[Evolution of complex treatment of patients with non-specific pleural empyema]. / Évoliutsiia metodov kompleksnogo lecheniia bol'nykh s nespetsificheskoi émpiemoi plevry.

AIM: To analyze long-term own experience of NPE treatment in view of evolution of surgical sanitation of pleural cavity. MATERIAL AND METHODS: The analysis included 5115 patients with NPE for the last 39 years (1977-2015). Morbidity, features of microflora of purulent exudate, changes in the structure of surgical methods were assessed. The role of computed tomography in the diagnostic algorithm and treatment of NPE was studied. RESULTS: The evolution of NPE surgical management includes introduction of video technologies, thermal surgical instruments and widespread use of computed tomography in the diagnosis of pleural empyema. So, significant reduction of patients who were discharged with residual cavities was observed. Postoperative mortality was 19.5% for the period 1977-1996 when traumatic open surgery was used. At the same time there were no deaths within 1997-2015 due to introduction of VATS pleural drainage. Overall mortality decreased from 4.9% to 3.2% for the same period due to reduced postoperative complications. CONCLUSION: The introduction of minimally invasive technologies, new thermal surgical instruments changed management of NPE patients, reduced the number of traumatic open procedures. So, improved outcomes were achieved.

[Surgical and combined correction of tracheal and laryngotracheal cicatricial stenosis and restenosis]. / Lechenie trakheal'nykh i laringotrakheal'nykh rubtsovykh stenozov i restenozov.

AIM: To improve treatment of patients with cicatricial tracheal stenosis using different methods of recanalization and circular resection. MATERIAL AND METHODS: Analysis involved 57 patients with cicatricial tracheal stenosis including 2 post-traumatic cases, 27 post-intubation cases, 25 cases after tracheostomy and 3 restenoses after previous circular resection. There were 5 cases of tracheal stenosis combined with tracheoesophageal fistula, 1 patient with chest nodular goiter, 8 cases of unclosed tracheostomy and 3 patients with long-existing laryngotracheal fissure. There were 25 women and 32 men aged 15-65 years. Stenosis length ranged from 3.0 to 4.5 cm in 66.6% of patients. There were 13 (22.8%) patients with subcompensated stenosis (d=0.5-0.7 cm) and 44 (77.2%) cases of decompensated stenosis (d<0.5 cm) combined with suppurative tracheobronchitis that required endosurgical recanalization with stenting or balloon dilatation. 45 patients underwent upper tracheal third resection, 9 - middle third resection, 3 - upper third and cricoid cartilage resection. Length of excised segment was 2.5-9.5 cm. Simultaneous suturing of esophageal anterior wall defect was performed in 5 cases. RESULTS: Complete recovery of tracheal lumen was achieved in 54 patients (93%). Restenosis occurred in 4 (7%) cases (3 of them underwent repeated resection with good results and 1 - stenting). CONCLUSION: Circular resection is optimal treatment of cicatricial tracheal stenosis. Endosurgical recanalization is preparatory method prior to radical surgery.

[The use of modified diagnostic scale in patients with acute appendicitis].

The diagnostic scale of acute appendicitis was combined using literature review and retrospective analysis of patients' data. Clinical symptoms, laboratory tests and ultrasound investigation were comprehensively analyzed. Thus, all patients could be divided in three groups: 1st group (1-3 points according to the used scale) had low possibility of the acute appendicitis; 2nd group (4-7 points) united patients, requiring further diagnostic challenges and dynamic follow-up; 3rd group (8 points and more) had patients, who should have been operated on. Intraoperative view and histological investigation of the appendix were considered as reference diagnostic methods. Thereby, sensitivity, specificity, accuracy and prognostic value of positive and negative results the suggested diagnostic scale were 87,0, 96,7%, 91,3, 94,0 and 89,2%, respectively. Number of vain appendectomy was 12,3%.The scale allows to perform the right surgical treatment tactics with no regard of personal doctor's experience.

[Doppler ultrasonic evaluation of hepatic functional reserve]. / Ul'trazvukovaia dopplerovskaia otsenka funktsional'nogo rezerva pecheni.

Ultrasonic Doppler measurement of the blood flow in the portal vein and hepatic artery was conducted to evaluate the function and functional reserve of the liver in 146 patients with various forms of cholangitis combined with biliary cirrhosis and hepatic insufficiency. The functional reserve of the liver was judged by comparison of the basic blood flow on a fasting stomach with the blood flow after a functional histamine load. Five types of responses of the portal vein blood flow to the functional load according to the degree of disturbed hepatic function were revealed. Comparison of the flow of blood along the portal vein in healthy individuals with that in patients with diabetes mellitus and a formed splenorenal shunt showed that disconnection of the blood flow from the splenic vein has no effect on the flow of blood in the portal vein. The latter is regulated at the level of microcirculation in the liver, which is confirmed by the correlation between the blood flow in the portal vein and in the hepatic artery.

[Disorders of organic hemodynamics of the liver and their correction in suppurative cholangitis]. / Narusheniia organnoi gemodinamiki pecheni i ikh korrektsiia pri gnoinom kholangite.

The blood flow in the portal vein and hepatic artery was studied by means of ultrasonic Doppler flow measurement to investigate organic and regional hemodynamics of the liver in purulent cholangitis. The blood flow in the portal vein was found to be significantly diminished in patients with acute cholangitis and hepatic failure. Hepatic microcirculation was studied on a experimental model of obstructive jaundice and obstructive purulent cholangitis in rats by polarographic measurement of hydrogen clearance. Considerable reduction of the volume rate of the local blood flow was noted, and the degree of the reduction was related to the severity and duration of the disease. Decompression of the biliary tract by external drainage improved the local blood flow rate which, however, diminished again in prolonged external drainage. The use of pharmacological agents for correction of microcirculation in decompression of the biliary tract led to total and rapid correction of the volume rate of the local blood flow.

[Treatment of pancreatic cysts using percutaneous punctures and drainage under ultrasonic control]. / Sanatsiia kist podzheludochnoi zhelezy s pomoshch'iu chreskozhnykh punktsii i drenirovanii pod kontrolem ul'trazvukovogo issledovaniia.

Percutaneous punctures and drainage of pancreatic cysts under USE control were conducted in 12 patients. It was found that the method is relatively simple, less injurious, and makes it possible in infected cysts to perform rapid cleansing and drainage of the purulent cavity without the hazard of the development of complications and to achieve in some cases complete sclerosis of the cystic cavity if it is not connected with the ductal system.