[Adjuvant lymphotrophic chemotherapy in the surgical treatment of progressive pulmonary tuberculosis].

The study was undertaken to enhance the efficiency of surgical treatment for progressive drug-resistant pulmonary tuberculosis, by applying adjuvant lymphotropic chemotherapy (ALCT). Seventy-one patients were examined and operated on; of them 35 patients received ALCT and 36 patients formed a control group. The determinants of the efficiency of the performed treatment were the frequency of specific postoperative complications. ALCT used in combination with the conventional antituberculous treatments made it possible to enhance the efficiency of surgical treatment, by halving the number of postoperative complications, reducing the duration of a postoperative period, and enhancing the intensity of chemotherapy, by taking into account the data on the resistance of a pathogen, without causing adverse reactions, and to improve the psychoemotional status of patients.

[Differential approach to lymphadenectomy in patients with progressive fibrocavernous pulmonary tuberculosis].

The resection specimens from 31 patients with fibrocavernous tuberculosis (FCT) underwent a complex clinical andimmunological study, as well as a morphological one. It was ascertained that partial or extended lymphadenectomy did not always positively correlate with an adequate postoperative immune response and it depended on the morphological features of lymphatic apparatus lesion. The direct results of surgical treatment of patients with FCT suggest that in patients with specific lymphadenitis and cell-mediated immunodeficiency, the frequency of postoperative specific pleuropulmonary complications and their severity considerably exceed those if there is an adequate immune response. In patients with progressive FCT, baseline cell-mediated immunity deficiency is aggravated by surgery, increasing the risk of postoperative specific and nonspecific infectious pleuropulmonary complications.

[The experience of applying of exogenous monoxide of nitrogen and argon plasma coagulation by cavernotomy in patients with fibro-cavernous pulmonary tuberculosis with the presence of multiple drug resistance].

The presented paper discusses the experience with exogenous nitric oxide (NO) and argon plasma coagulation (APC) used at cavernotomy in 31 patients with multidrug-resistant fibrocavernous pulmonary tuberculosis. Supplementary treatments depending in infectious risk factors were comprehensively evaluated. The application of APC and NO significantly improved the results of open cavern sanitation, as evidenced by the bacterial excretion index, and doubled the immediate efficiency of surgical treatment.

[The diagnosis and treatment of acute pulmonary circulatory disorders after resection for tuberculosis].

The authors analyzed postoperative complications after 4174 pulmonectomies for tuberculosis in the period of 1982-2004. The verified cases of acute venous circulatory disorders in the remnants of the lung after partial resections were observed in 12 (0.3%) patients. The main causes of hemorrhagic infarct of the part of the lung were erroneous ligation of the vein or its rupture; thrombosis of the venous trunk; partial removal of a pulmonary portion with devascularized tissue left; extensive intrapulmonary hematomas. In case of acute circulatory disorder developed in the resected lung, mortality may amount to as high as 58% due to secondary complications (sepsis in the presence of generalized gangrene and lung tissue decay, purulent pleurisy with bronchopleurothoracic fistulas, arrosion profuse hemorrhage). The above complication is a rare, but extremely severe iatrogenic abnormality largely associated with shortcomings of surgical techniques.

[Peptic ulcer is a risk factor in the surgical treatment of pulmonary tuberculosis]. / Iazvennaia bolezn' -- faktor riska pri khirurgicheskom lechenii tuberkuleza legkikh.

Peptic ulcer of the stomach and duodenum is the most common (10-18%) concomitant gastrointestinal pathology in phthisiosurgical patients. Treatment of these patients presents a challenge due to a drastic reduction in the efficiency of oral antibacterial therapy resulted from poor tolerability of chemical drugs and to a risk for surgical complications particularly in the early period after lung surgery. In 1996-2002, a total of 495 patients with tuberculosis at various sites were endoscopically studied; peptic ulcer in different phases was detected in 30.9% of the patients. There has been a considerable increase in the incidence of peptic ulcer among phthisiosurgical patients in the past 3 years (up to 16-17% among those undergone lung surgery for tuberculosis). A package of measures has been developed to reduce the incidence of life-threatening complications due to peptic ulcer in the postoperative period. It is concluded that peptic ulcer is a significant risk factor in phthisiosurgery as a serious contraindication to planned surgery and as a source of postoperative complications.

[The surgical treatment of cancer of the esophagus and cardia. The complications and hazards]. / Khirurgicheskoe lechenie raka pishchevoda i kardii. Oslozhneniia i opasnosti.

One-stage operations for carcinoma of the esophagus and cardia were performed on 100 patients. The substitution of the resected esophagus was made with a isoperistaltic tube from the greater curvature of the stomach with anastomosis on the neck, in the pleural or abdominal cavities. Palliative interventions were fulfilled on 31 patients with inoperable carcinomas. An analysis of the structure and causes of postoperative complications and postoperative lethality has shown that among the most frequent causes of deaths in the postoperative period were purulent-infectious complications as a result of ischemia of gastric transplants and incompetence of sutures of the anastomoses as well as pleuro-pulmonary complications. Special attention was given to an analysis of complications after operations performed without thoracotomy from the cervico-abdominal access. The amount of postoperative complications was 30%, postoperative lethality 15%. One-year survival after operations made up 57%, 3-year survival--less than 30%, 5-year survival--less than 15%. Some recommendations are given for the surgical policy and methods of prophylactics of certain complications. Endolymphatic infusions of cytostatics used as adjuvant chemotherapy in complex treatment of patients with cardioesophageal carcinoma represent a perspective direction providing longer life of the patients without recidivations. From the oncological viewpoint the operation without thoracotomy are not always thought to be justifiable.

[Surgical tactics in spontaneous pneumothorax]. / Khirurgicheskaia taktika pri spontannom pnevmotorakse.

219 cases of nonspecific spontaneous pneumothorax have been analysed. The bullous lung disease was the reason of pneumothorax in 55% of cases. Diagnostic and curative thoracoscopy is an important element of diagnosis. It was performed in 45 patients. Surgical operations were done in 56 patients. An active surgical policy in the treatment of spontaneous pneumothorax is advocated. Partial and subtotal pleurectomy plays an important role in surgery, especially in diffuse bullous lung disease.

[Simultaneous operations in the surgical treatment of cancer of the esophagus and cardia]. / Odnomomentnye operatsii v khirurgicheskom lechenii raka pishchevoda i kardii.

In the clinic one-stage operations for cancer of the esophagus of different localizations and cardia were performed on 63 patients. The substitution of the removed esophagus was fulfilled with an isoperistaltic tube made from the greater curvature of the stomach with anastomosis on the neck or in the pleural cavity. After intrapleural plasty lethality was 21%, after total one with extracavital esophagogastroanastomoses--14%. For prevention of ischemic complications an intraoperative assessment of viability of the transplant was performed with the help of microphotoplethysmography. The authors have shown the advantage of endolymphatic route of administration of cytostatic in 25 patients as compared with the intravenous one.

[Prevention and treatment of pleuropulmonary complications after simultaneous reconstructive operations on the esophagus in esophageal cancer]. / Profilaktika i lechenie plevrolegochnykh oslozhnenii posle odnomomentnykh rekonstruktivnykh operatsii na pishchevode po povodu raka.

Pleuropulmonary complications in 50 patients who underwent operation for esophageal carcinoma with simultaneous esophagogastroplasty were most frequent (59%) and serious and accounted for up to 60% of all causes of early postoperative mortality. In operations through a transthoracic approach these complications occur more frequently (75%) than in operations without thoracotomy (48%). The possible causes and measures for the prevention of pleuropulmonary complications in the pre-, intra-, and postoperative periods are discussed. Particular attention is focused on the acute respiratory insufficiency syndrome during resection of the esophagus without thoracotomy. It is concluded that this serious pathological condition can be avoided by a complex of preventive and therapeutic measures carried out in all stages of treatment.

[The morphofunctional status of the isoperistaltic gastric transplant for esophagoplasty]. / Morfofunktsional'noe sostoianie izoperistal'ticheskogo zheludochnogo transplantata dlia plastiki pishchevoda.

Thirteen patients with carcinomas of the esophagus underwent one-stage operations--extirpation of the esophagus without thoracotomy with simultaneous esophagoplasty using isoperistaltic gastric tube made of the greater curvature of the stomach, in posterior mediastinum with esophagogastrostomy in the neck. The morphofunctional state of the gastric transplants was investigated at early and late periods (for 8 months) after operations. The reduction of blood in the transplants to 40% of the initial, deterioration of acid production, depression of the motility, ischemic atrophy of mucosa and increased fibrosis in submucosa were revealed. Nevertheless satisfactory results of the isoperistaltic tubular esophagoplasty were obtained in 77% of patients in early periods and in 54% of the patients during the first year after operation.

[Is jejunostomy needed in single-stage plastic operations on the esophagus?]. / Nuzhna li eiunostomiia pri odnomomentnykh plasticheskikh operatsiiakh na pishchevode?

50 patients with carcinomas or corrosive strictures of the esophagus were operated upon with the simultaneous esophagogastroplasty. At the same time the primary provisional jejunostomy after Witzel was performed on 20 of them in order to ensure an adequate decompression and nutrition at the early postoperative period. In cases of dangerous complications (fistulas of esophagogastrostomies--in 37%, purulent mediastinitis or empyemas--in 14% etc.) the use of jejunostomy allows enteral nutrition to be prolonged up to the moment of the independent oral feeding. It is concluded that the formation of primary jejunostomy for curative and prophylactic purposes is expedient in the simultaneous reconstructive esophageal operations for tumors and strictures.