[Treatment of mediastinitis]. / Lechenie mediastinita.

The authors work is based on experience in the study of 56 patients with acute mediastinitis of various origin who were treated in the period from 1981 to 1990. There were 33 males and 23 females whose ages ranged from 16 to 65 years, Odontogenous mediastinitis was diagnosed in 23, tonsillogenous in 2, and mediastinitis resulting from injury to the esophagus in 31 patients. Instrumental injuries prevailed. All patients underwent operation. The character of the operation was determined by the duration, localization, and severity of the pyonecrotic process in the mediastinum. Diffuse anterior mediastinitis was managed by tunneling and drainage of the mediastinum through the seat of the removed xiphoid process. Prophylactic treatment of the mediastinal space and intensive therapy including active detoxification were applied in the 56 patients who underwent operation died, 26 of them were admitted to the clinic 24-72 hours after the onset of the disease in a state of severe intoxication caused by violently developing mediastinitis. The remaining 27 patients recovered.

[Recurrent pulmonary hemorrhage]. / Retsidiviruiushchee legochnoe krovotechenie.

The results of treatment of 235 patients with pulmonary hemorrhage of various etiology which stayed in clinic in 1980-1992 yrs. were analyzed. Of 216 patients, whom diagnostic bronchoscopy was performed, the hemorrhage origin was found in 137, of whom in 13 its localization was imprecise. Seventeen patients have died, of whom 11--before operative intervention was done. The method of temporary occlusion of presumably bleeding lobar or segmental bronchus with the help of obturator containing the leaded out transnasally catheter was proposed to localize precisely the pulmonary hemorrhage origin. The hemorrhage origin localization is confirmed by subsequent appearance of blood from the external end of catheter.

[Complications in hiatal hernia]. / Oslozhneniia pri gryzhakh pishchevodnogo otverstiia diafragmy.

Of 1498 patients suffering of hiatal hernias of the diaphragm 375 were operated on for complicated course of the disease. It was established that in some of the complicated course of the disease the background is the vagal-solar syndrome developing due to traumatization of the branches of vagal nerves and solar structures by the stomach prolapsing into the mediastinum. To control this phenomenon the authors used in 167 patients their original method of surgical correction of hiatal hernias of the diaphragm. The result was favourable in 87.7% of the total number of 375 patients with complicated forms of hiatal hernias of the diaphragm. Lethality--0.8%.

[Temporary occlusion of the bronchi in the treatment of complex suppurative destruction of the lungs]. / Vremennaia okkliuziia bronkhov v lechenii oslozhennykh gnoinykh destruktsii legkikh.

In the period from 1984 to 1987 the authors had under observation 179 patients with acute pulmonary destruction following various courses. Variants of temporary occlusion of the fistula-carrying bronchus were performed in 54 patients in whom the disease was complicated by bronchopleural fistula and pyopneumothorax. Occlusion of a lobar or segmental bronchus (51 patients) was preceded by preliminary flow cleansing of the affected bronchopulmonary areas and intrapleural hydrolavage of the lung with alternating pressure. In 3 patients temporary occlusion of the bronchus was conducted with a hollow obturator according to the method suggested by the authors; the method allows cleansing of the affected lung with the occluded bronchus to be combined with its gradual re-expansion. Four among the 54 treated patients died, 50 recovered.

[New approach to the treatment of status asthmaticus caused by hiatal hernia]. / Novyi podkhod k lecheniiu astmaticheskogo sostoianiia, obuslo- vlennogo gryzhei pishchevogo otverstiia diafragmy.

From 1986 to 1988, 170 patients with asthmatic state were observed. Of them in 13, the X-ray study revealed hiatal hernia (HH) and reflux-esophagitis. The analysis of observations of 1173 patients with HH was carried out. In a number of patients together with the symptoms of pathology of the respiratory system, the vegetative, cardial and other disorders were found. All these disorders the authors consider a consequence of irritation of the vagus and celiac plexus occurring in HH. A complex of medicamentous therapy of the asthmatic state caused by HH is suggested.

[Respiratory and dysuric disorders in hiatal hernia]. / Respiratornye i dizuricheskie narusheniia pri gryzhakh pishchevodnogo otverstiia diafragmy.

In the period of 1973-1987 the authors followed-up 1053 patients with hiatal hernia with different types of a clinical course. Various respiratory symptoms (cough, attacks of asphyxia, etc.) were observed in 181 patients, dysuric symptoms (dysuria, urethral colics, etc.) were observed in 66 patients. Of this number 347 were operated upon. A positive effect was achieved in 36 of 41 operated patients with bronchopulmonary disorders and in 16 of 23 patients with dysuric disorders. Organic respiratory and urinary changes were undetectable before operation. The authors considered a possibility of the development of the vagosolar syndrome lying in the basis of the pathogenesis of the above disorders.