syndrome. Emergency surgeries were performed on all patients. At first the opening was carried out, than drainage of posterior lower mediastinum were performed by Savinykh-Rozanov method with wound closure of the oesophagus walls. The complications were noted in 2 patients (the first case-pleural empyema, the second case-pulmonary embolism). Late complications, such as esophagostenosis in the place of wound closure were followed up in 3 patients in terms more than one month after operation.

[Amniotic fluid embolism as a cause of maternal death].

This article reports the case of death of a puerperal woman resulting from amniotic fluid embolism. The diagnosis was established based on the results of the pathohistological study that revealed the presence of mucoproteides and epithelial scales in pulmonary blood vessels and capillaries.

[The expert observation of myocardial contusion in a child].

A case of the myocardial contusion associated with the closed blunt chest injury in the girl aged 1 year 7 months is presented. The autopsy revealed hemorrhage of an irregular oval shape, coloured dark-red, and confined to the region with the area of 4.0 x 3.5 cm. It penetrated throughout the entire thickness of the lower part of the left atrial myocardium and the upper and middle parts of the left ventricle. No other changes were found in the heart, nor were congenital cardiac and vascular malformations documented. The main factors playing an important role in the formation of the myocardium contusion are discussed. The authors emphasize that it is the children having the narrow chest with the pliable wall who constitute the group at the highest risk of accidents resulting in the chest injury and myocardial contusion.

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.

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.