[Risk factors for aerostasis failure in case of lung resection].

The results of risk factors analysis of aerostasis failure in 141 patients are presented in the article. All patients were operated in the A.V. Vishnevskogo Institute of Surgery at the period from January 2009 to December 2010. During statistical analysis it was considered surgeries volume, presence of emphysema, respiratory function etc. Also it was defined the dependence of venting duration in patients with residual pleural cavity and long aerostasis failure.

[The sutureless lung resection with Ligasure device: the possibilities and perspectives].

The experimental study of the durability of the "collagen" suture of the lung, performed with the use of the Ligasure device, was conducted. 17 patients, whom 21 lung resection was performet took part in the study. In the experimental part of the study the average rupture pressure of the collagen plomb was 413±99.4 mm Hg for the intact lung parenchyma and 212±66.7 mm Hg for the emphisematously changed tissue. The prolonged aerostatic insufficiency was registered only in two cases. The Ligasure suturing device proved to be the highly effective and safe for the use in thoracic surgery.

[Thoracoscopic surgery for traumatic injuries of thoracic spine].

The paper deals with endoscopic surgical treatment of traumatic injuries of thoracic spine. Indications and contraindications, pre-surgical preparation procedures are discussed. Surgical technique is described. Advantages of thoracoscopic operations include: minimal invasiveness, decreased blood loss, less intensive postoperative pain, better functional and cosmetic outcomes. An example of successful treatment of female patient with combined trauma and multilevel injury of the spine using endoscopic technique is presented.

[Thoracoskopy in diagnosis and treatment of lung injuries].

The thoracoscopy was used at 150 patients with penetrating wounds of thorax. Severity of injury according to ISS scale was 9.02+/-1.1 scores, RTS criteria - 7.84+/-0.0 scores, and TRISS - 99.8+/-0.1%. Lung injuries were diagnosed at 71 (47.3%) patients. Features of various wounds of lung and methods of closure have been analyzed. Bleeding, air intake and intrapulmonary hematoma were the indications for hermetic closure of wound canal. Coagulation of lung wound was performed at 24 (33.8%) patients, closure with endosurgical techniques - 30 (42.2%); the wounds have not been closured at 8 (11.3%) patients. Conversion to thoracotomy was necessary at 5 (7%) patients with deep wounds of lung. The thoracoscopic surgical procedure has been completely performed at 58 (81.7%) patients. The better postoperative results were achieved after endosurgical closure of lung wounds. Computed tomography is perspective method of preoperative diagnosis of lung injury severity.

[Thoracoscopy in the treatment of intrapleural bleeding due to injury of chest wall vessels].

Thoracoscopy was used in the treatment of 141 patients with penetrating wounds of chest. Injuries of chest wall vessels were diagnosed at 68 (48.2%) patients. Rate of thoracoscopy conversion due to bleeding from chest wall wounds was 4.3%. Thoracoscopy is effective at injuries of intercostals arteries and their muscular branches, but injuries of internal thoracic artery require conversion into thoracotomy at 50% cases. It is revealed that expediency of thoracoscopy is in direct proportion to time from injury point and is inversely to hemothorax volume.

[Video-thoracoscopy in the treatment of patients with penetrating wound of the thorax].

Thoracoscopic surgical procedures were used in the treatment of 79 patients with penetrating wound of the thorax complicated by hemothorax. Small hemothorax was diagnosed in 72.1% patients; 56.1% had injuries of thoracic organs, 26.3% -- injuries of diaphragm. Thoracoscopic hemostasis and correction of intrathoracic injuries were performed in 84,6% patients. Conversion to video-assisted minimally-invasive thoracotomy (because of injuries of the diaphragm as a rule) occurred in 15,8% patients, conversion to typical thoracotomy -- in 3.5%. In medium hemothorax (16.4% patients) injuries of thoracic organs and anatomic structures were diagnosed in 76.9% cases. Hemostasis and correction of intrathoracic injuries through thoracoscopic approach were performed in 43.8% patients, conversion to typical thoracotomy was necessary in 7% cases. Big hemothorax was diagnosed in 11.4% patients, 55.6% of them had injuries of thoracic organs and anatomic structures. Complete thoracoscopic procedure was performed in 44.4% cases; 33.3 patients required conversion to thoracotomy. Thoracoscopy is an effective method of surgical treatment of thoracic injuries in patients who don't require urgent thoracotomy. This procedure permits repair of intrathoracic injuries in 73.4% cases. Postoperative complications were seen in 15% cases, postoperative lethality was 1.4%.

[Thoracoscopy in surgery of thoracic wounds]. / Rol' torakoskopii v khirurgii ranenii grudi.

One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. Injuries uncorrectable by endosurgically were diagnosed during thoracoscopy in 2.9% patients. Indications for urgent thoracoscopy in thoracic injuries are the following: 1) middle and small hemothorax or hemopneumothorax; 2) suspicion for heart wound; 3) suspicion for diaphragm injury; 4) tense pneumothorax. Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.

[Immunotherapy of autologous focus of infiltrating lymphocytes in resection of pulmonary tuberculosis]. / Immunoterapiia autologichnymi ochag-infil'triruiushchimi limfotsitami v rezektsionnoi khirurgii tuberkuleza legkikh.

The development of immunotherapy modalities using active immunologically "trained" cells obtained just from a focus of tuberculous inflammation is a promising direction of the prevention and treatment of recurrent tuberculosis. Thirty patients were examined. A procedure was developed for autoimmunotherapy. The study showed it possible to obtain living, sterile, tuberculous inflammation focus-trophic lymphocytes in the amount sufficient for an immunotherapeutical effect. Autoimmunotherapy was found to reduce the number of postoperative recurrences (6% in the experimental group versus 20% in the control one), promoted prompter recovery of tuberculous bronchitis, earlier normalization of the parameters of systemic and antituberculous immunity after surgery. Densitometric analysis of X-ray films revealed a significant focal consolidation (by 1.37 times) after using focus-infiltrating lymphocytes. Autoimmunotherapy using focus-infiltrating lymphocytes makes it possible to improve the outcomes of surgical treatment of patients with pulmonary tuberculosis by reducing the risk of postoperative recurrent tuberculosis, to apply resection interventions in disseminated and bilateral pulmonary tuberculosis more extensively, to use saving resections aimed at removing the basic focus of a tuberculous lesion if there are disseminated focal seedings, and to promote the solution of a problem of the surgical management of patients with drug-resistant mycobacteria.

[Methodology of the study of pleural effusion cells]. / K voprosu o metodologii izucheniia kletok plevral'nogo ékssudata.

Discusses the methods for assessing the intensity of cytochemical reactions of leukocytes of pleural exudation and blood. Visual assessment of the intensity of cytochemical staining depends on the size of the cell. Morphometric methods revealed that pleural exudation cells differ in size from blood leucocytes, and hence errors occur during routine assessment of the intensity of cytochemical reactions. Corrective coefficients for L. Kaplow's formula to rule out such errors are proposed.

[Clinical and immunologic characteristics of various forms of acute peritonitis]. / Kliniko-immunologicheskie paralleli pri razlichnykh formakh ostrogo peritonita.

The condition of the cellular link of the immune system was studied in 30 patients with various forms of acute peritonitis. It was found that the reaction of the immune system in peritonitis is characterized by a phase property and is manifested by processes of redistribution and activation of the immunocompetent cells and normalization of reactivity. The ratio of these phases is determined by the severity of inflammation and intoxication. It is shown that inhibition of the immune system is most marked in diffuse peritonitis, which is due to the higher absorption capacity of the peritoneum in this stage of the pathological process. It was established that the response of the immune system to the operative trauma depends on the spread of peritonitis. The number of T-helpers, T-suppressors, and activated lymphocytes and the activity of the neutrophil alkaline phosphatase are most important in the prognosis of postoperative complications. These parameters may also be used in assessment of the efficacy of immunomodulation with levamisole.

[Effect of soy protein isolates in the diet of animals on the histochemical characteristics of the digestive tract]. / Vliianie izoliatov belkov soi v ratsione zhivotnykh na gistokhimicheskie kharakteristiki pishchevaritel'nogo trakta.

Histochemical methods were used to study the mucus-producing processes in the stomach and intestine of experimental animals under conditions of long-term feeding with soybean protein isolates. These methods helped in determining the action of neutral glycoproteins and sulfated polysaccharides in the stomach and intestine of the test animals. The experiments conducted have shown the absence of side effects of soybean isolates on the morphology of the stomach and intestine and on the qualitative polysaccharide composition of their epithelial secretions.