[Esophagoplasty in combined scarry lesions of the esophagus, laryngopharynx and the trachea in children].

The experience of plasty of the pharynx and esophagus with graft of the free small intestine segment was presented in 12 children after burn stricture by the potassium permanganate. The technical aspects of operation using methods of the reconstructive vascular surgery were described. Good short-term result was obtained in all the patients. The long-term results were investigated during 15 years. It was observed, that the graft diverticulum developed by 4-7 years in 3 patients, whom repeated operation should be performed. According to the authors, the regional plasty of the esophagus by free revasculizated small intestine graft was really effective surgical supply and could be considered as the method of choice in limited scarry lesions of the pharynx and cervical esophagus, but the method should be improved.

[Repeated plasty of the esophagus in children with the application of transplant from the ileum].

The authors give topographic-anatomical substantiation of a possibility to employ the ileum for esophageal replacement and describe a technique of forming such transplant. Their clinical experience includes 9 operated children. Earlier they had endured from 1 to 4 attempts of esophageal replacements by different traditional methods. In all children operated upon good results were obtained. It allows the ileum to be included in the arsenal of possible methods of esophageal replacement and considering it as an alternate variant in nonstandard situations.

[Specific formation of esophageal autotransplant in the compromized and resected stomach].

An experience with 60 operated patients allows introduction of accuracy in the idea of possibility to use the compromised with different diseases and surgical procedures stomach in plasty of the esophagus. Technical specific features of forming the transplant are developed. Practicability of esophageal plasty with the small bowel using the loop of the bowel involved in digestive anastomoses is shown. In nonstandard situations the success of surgery is determined by an individual choice of plastic material, using reconstructive vascular surgery and rational method of placing the transplant.

[Influence of genetic factors on the result of therapy for diffuse euthyroid goiter].

The purpose of the present study was to investigate a relationship between the distribution of genotypes of the polymorphic markers TSHR (rs3783949, A/C substitution), NIS (rs7250346, C/G substitution), DUOXI (rs2467825, A/G substitution), DUOX2 (rs71713669, G/T substitution), and TRO (rs!7091737, G/T substitution) genes and the result of treatment for diffuse euthyroid goiter (DEG) using two regimens: monotherapy with iodine preparations and combined therapy with iodine and levothyroxine. To identify a more effective and safe treatment for DEG, the authors compared thyroid volume, the levels of pituitary thyroid-stimulating hormone and thyroid peroxidase antibodies in two groups: 1) monotherapy with KI (200 pg/day) (n = 40) and 1) combined therapy with KI (100 pg) + L-T4(lpg/kg/day) (n = 41). According to the result of treatment, each group was divided into 2 subgroups: "fair result" and "poor result" (the thyroid volume failed to achieve the normal range or continued to increase). Correlation analysis was made to assess a relationship between the polymorphism of the genes and the result of therapy for DEG. There was a significant correlation between the distribution of genotypes of the polymorphic marker the TSHR gene and the result of treatment for DES in the monotherapy group: there were prevalent AA + AC and CC genotypes with fair and poor results, respectively. There was no significant correlation between the distribution of the genotypes of the study polymorphic markers and the result of treatment using the combined therapy. Thus, the result of treatment for DES via monotherapy with iodine preparations may depend on genetic factors.

[Thyroid structural changes: results of a screening ultrasound study of a Moscow population].

То assess the prevalence and pattern of thyroid disease in Moscow, a mild iodine-deficiency area, the authors examined a random sample of 1103 individuals (1004 females and 99 males) during 14 months. The examinees' age ranged from 17 to 80 years; the mean age was 36.7±14.05; median was 37 years. The survey involved a physical examination with thyroid palpation, brief history data collection, and thyroid ultrasound study on a "Mysono"portable apparatus with a 7.5-MHz linear transducer, operating on a real-time basis. Among the examinees the echographic signs of these or those thyroid changes were found in 36% of cases. The most common abnormalities were focal thyroid tissue changes, whose prevalence was 12.4%. Thyroid nodular masses were encountered at a slightly less frequency (10.5%). Of them, nodular and multinodular goiter accounted for 6 and 4.5%, respectively. The third group of changes is presented by a diffuse decrease in thyroid tissue echogenicity (9%). Diffuse goiter was less frequently identified; its frequency was 5%. A minor proportion (0.1%) of the examinees had a history of operations for this or that thyroid disease.

[Esophagoplasty in patients with the "waning" stomach or without the stomach]. / Ezofagoplastika pri "ushcherbnom" zheludke ili ego otsutstvii.

An experience with 48 intrathoracic esophagoplasties in patients with "waning" stomach or its absence is generalized. The results obtained show that scarry-ulcerous damages of the pyloroduodenal and cardioesophageal portions, local surgical procedures, gastrostomy included, are not considered as deterrent factors for using the stomach as the plasty material for esophagoplasty. For the resected stomach or its absence the small intestine should be preferred in the formation of the anastomosis within the limits of the thoracic cavity and large intestine--when putting anastomosis on the neck. A complete clinical effect was obtained in 45 patients. Three patients died (6.25%).

[Possible complications of lymph node dissection in esophagus cancer and ways to prevent them]. / Vozmozhnye oslozhneniia limfodissektsii pri rake pishchevoda i puti ikh profilaktiki.

The experiences with surgical treatment of esophagus cancer show that performing lymphodissection makes the operation more laborious and potentially results in the development of severe complications such as an injured recurrent nerve, chylothorax, higher risk of bleeding etc. Using their clinical experiences including 80 patients of the group of investigation and 194 patients of the control group, the authors describe methodological aspects of optimization of the operative intervention, possible complications and ways for their prevention. At the same time, the results of the treatment show that it is possible to avoid severe consequences of lymphodissection by means of adequate and purposeful prophylactics and timely elimination. The worked through links of the whole chain of the surgical intervention allow minimization of the potential negative phenomena of lymphodissection and so it can be considered as an integral part of the operation for esophageal cancer.