[Esophageal stenting complications].

The aim of the study was to analyze esophageal stenting complications in case of cancer and benign diseases. It was investigated complications in 8 patients in terms from 7 days to 1 year after intervention. In 4 patients esophageal stenting was performed for constrictive esophageal cancer and compression with pulmonary cancer metastases into mediastinal lymphatic nodes. 2 patients had esophageal stenting for post-tracheostomy tracheo-esophageal fistula, 1 patient - for spontaneous esophageal rupture, 1 patient - for post-burn scar narrowing of esophagus and output part of the stomach. Severe patients' condition with tumor was determined by intensive esophageal bleeding in 2 cases, bilateral abscessed aspiration pneumonia, tumor bleeding, blood aspiration (1 case), posterior mediastinitis (1 case). Severe patients' condition with benign disease was associated with decompensated esophageal narrowing about proximal part of stent (1 case), increase of tracheo-esophageal fistula size complicated by aspiration pneumonia (1 case), stent migration into stomach with recurrence of esophago-mediastino-pleural fistula and pleural empyema (1 case), decompensated narrowing of esophagus and output part of the stomach (1 case). Patients with cancer died. And patients with benign diseases underwent multi-stage surgical treatment and recovered. Stenting is palliative method for patients with esophageal cancer. Patients after stenting should be under outpatient observation for early diagnosis of possible complications. Esophageal stenting in patients with benign diseases should be performed only by life-saving indications, in case of inability of other treatment and for the minimum necessary period.

[Treatment of patients with suicidal and autoagressive neck, thorax and abdomen injuries].

The issue is devoted to the analysis of case reports of 305 patients with suicidal and autoagressive neck, thorax and abdomen injuries. The objective prevalence of penetrating injuries of the abdomen among men with depressive disorders was registered. The most complicated, both for surgeon and psychiatrist, were cases of combined neck, thorax and abdomen injuries in elderly patients.

[Postoperative complications of heart and pericardial injuries].

The 31-year experience of 839 cases of heart and pericardial injuries was analyzed. The complicated course was registered in 36%. Such factors as patient's age, blood loss, severity of injury and patient's condition on admission, defined the possibility of complications. No less important were the characteristics of postoperative treatment and early diagnostics of the injury. The thorough analysis of reasons of the complications' development allowed to work out some prophylactic measures and to decrease the frequency of postoperative lethality from 13.8 to 6.8%, whereas the complications rate was decreased from 43.8 to 32.3%.

[Thoracic ultrasound in penetrating chest trauma: the tactics management].

The thoracic ultrasound for the detection of hemothorax and hemopericardium was performed in 655 patients with penetrating thoracic trauma. Ultrasound findings were compared with the results of surgical exploration. Sensitivity and specificity of ultrasound in detection of hemothorax was 72.1 and 90.1%; in detection of hemopericardium - 70.6 and 73.7%, respectively. The results of the US diagnostics depended on patients' position (supine or when seated) and on time interval between the examination and surgery. The isolated US investigation in supine position leads to the increase of false negative results. We consider that in hemodynamically stable patients the doutbtfull US data in detection of hemopericardium is the indication to videothoracoscopy. The lower-chest injuries with the US signs of hemothorax are considered to be the indication for VATS except for the obvious left-side thoracoabdominal injuries.

[Septic complications of penetrating thoracic injuries].

224 cases of septic complications after penetrating thoracic injuries were analyzed. Pleura empyem was observed in 105 of 7572 patients (overall number of the injured), lung abscess - in 22 cases, pericarditis was diagnosed in 108 patients, costal and sternal osteomyelitis - in 26 and mediastinitis - in 21 patients. Overall frequency of septic complication was 2,96%. Main reasons of septic complications were: massive blood loss, initial contamination, thoracotomy through the initially infected wound, long -lasting and coagulated hemothorax and late diagnosis and hospitalization. Staphylococcus aureus was the most frequent microbe detected - 29,4%. Lethality rate was 9,8% (22 patients). Adequate drainage of the wound allowed rehabilitation of the majority of patients. Cases with costal osteomyelitis required major surgical dissection in 73,1%.

[Posttraumatic pericarditis - the treatment and prophylaxis].

Results of treatment of 100 patients with posttraumatic pericarditis after stab (n=79) and blunt (n=21) thoracic trauma. Factors, leading to pericarditis onset, were primary infection, direct heart and pericardium injury (87,3%), inadequate pericardial cavity drainage (13,9%), insufficient medicamental pericarditis prophylaxis postoperatively (8,9%). Late medical recourse after blunt trauma of the thorax had led to pericarditis onset due to clotted hemothorax (23,8%), exudative pleurisy (19%) and pleural empyema (14,3%). Early diagnose and complex conservative treatment of posttraumatic pericarditis allowed recover in 78,5% (n=62) and 81% (n=17) of patients with stab and blunt thoracic trauma, respectively. Pericardial cavity drainage with intrapericardial streptokinase introduction proved to be an effective method of treatment of fibrinopurulent pericarditis.

[Shock score and surgical tactics for thoracic injury treatment].

Results of surgical treatment of 216 patients with thoracic injuries were retrospectively analyzed. 111 (51,4%) were operated on with the use of open technologies, whereas the rest 105 (48,6%) patients were treated with the use of videothoracoscopy. Patients were divided into 2 groups according to the shock score value. Was demonstrated, that videothoracoscopic operation was reasonable by shock score value less then 1,5. In patients with the shock score value more then 1,5, open surgery was more appropriate. Success of videothoracoscopic injury repair is stipulated also by detailed preoperative diagnostics, detecting the extent of the injury of the thorax and wounds of other regions, requiring urgent treatment.

[Diagnosis and treatment heart and pericardium wounds]. / Diagnostika i lechenie ranenii serdtsa i perikarda.

The experience of diagnosis and treatment of heart and pericardium wounds in 152 patients are presented. In obecure diagnosis the authors prefer X-ray examination and echocardiography. Total lethality was 23.6%. Its high level is due to injury of coronary arteries and intracardiac structures, other thoracic and abdominal organs. The left anterolaferal thoracotomy is the optimum approach in wounds of the heart and pericardium. The most frequent complication of postoperative period is pericarditis, its echographic symptoms were revealed in 91% examinys. Non-steroid and steroid antiinflammatory drugs are effective for prophylaxis and treatment of pericarditis.

[Surgical tactics in patients with postburn cicatricial esophageal stenosis]. / Khirurgicheskaia taktika u bol'nykh s posleozhogovymi rubtsovymi suzheniiami pishchevoda.

Surgical policy during the first years after burn was aimed at the recovery of natural nutrition. To achieve that, esophageal bougienage (503 cases) or total retrosternal esophagoplasty from the large intestine (192 cases) were performed. The authors hold that in order to attain complete medical rehabilitation for the patients, it is necessary to remove all the cicatricially changed tissues. Esophageal resection was performed in 78 patients, including 27 with preservation of the n. vagus. In the long-term postburn period, a problem arises as to the surgical correction of functional and morphological alterations associated with the establishment of artificial esophagus (80 cases including 35 patients who were operated on by S. S. Yudin). While choosing surgical policy it is necessary to take into account both the technical skills of a surgeon and the whole complex of changes in the patient's body, which have already developed and are going to develop in the future.

[Resection of the esophagus in patients with sequelae of chemical burns]. / Rezektsiia pishchevoda u bol'nykh s posledstviiami khimicheskikh ozhogov.

Indications for resection of the esophagus in cicatricial constriction were elaborated on the basis of 58 cases of resection of cicatricially changed thoracic esophagus. Comparative analysis of gastric secretory and motor-evacuative function after two variants of esophageal resetion (after Dobromyslov-Torek and with preservation of the trunks of the vagus nerves) showed the efficacy and expediency of leaving intact the vagus nerves in resection of a cicatricially changed esophagus in the presence of appropriate indications.