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To analyze the results of thoracoscopic esophagectomy for benign esophageal diseases.The study included 78 patients who underwent thoracoscopic esophagectomy between 2011 and 2019. Peptic and burn strictures of the esophagus were diagnosed in 53 patients, achalasia - in 24 patients. Minimally invasive esophagectomy and esophagoplasty with isoperistaltic gastric tube and esophagogastrostomy on the neck was performed in 68 patients, Ivor Lewis esophagectomy - in 1 patient, coloesophagoplasty - in 9 patients. We used manual technique of anastomosis in 58 patients, stapling device - in 19 patients. In 1 case, surgery was finished with esophagostomy and gastrostomy.Mean blood loss was 200 ml (10-1200), surgery time - 450 min (265-765 min). Early postoperative complications occurred in 37 patients including anastomotic leakage in 24 cases. In long-term period, anastomotic strictures developed in 9 patients. No mortality was observed.Minimally invasive esophagectomy for benign esophageal diseases ensures favorable clinical outcomes. However, no consensus in the choice of surgical approach and indications, as well as small number of these patients cause challenges in implementation of this technique. There are different opinions regarding technique of anastomosis on the neck and surgical access in thoracoscopic esophagectomy.Анализ результатов торакоскопической эзофагэктомии у пациентов с доброкачественными заболеваниями пищевода.В ретроспективное когортное исследование включены 78 пациентов, которым выполнена минимально инвазивная эзофагэктомия по поводу доброкачественных заболеваний пищевода в отделении высокотехнологичной хирургии и хирургической эндоскопии МКНЦ им. А.С. Логинова и в отделении торако-абдоминальной хирургии и онкологии РНЦХ им. Б.В. Петровского с 2011 по 2021 г., в том числе у 53 по поводу пептических и ожоговых стриктур пищевода и у 24 по поводу ахалазии кардии или кардиоспазма. В 68 случаях минимально инвазивная эзофагэктомия дополнена пластикой пищевода изоперистальтической желудочной трубкой с формированием эзофагогастроанастомоза на шее, у 1 пациента выполнена операция Льюиса и у 9 больных сделана пластика пищевода толстой кишкой. У 58 пациентов анастомоз формировали ручным способом, у 19 — с использованием механических сшивающих аппаратов. В 1 случае операция завершилась выведением эзофаго- и гастростомы.Медиана объема кровопотери составила 200 мл (10—1200 мл), длительность операции — 450 мин (245—765 мин). В ближайшем послеоперационном периоде у 37 больных отмечены осложнения, в том числе несостоятельность швов эзофагогастро- и эзофагоколоанастомоза у соответственно у 17 и 4 пациентов. В отдаленном периоде у 9 больных развилась стриктура анастомоза. Летальных исходов не было.Применение минимально инвазивных технологий при резекции или экстирпации пищевода по поводу доброкачественных заболеваний позволяет достигнуть благоприятных результатов. Тем не менее трудности с внедрением данной методики определяются отсутствием единого мнения при выставлении показаний и выборе тактики лечения, малым числом больных, различием взглядов в отношении выбора ручного или аппаратного способа формирования анастомоза на шее и варианта оперативного доступа при торакоскопической эзофагэктомии.

In this work, we demonstrate that the thiol-yne click reaction could be efficiently mediated by ultrasonic irradiation and implement the ultrasound-assisted thiol-yne click reaction to chitosan chemistry as a polymer-analogous transformation. We optimize power and frequency of ultrasound to preserve selectivity of the click reaction and avoid ultrasonic degradation of the chitosan polymer chain. Thus, we obtain a new water-soluble betaine. Using ionic gelation of the obtained betaine derivatives of chitosan, we prepare nanoparticles with a unimodal size distribution. Furthermore, we present results of antibacterial and transfection activity tests for the chitosan derivatives and their based nanoparticles. The derivative with a medium molecular weight and a high degree of substitution demonstrated the best antibacterial effect. It derived nanoparticles with a size of ca. 100 nm and ζ-potential of ca. +69 mV revealed even higher antibacterial activity, slightly superior to commercial antibiotics ampicillin and gentamicin. On the contrary, the obtained polymers possess a much more pronounced transfection activity as compared with their based nanoparticles and species with a low degree of substitution acts as the most efficient transfecting agent. Moreover, the obtained betaine chitosan derivatives as well as their derived nanoparticles are non-toxic.

Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus.To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program.Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair.The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections.The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.Существенное улучшение результатов лечения и сокращение сроков послеоперационной госпитализации может быть достигнуто при условии привлечения к ведению пациентов мультидисциплинарной команды специалистов. Внедрение программы ускоренного восстановления, учет и коррекция всех возможных факторов периоперационного периода позволят создать протокол лечения больных после обширных операций на пищеводе.Улучшение результатов реабилитации пациентов после обширных оперативных вмешательств по поводу доброкачественных и злокачественных заболеваний пищевода путем внедрения программы ускоренного восстановления.Больным с доброкачественными и злокачественными заболеваниями пищевода выполнены радикальные реконструктивные оперативные вмешательства в условиях общей сбалансированной анестезии с искусственной вентиляцией легких. При совместном участии специалистов из отделений хирургии, анестезиологии и реанимации разработана собственная программа ускоренного восстановления на основе существующих рекомендаций по ведению пациентов и систематических обзоров по применению протокола ускоренного восстановления после реконструктивных вмешательств на пищеводе по дням.Разработанная программа ведения пациентов признана эффективной вследствие сокращения количества койко-дней в отделении реанимации и интенсивной терапии, общей продолжительности послеоперационной госпитализации у всех пациентов основной группы. Сокращению сроков наблюдения пациентов в отделении реанимации и интенсивной терапии способствовало применение малоинвазивных видеоэндоскопических методов. Менее выраженная хирургическая стресс-реакция наблюдалась у пациентов группы торакоскопических субтотальных резекций пищевода.Внедрение и применение программы ускоренного восстановления способствует уменьшению сроков общей госпитализации и количества койко-дней в отделении реанимации и интенсивной терапии при реконструктивных вмешательствах на пищеводе, а также позволяет оптимизировать схемы послеоперационного ведения пациентов как без осложнений, так и при их развитии.

Copper(II) complexes with 1,1,1-trifluoro-4-(4-methoxyphenyl)butan-2,4-dione (HL1) were synthesized and characterized by elemental analysis, FT-IR spectroscopy, and single crystal X-ray diffraction. The biological properties of HL1 and cis-[Cu(L1)2(DMSO)] (3) were examined against Gram-positive and Gram-negative bacteria and opportunistic unicellular fungi. The cytotoxicity was estimated towards the HeLa and Vero cell lines. Complex 3 demonstrated antibacterial activity towards S. aureus comparable to that of streptomycin, lower antifungal activity than the ligand HL1 and moderate cytotoxicity. The bioactivity was compared with the activity of compounds of similar structures. The effect of changing the position of the methoxy group at the aromatic ring in the ligand moiety of the complexes on their antimicrobial and cytotoxic activity was explored. We propose that complex 3 has lower bioavailability and reduced bioactivity than expected due to strong intermolecular contacts. In addition, molecular docking studies provided theoretical information on the interactions of tested compounds with ribonucleotide reductase subunit R2, as well as the chaperones Hsp70 and Hsp90, which are important biomolecular targets for antitumor and antimicrobial drug search and design. The obtained results revealed that the complexes displayed enhanced affinity over organic ligands. Taken together, the copper(II) complexes with the trifluoromethyl methoxyphenyl-substituted β-diketones could be considered as promising anticancer agents with antibacterial properties.

Copper(II) complexes with 1,1,1-trifluoro-4-(4-methoxyphenyl)butan-2,4-dione (HL1) were synthesized and characterized by elemental analysis, FT-IR spectroscopy, and single crystal X-ray diffraction. The biological properties of HL1 and cis-[Cu(L1)2 (DMSO)] (3) were examined against Gram-positive and Gram-negative bacteria and opportunistic unicellular fungi. The cytotoxicity was estimated towards the HeLa and Vero cell lines. Complex 3 demonstrated antibacterial activity towards S. aureus comparable to that of streptomycin, lower antifungal activity than the ligand HL1 and moderate cytotoxicity. The bioactivity was compared with the activity of compounds of similar structures. The effect of changing the position of the methoxy group at the aromatic ring in the ligand moiety of the complexes on their antimicrobial and cytotoxic activity was explored. We propose that complex 3 has lower bioavailability and reduced bioactivity than expected due to strong intermolecular contacts. In addition, molecular docking studies provided theoretical information on the interactions of tested compounds with ribonucleotide reductase subunit R2, as well as the chaperones Hsp70 and Hsp90, which are important biomolecular targets for antitumor and antimicrobial drug search and design. The obtained results revealed that the complexes displayed enhanced affinity over organic ligands. Taken together, the copper(II) complexes with the trifluoromethyl methoxyphenyl-substituted β-diketones could be considered as promising anticancer agents with antibacterial properties. © 2021, MDPI. All rights reserved. This work was funded by RFBR and Sverdlovsk region (project numbers 20-43-660042 and 20-53-00006) and supported by the basic theme of the Russian Academy of Sciences (state registration no. AAAA-A19-119011790132-7 and project no. AAAA-A19-119012490006-1). XRD experiments and analytical studies were carried out using the equipment of the Center for Joint Use “Spectroscopy and Analysis of Organic Compounds” at the Postovsky Institute of Organic Synthesis UB RAS. X-ray study was supported by the U.S. National Science Foundation (Grant DMR-1523611 PREM). The cytotoxicity assay was carried out at the “Simbioz” Center for the Collective Use of Research Equipment in the Field of Physical–Chemical Biology and Nanobiotechnology at IBPPM RAS. This work has been supported by the RUDN University Strategic Academic Leadership Program.

Well-defined diazotates are scarce. Here we report the synthesis of unprecedented homoleptic palladium(II) diazotate complexes. The palladium(II)-mediated nitrosylation of 2-aminopyridines with NaNO2 results in the formation of metal-stabilized diazotates, which were found to be cytotoxic to human ovarian cancer cells.

To report our initial experience of robot-assisted McKeown esophagectomy with stapled cervical esophagogastrostomy.There were 5 robot-assisted McKeown esophagectomies in patients with benign end-staged and malignant diseases of the esophagus for the period from October 2019 to February 2020.No conversions and intraoperative complications were observed. Mean surgery time was 406±48 min, total intraoperative blood loss - 108±45 ml. Four patients had minor complications (wound infection, atelectasis, pneumothorax) that required conservative treatment. We have controlled anastomosis in 2-3 postoperative days with water-soluble contrast, none patient had an anastomotic leakage. Mean hospital-stay was 5 days. Complete (R0) resection was accomplished in all patients with malignant neoplasms.Our first experience showed that robot-assisted McKeown esophagectomy is a safe and feasible surgical option for esophageal diseases. Robot-assisted interventions require advanced endoscopic surgical experience.С появлением эндовидеохирургических технологий произошло их активное внедрение в хирургию пищевода, что позволило минимизировать хирургическую травму и кровопотерю, а также частоту интра- и послеоперационных осложнений по сравнению с традиционными открытыми методами операций. Дальнейшее совершенствование эндовидеохирургических технологий привело к появлению роботизированного хирургического комплекса da Vinci, обладающего целым рядом технических преимуществ.Представить первый опыт выполнения робот-ассистированных субтотальных резекций пищевода с одномоментной пластикой желудочной трубкой по McKeown с формированием механического эзофагогастроанастомоза на шее.С октября 2019 по февраль 2020 г. выполнено 5 робот-ассистированных субтотальных резекций пищевода с одномоментной пластикой желудочной трубкой по поводу рака пищевода и ахалазии IV стадии.Средняя продолжительность операций составила 406±48 мин (319—460 мин). Конверсий, интраоперационных осложнений не было. Суммарная кровопотеря в среднем составила 180±45 мл. У 4 пациентов в послеоперационном периоде наблюдали «малые» осложнения (нагноение раны, ателектаз, пневмоторакс), которые купированы консервативно. На 2—3-и сутки после операции пациентам проводили рентгенологический контроль анастомоза, при этом несостоятельности швов не выявлено ни в одном наблюдении. Средний срок пребывания в стационаре составил 5 койко-дней. У больных, оперированных по поводу рака, при гистологическом исследовании краев резекции макропрепарата роста опухоли не выявлено (R0).Наш первый опыт показал, что робот-ассистированная эзофагопластика по McKeown безопасна и выполнима при заболеваниях пищевода. В то же время робот-ассистированные вмешательства требуют навыков и опыта эндовидеохирургических операций, а также выхода хирурга на плато кривой обучения.

We evaluated the possibility and effectiveness of transaxillary gas-free approach for minimally invasive Zenker's diverticulectomy. A 64-year-old patient with large Zenker's diverticulum (6 cm) and pathognomonic symptoms is presented. Transaxillary gas-free minimally invasive diverticulectomy was performed using an endoscopic linear stapler. Surgery time was 137 min. There were not any postoperative complications including recurrent laryngeal nerve injury. X-ray examination after 2 postoperative days revealed no signs of anastomotic leakage, so the patient was allowed to drink and consume liquid food from the 3rd day. Patient was discharged on the 7th day. Minimally invasive surgical technology ensures effective and radical transaxillary diverticulectomy in patients with Zenker's diverticulum. The advantages of this method are good and detailed exposition of surgical field, including recurrent laryngeal nerve, more precise and less invasive manipulations and better cosmetic effect. The method may be an alternative to traditional and endoscopic diverticulectomy for a certain group of patients. However, experience accumulation and further prospective studies are required.Оценить возможность и эффективность трансаксиллярного безгазового доступа для эндовидеохирургического удаления дивертикула Ценкера.Представлено клиническое наблюдение пациента в возрасте 64 лет с дивертикулом Ценкера больших размеров (6 см) с выраженной характерной клинической симптоматикой. Выполнена трансаксиллярная безгазовая эндовидеохирургическая дивертикулэктомия с помощью эндоскопического линейного сшивающего аппарата.Продолжительность операции 137 мин. В послеоперационном периоде осложнений, в том числе клинических признаков повреждения возвратного гортанного нерва, не отмечено. Контрольное рентгеноконтрастное исследование выполнено на 2-е сутки — признаков несостоятельности швов не установлено. Больному разрешили пить, а с 3-х суток употреблять жидкую пищу. Выписан из стационара на 7-й день.Мини-инвазивные эндовидеохирургические технологии у больных с дивертикулами Ценкера позволяют эффективно и радикально производить дивертикулэктомию через подмышечный доступ. Преимуществом нового метода является хорошая и детальная экспозиция операционного поля, в том числе возвратного гортанного нерва, прецизионные манипуляции, незначительная травматичность, а также лучший косметический эффект, чем при открытом доступе. Метод может стать альтернативой традиционной и эндоскопической дивертикулэктомии у определенной группы больных, однако требуются накопление опыта и дальнейшие проспективные исследования.

To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery.Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group (There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group (Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.Оценить эффективность и безопасность протокола ведения пациентов в периоперационном периоде, основанного на принципах fast track, в реконструктивной хирургии пищевода.С 2014 г. в отделении торакоабдоминальной хирургии и онкологии ФГБНУ «РНЦХ им. акад. Б.В. Петровского» для периоперационного ведения пациентов, нуждающихся в реконструктивных операциях на пищеводе, применяется протокол, основанный на принципах fast track. Пациенты, пролеченные с применением нового протокола (2017—2020 гг.), составили основную группу (Группы статистически значимо не различались по полу, возрасту, статусу ASA, индексу массы тела. В результате применения нового протокола периоперационного ведения продолжительность пребывания в стационаре сократилась до 11 (8; 22) сут в группе ФТ (для сравнения: 14 (12; 18) сут в группе ТВ),Современный протокол периоперационного ведения, основанный на принципах fast track, продемонстрировал свою безопасность и эффективность при проведении обширных реконструктивных вмешательств на пищеводе, позволив сократить длительность пребывания пациентов в стационаре и в отделении реанимации и интенсивной терапии, а также снизить частоту респираторных осложнений.

To investigate the role of video-assisted subtotal esophageal resection in treatment of patients with benign esophageal diseases.Fifty-one patients with benign esophageal diseases have undergone subtotal esophageal resection in our department for the period 2010-2017. Thoracoscopic technique was applied in 25 cases, open approach - in 26 patients. Total surgery time, thoracoscopic stage duration, length of hospital-stay (LOS), ICU-stay, Clavien-Dindo morbidity rates with separate registration of respiratory complications, mortality have been considered.Groups were similar in terms of age, gender, ASA status. Thoracoscopic stage duration gradually decreased from 175 to 65 min with average time of 102 (75; 123) min. Total surgery time was 390 (270; 495) min in group 1 and 465 (341; 561) min in the control group (р=0.035). Mean ICU-stay decreased up to 2 (1.25; 3.75) days compared with the control group (5 (3.92; 5.85) days, р0.0001). Conversion rate was 8%. In the main group complications Clavien-Dindo grade 2 were detected in 10 (40%) patients compared with 20 (69%) cases in the control group (р=0.009). Respiratory complications occurred in 5 patients in group 1 and in 13 cases of the control group (р=0.039). Mortality was absent.Thoracoscopic subtotal esophageal resection may be advisable alternative to open surgery for patients with benign esophageal diseases due to lower postoperative morbidity and earlier rehabilitation followed by improved outcomes.Цель исследования ― изучение роли видеоэндоскопических операций в лечении пациентов с доброкачественными заболеваниями пищевода при проведении его субтотальной резекции. Материал и методы. С 2010 по 2017 г. в хирургическом отделении 1 ФГБНУ 'Российский научный центр хирургии им. акад. Б.В. Петровского' на лечении находился 51 больной с доброкачественными заболеваниями пищевода после выполнения субтотальной резекции органа: 25 пациентам (основная группа, 1-я) была выполнена торакоскопическая субтотальная резекция пищевода (ТСРП), 26 ― вмешательство из открытого доступа (группа сравнения, 2-я). Оценивались длительность оперативного вмешательства, длительность торакального этапа, продолжительность пребывания в отделении реанимации и интенсивной терапии (ОРИТ) и общая продолжительность пребывания в стационаре в послеоперационный период, частота развития осложнений по классификации Clavien―Dindo с отдельной регистрацией осложнений со стороны дыхательной системы, летальности. Результаты. Группы достоверно не различались по полу, возрасту, статусу ASA. Продолжительность торакоскопического этапа комбинированных операций за время накопления опыта снизилась со 175 до 65 мин, достигнув в среднем 102 (75; 123) мин. Общая продолжительность оперативного вмешательства в 1-й группе составила 390 (270; 495) мин, во 2-й ― 465 (341; 561) мин, р=0,035. Средняя продолжительность пребывания в ОРИТ после ТСРП снизилась до 2 (1,25; 3,75) сут по сравнению с группой открытых операций ― 5 (3,92; 5,85) сут, р0,0001. Частота конверсии доступа составила 8%. Осложнения по классификации Clavien―Dindo II степени в 1-й группе выявлены у 10 (40%) больных, во 2-й ― у 20 (69%) больных, р=0,009. Осложнения со стороны респираторной системы выявлены у 5 пациентов в 1-й группе и у 13 во 2-й, р=0,039. Летальность в обеих группах составила 0. Вывод. Применение торакоскопической субтотальной резекции при лечении пациентов с доброкачественными заболеваниями пищевода в настоящее время может рассматриваться как значимая альтернатива открытым операциям, поскольку сопровождается сокращением частоты развития осложнений и способствует более ранней реабилитации пациентов, улучшая результаты их лечения.

At present, no doubt enhanced by the attention of clinicians to monitor blood glucose and methods of its correction in ICU patients. Evidence of the effect of the expressed glycemic balance disorders on the results of treatment of such patients determine of the problem. Attempts to create a computer algorithm to determine the rate of insulin. The aim of the study was to investigate the efficacy and safety of the module Space glycemic control (SGC, "BBraun Germany) with intravenous insulin therapy in patients with thoracoabdominal surgery.Single-center prospective observational study was conducted in the ICU in 50 patients in the early period after operations on the abdominal and thoracic cavity, mediastinum.The average duration of the monitoring group with SGC was 57 hours (17 to 280 hours). The average length of the period during which the patients were recorded in the target range glycemia was 80.4% of the total time of SGC monitoring. The average value of glucose in capillary blood proved to 7,6?1,58 mmol/l. The incidence of severe hypoglycemia was 2% (1 patient).Application module SGC should expedient be used in patients after extensive thoracoabdiminal surgical procedures in which recorded postoperative hyperglycemia.

Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).Описано клиническое наблюдение трехэтапного лечения пациента с одновременно существующими аортолегочным и аортопищеводно-бронхиальным свищами, развившимися после имплантации стент-графта в нисходящую грудную аорту по поводу аневризмы, и осложненным рецидивирующим массивным легочным кровотечением. Своевременное успешное одномоментное протезирование нисходящей аорты, субтотальная резекция пищевода, устранение дефекта левого главного бронха позволили ликвидировать очаг хронической инфекции в средостении, надежно изолировать аортальный протез и обеспечить гладкий послеоперационный период и безрецидивную выживаемость. Последующая этапная эзофагопластика привела к излечению и полноценной социальной реабилитации пациента.

Research is devoted to study of the efficiency of osteoplastic means use at surgical interventions in oral cavity in comparison with healing of a bone wound under a blood clot. The data of experimental research and examples of clinical use of osteoplastic materials and bioresorbable membranes are presented.

Results of surgical treatment without transfusion of donor's blood in 58 patients were compared with ones in 40 patients treated with allogenous transfusions. Blood-saving program included preoperative storage of autoplasma, acute normovolemic hemodilution, recombinant human erythropoietin and perftoran. Both groups of patients were similar by types of surgeries performed on gastrointestinal tract. Results of treatment in the study group (58 patients) were better: there were less postoperative complications; period of postoperative rehabilitation was shorter. It is demonstrated that it is possible to refuse allogenous hemotransfusion in 96.6% cases of traumatic surgeries on gastrointestinal tract.

Reactions of the sympathoadrenal system were studied during surgical interventions in children aged 1.5-3 years with congenital heart disease operated under conditions of artificial circulation and hypothermia. The state of the sympathoadrenal system was different in uneventful and complicated course of the operation, which may indicate a different efficiency of the neurovegetative blocking and antistress protection from surgical trauma.

Pressure-support ventilation (PSV) with supporting pressure (SP) levels 20, 15, 13, 10, and 8 mm H2O was used in 111 patients with congenital heart disease after open-heart surgery during transfer to spontaneous respiration. PSV was associated with a significant decrease of respiratory rate and increase of respiratory volume (RV) at high SP levels. Respiration in the PSV mode permits the patient to control the inspiration flow, duration of inspiration phase, and RV, thus improving the patient-device synchronization. Cardiac index (CI) was changing with decrease of SP from 20-15 to 13 mm H2O in patients with different diseases during high SP PSV. This is caused by changed pulmonary circulation (transfer to intraacinar type) which increased the negative correlation between CI and chosen SP. In addition, CI depends not only on RV, but on the status of lung parenchyma as well.

Static compliance and inspiratory resistance were assessed in 218 patients aged over 3 years after open-heart surgery for correction of congenital heart disease during the immediate postoperative period without complications. Cst in the immediate postoperative period in patients with Fallot's tetralogy, intraventricular septum defect, intraatrial septum defect, and incomplete form of atrioventricular communication was higher than in patients operated on for Fallot's tetralogy with a previous systemic-pulmonary anastomosis and pulmonary artery atresia, whereas Rinsp was virtually the same in all groups. Age-specific differences were noted. The data are recommended for use as reference values in stress.

The authors assessed the efficacy and safety of intravenous lomir used to treat arterial hypertension in 10 coronary patients early after aortocoronary shunting. The following parameters were monitored: systolic, diastolic, and mean arterial pressure, ECG, pressure in the pulmonary artery, blood gases, and minute volume obtained by thermodilution. Intravenous lomir was found to be a highly effective hypotensive agent in patients in the early periods after aortocoronary shunting, well tolerated by the patients, the infusions being easy to monitor and involving virtually no side effects. Lomir improved the coronary bloodstream, virtually did not influence the heart rate, atrioventricular conduction, and pumping function of the heart.

The data are presented on the use of fatty emulsions for parenteral nutrition of 68 cardiosurgical patients with renal failure in the postoperative period. It has been established that intravenous administration of fatty emulsions ensures up to 50% of an overall daily calories uptake, with the infusate volume restricted considerably, helps stabilize energy and nitrogen body balance and reduces the risk of complications associated with hyperosmolality and hyperglycemia.

The results of comprehensive examinations of 13 children with orbital injuries, in whom injuries to the optic nerve were diagnosed, are analyzed. Computer-aided tomography and examinations with visual evoked potentials helped detect the signs of optic nerve injuries in the first days after the injury even in cases without ophthalmoscopic changes. Grave disorders of the involved eye visual evoked potentials were detected, that evidenced organic changes of the third neurone, despite high vision acuity. Disordered visual evoked potentials of the intact eye as against age-specific norm were detected in 8 children.

The data on the use of various schemes of artificial nutrition (AN) are reviewed in 137 patients with postoperative complications after cardiopulmonary bypass surgery. It has been established that AN as part of a complex therapy of patients in the early postoperative period has a correcting effect on metabolism and promotes the improvement of the patients' clinical condition. Rational combination of parenteral and enteral tube nutrition ensures adequate AN of cardiosurgical patients in the early postoperative period.

The relationship between the stroke output and parameters relating to left-ventricular contraction and relaxation was examined within the early hours after the implantation of prosthetic aortic valve. Quantitative analysis demonstrated a close correlation between left-ventricular performance and diastolic regidity. Left-ventricular diastolic regidity is shown to make a more important contribution than contractility to the formation of stroke output. For this reasons, a therapy aiming only to improve myocardial contractility in patients after prosthetic aortic valve implantation failed to effectively improve their clinical condition.

A peculiar form of sclerodermia is described in a 10 year girl. Initially, the disease pronounced itself with focal epileptic spells involving lated the focal sclerodermia and facial hemiatrophy. The peculiar feature of the case is the bilateral uveitis and subclinical serose meningitis. Brain CT scans and Doppler investigation of extracranial carotid and vertebral arteries were performed.

Examination of 107 patients that had undergone radical correction of tetralogy of Fallot using computer monitoring and mathematical modelling of circulation showed that right-ventricular failure was characterized by reduced cardiac output, high central venous pressure at relatively low left-ventricular pressures, high PV-PLA gradient at low pumping function of the right ventricle. An increase in the volume load in right-ventricular failure may lead to suppressed pumping function of the right heart. Thus, infusion therapy should be administered in relation to the PV-PLA gradient and its changes with increased adrenomimetic doses. Replacing assisted ventilation by spontaneous breathing should be accomplished in these patients using the technique of intermittent forced lung ventilation which is most optimal.

The authors report the indications to and the results of clinical application of interstitial injections of iodine-131 in unresectable tumors, recurrences and regional metastases of thyroid cancer. Interstitial injection of iodine-131 in 35 inoperable patients (66 injections of iodine-131) made it possible to reduce considerably the size of tumor by 1 g of the tumor, on the average, were of the order of 5140 rad, radiation exposure of blood and kidneys--0.03 rad/litre and 139 rad, accordingly. Neither complications nor grave local and general reactions were noted.

X-ray computerized tomography was used to examine the brain in 39 patients aged 14 to 39 years with different experience of using volatile narcotically acting substances. The discovered alterations make it possible to appraise the influence of toxic substances and the degree of brain atrophy, which attests to the diagnostic value of computerized tomography in patients with toxicomanias.