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Objective: To analyze the mechanisms and severity of endothelial dysfunction in patients with pleural effusion of various origins using skin thermometry., Material and Methods: We studied microcirculation in 135 patients with pleural effusions of various origins. Local skin thermometry and computer wavelet analysis were performed in 3-5 days after thoracoscopy with pleural biopsy using Microtest-100WF device with a temperature measuring resolution of 0.001°C. We estimated endothelial, myogenic and neurogenic indices using spectral analysis of skin temperature fluctuations in a range 0.0095-2 Hz. The control group comprised 40 healthy participants aged 23-36 years., Results: Three groups of patients were distinguished depending on the cause of effusion: malignant pleural effusions ( n =65, 48.1%); inflammatory pleural effusions (para-pneumonic, post-traumatic, pancreatogenic, tuberculous) ( n =58, 43%); transudates (hepatogenic, cardiogenic, and nephrogenic) ( n =12, 8.9%). There were no significant differences in vascular tone in response to local heating of the second finger of the hand up to 40°C. Measurements were carried out within 10 min in all groups. Patients with diabetes mellitus and cardiovascular diseases ( n =48, 35.6%) had significant decrease of thermal vasodilation index in endothelial range up to 2.93±1.77, in the control group - up to 4.21±2.40 ( p =0.041)., Conclusion: Endothelial dysfunction is a universal non-specific aspect in pathogenesis of various diseases. This process is essential in pleural effusion. Local thermometry and computer wavelet analysis revealed no significant differences between patients with malignant, inflammatory and transudative pleural effusions. Pleural effusions in the context of cardiovascular pathology and/or diabetes mellitus occur due to impaired vasodilatation mechanisms in endothelial range.

Advanced multiple organ parasitic invasion is reported in the article. A thorough assessment of pathological process, surgical anatomy and preoperative examination resulted radical surgery despite multiple organ disease. Surgical procedure included extended left-sided hemihepatectomy, atypical resection of S 6 liver segment and pancreas, removal of themediastinal parasite with partial excision of parietal pleura and pericardium.

Drainage and endoscopic methods of sanitation of the pleural cavity do not always allow to achieve effective debridement of pathological contents., Aim: To development and introduction into clinical practice of hydrosurgical technologies for debridement of the pleural cavity., Material and Methods: From 423 children with acute community-acquired pneumonia 88 (20.80%) children destructive pneumonia were diagnosed. Of the 88 patients with destructive pneumonia, 28 patients did not have pleural complications and were excluded from the study. 60 patients were divided into 2 groups depending on the method of surgical treatment. In the first group (n=30), two additional subgroups were formed: IA group (main n=15) - they carried out drainage and washing the pleural cavity with saline; IB group (control n=15) - only drainage of the pleural cavity. The second group (n=30) were also divided into 2 subgroups; Group IIA (main n=15) children operated according to the method of video-assisted thoracoscopic sanitations of the pleural cavity developed by us using hydrosurgical technologies; Group IIB (control n=15) - children are operated on by the method of traditional video-assisted thoracoscopic sanitations of the pleural cavity. A prospective, non-randomized, single-center study was conducted to evaluate the effectiveness of various treatments. The treatment plan was determined on the basis of a combination of anamnesis, clinical and instrumental studies and laboratory parameters., Results: All studied in the comparison groups were homogeneous by sex, weight and height. The results of applying the Kruskal-Wallis test revealed statistically significant differences between the groups for the periods of relief of the intoxication syndrome (p<0.001) and the periods of relief of the pain syndrome (p=0.012) in favor of the main group. Summarizing all analyzing the parameters in the comparison groups allowed us to prove the advantage of the proposed treatment methods over the treatment methods used in the control groups., Conclusion: Hydrosurgical methods of treatment demonstrate obvious clinical and economic efficacy, which leads to the rapid reexpantion of the affected lung.

Objective: To analyze surgical treatment of tuberculous pleural empyema in children depending on the stage of the process., Material and Methods: There were 82 patients aged 4-17 years with tuberculous pleural empyema. Clinical and X-ray features of different stages of disease are described. Certain types of surgical interventions at each stage of the process are analyzed., Results: In 72 children with empyema stage III 76 surgeries were performed. Postoperative complications occurred in 2 (2.6%) cases (delayed lung inflation) that required thoracocentesis with pleural drainage. There was no postoperative mortality., Conclusion: Complex treatment of tuberculous pleural empyema in children and adolescents with the use of modern surgical methods is followed by satisfactory outcomes in all patients. However, surgical technique, postoperative morbidity and hospital-stay depend on the stage of the process. Unfortunately, almost 90% of patients had empyema stage III. Therefore, minimally invasive surgery was not advisable and extensive, traumatic surgeries were required.

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.

299 patients with spontaneous pneumothorax were treated. All patients were divided in two groups. Patients of the first group (n=182) received thoracic puncture and/or drainage. The second group (n=117) has surgery, directed at liquidation of the source of pneumothorax, i.e., they received either atypical lung resection or subtotal parietal pleurectomy. The recurrent pneumothorax was registered in 24 (13.2%) patients of the first group and in 4 (3.4%) patients of the second. Authors state that radical surgical procedure for the spontaneous pneumothorax is an atypical lung resection with parietal pleurectomy. The use of active surgical tactics allows to decrease the number of recurrencies on 9.8%.

The aim of the study was to assess the effectiveness of videothoracoscopic (VATS) costal pleurectomy in patients with primary and secondary spontaneous pneumothorax (SP). 136 patients were selected for the retrospective study. Among them 114 were men, the rest 22 - women with a mean age of 29.3 years (range 16 to 37 years). 123 patients had primary SP; 13 patients were diagnosed with interstitial lung disease and secondary SP. The follow-up time after surgery was minimally 3 years. The duration of the postoperative thoracic draining was 2.1 days for patients with primary SP and 3.4 days for those with the secondary SP. The length of the ICU stay was 1.1 and 1.2 days respectively. The overall complication rate was 9% for patients with primary SP and 47% for patients with secondary SP; the recurrence rate was 1 and 23%, respectively. Thus, marked satisfactory immediate and long-term outcomes among patients with primary SP, the VATS pleurectomy can not be considered the method of choice for patients with secondary SP, cause by interstitial lung disease.

The treatment results of the 286 patients with pleural empyem after thoracic injuries (n=107) and closed trauma of the pleural cavity (n=179) were retrospectively analyzed. The frequency of pleural empyem was 1.39% by injuries and 1.34% by the closed thoracic trauma. 15 (14%) patients of the first group developed the bronchopleural fistula, whereas the complication was observed in 32 (17.9%) patients of the second group. The adequate pleural drainage with intrapleural enzyme therapy in acute inflammation period allowed recovery in 78% and 71.9% of patients, respectively. Early videothoracoscopic sanation of the pleural cavity shortened the recovery time in more then 1.5 times. The chronization of the empyem was more often observed after the closed thoracic trauma - 14.5% rather than 6.5% after the open thoracic injury. The lethality rate by pleural empyem was 14% after the open injuries and 15.6% after the closed trauma.

The experience of treatment for 609 patients with empyema of the pleura with the use of videothoracoscopy technique has been summarized. 436 (71.6%) patients were at stage 1 of the disease, 126 (20.7%)--stage 2 and 47 (7.7%)--stage 3. All complications of intrapleural bleedings arisen in 3 (0.5%) patients, have been controlled through thoracoscope. There were no postoperative complications. Transformation of videothoracoscopic operation into the open one has been required in 11 (1.8%) patients: in 4--due to extensive destruction of the lung tissues, in 4--due to atelectasis of the lung, and in 3--because of the danger of endoscopical injury to the mediastinal organs. Feasibility of videothoracoscopic decortication of the lung and pleurectomy at stage 3 of chronic empyema of the pleura was demonstrated. 37 (78.7%) patients were cured by this method.

219 cases of nonspecific spontaneous pneumothorax have been analysed. The bullous lung disease was the reason of pneumothorax in 55% of cases. Diagnostic and curative thoracoscopy is an important element of diagnosis. It was performed in 45 patients. Surgical operations were done in 56 patients. An active surgical policy in the treatment of spontaneous pneumothorax is advocated. Partial and subtotal pleurectomy plays an important role in surgery, especially in diffuse bullous lung disease.

Timely discovery of the bullet or its fragments in the human body and determination of the character and size of the damage inflicted to the internal organs guarantee adequate treatment of the injured. USE makes it possible to exclude or recognize injury to the parenchymal organs (subscapular and intra-tissue hematomas, complete crushing of the organ), and to reveal free or bounded fluid in the abdominal and pleural cavities and in the retroperitoneal space. Moreover, USE may be applied for identifying the location of the bullet or fragment in he parenchymal organ, the subcutaneous fat or the retroperitoneal fat. Intraoperative USE proves to be of great aid in many cases because it allows complete examination of the structure of the internal organs and the abdominal spaces in all planes and the condition of the retroperitoneal fat. The article describes cases in which USE helped in precise localization of the bullet and in revealing the character of the damage, as the result of which an optimal plan of surgical intervention was chosen.

The results of treatment of 418 patients with spontaneous pneumothorax are discussed. A total of 167 operations were carried out; they consisted in direct removal of the cause of the pneumothorax and operative pleurodesis. The complex of surgical measures included drainage of the pleural cavity, costal or apical pleurectomy, laser pleurodesis, and one-stage operation on both lungs by means of median sternotomy. Precise indications for applying each of the methods described were defined. Recurrent pneumothorax after the operative interventions was not encountered.