[Post-intubation rupture of thoracic trachea in a patient with iatrogenic esophageal perforation and mediastinitis]. / Postintubatsionnyi razryv grudnogo otdela trakhei u bol'noi s perforatsiei pishchevoda pri fibroendoskopii i mediastinitom.

Iatrogenic injuries of the esophagus and trachea are rare. However, these are life-threatening events due to severe complications. The authors report iatrogenic perforation of cervical esophagus with a long false passage in posterior mediastinum in an 83-year-old patient undergoing endoscopic retrograde cholangiopancreatography for choledocholithiasis. Post-intubation rupture of thoracic trachea was diagnosed early after suturing the defect of esophagus and drainage of mediastinum. Treatment strategy was analyzed and conservative management of tracheal injury was substantiated.

[Diagnostics and surgical treatment of the posttraumatic septic mediastinitis].

Treatment results of 38 cases of septic mediastinitis for the last 17 years were analyzed. The frequency of mediastinitis as a complication of the penetrating wound was 0.28%, and of the closed thoracic trauma - 0.1%. Reasons and risk factors of the mediastinitis development have been revealed. The enlargement of the mediastinum on the X-ray allowed the primary diagnostics of suspicion on the mediastinitis in 39.5% of cases. The spiral computed tomography provided information for the further treatment options. The mediastinum drainage was an effective method of treatment, providing the improvement in 69.6% patients after penetrating wound and in 73.3% after the closed thoracic trauma.

[Characteristics of motility function of the esophagus in patients with aphagia].

In article is shown the results of investigation of motility function of esophagus in 18 patients with pharyngoesophageal obstruction. 16 patients were operated. The essence of method was in simultaneous registration of UES intracavitary pressure and impedance. We discovered that all patients have both not opening of for the swallow and disturbances of sphincteral function of LES and contractive activity of thoracic esophagus. Dynamic of this parameters in 7 operated patients was monitored. Obtained data were analyzed according to clinical results of surgery.

[Diagnostics and treatment of posttraumatic septic costal osteomyelitis].

Results of treatment and diagnostics of 47 patients with posttraumatic septic costal osteomyelitis were analyzed. 26 patients had open and 21 - closed thoracic injuries. Major reasons of osteomyelitis tended to be the initial infection of the bony injury, pleural surgical revision through the initial wound and late medical help by the closed thoracic injuries. Osteomyelitis was diagnosed with the help of and X-ray examination in 14,9%, multispiral computed tomography was informative in 48,4% and scintigraphy demonstrated bone destruction and inflammation in 96,8% of cases. With no depandance from the type of an injury, the most frequent infectious agents were the Staphylococcus aureus (51,2%) and Pseudomonas aeruginosa (32,5%). Conservative treatment was successful in 26,9% after open injuries and in 42,9% of the blunt thoracic trauma. Wide costal resections were conducted in 73,1% and 52,4% of patients with open and closed injuries, respectively.

[Diagnostics and surgical treatment of pharyngoesophageal impassability].

Data of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients. Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8. 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years. Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.

[Instrumental diagnosis of reflux esophagitis]. / Instrumental'naia diagnostika refliuks-ézofagita.

One hundred and forty patients with clinical symptoms of gastroesophageal reflux disease were examined. Instrumental examination included esophagogastroduodenoscopy (140 patients) with target biopsy (44 patients), x-ray study of the esophagus and stomach (95), intragastric pH-metry (74), esophagomanometry (67). It is demonstrated that all the patients with clinical picture of gastroesophageal reflux disease suffer from reflux-esophagitis (RE) of various severity. Definite morphological equivalents correspond to each of endoscopic forms of RE. Complex instrumental diagnosis of RE must include intragastric pH-metry and esophagomanometry in line with esophagogastroduodenoscopy and morphological study. It is necessary to perform x-ray study in peptic strictures of the esophagus and in combination of RE with large axial hiatal hernias. Cardial or cardial-fundal hiatal hernia, increase of intragastric pressure and hyperacidity promote development of the most severe (destructive) forms of RE.

[X-ray study in the diagnosis of traumatic mediastinitis and its complications]. / Rentgenologicheskoe issledovanie pri diagnostike travmaticheskogo mediastinita i ego oslozhnenii.

The study was based on the clinical and X-ray analysis of 68 patients treated at the Thoracoabdominal Surgery, N.V. Sklifosovsky Research Institute of Emergency Care, in 1992-1997. The paper gives pre- and postoperative X-ray findings of patients with mediastinitis. It shows it possible to define the precise location of a mediastinal inflammatory process, its severity and possible complications. The X-ray symptomatology of mediastinitis is presented according to the location and developmental stage of a mediastinal process. Jointly with surgeons, the authors have developed a procedure for X-ray examination of patients in the postoperative period, which involves the study of the course of the disease and the evaluation of the adequacy of performed treatment. The paper analyzes the most specific and severe complications of traumatic mediastinitis. Special emphasis is laid on the fact that during control X-ray studies it is important to keep the procedure that permits timely diagnosis of complications at different developmental stages of mediastinitis.