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A 20-year experience of treatment of 633 patients with cancer of the thoracic esophagus has been evaluated. Far advanced disease was diagnosed in 384 (60.7%). Radical, palliative and symptomatic surgery was performed in 421 (66.5%), 44. (6.9%) and 168 (26.6%), respectively. No significant differences were reported between the immediate results of radical and palliative treatment. Since survival and quality of life after palliative resection appeared to be better than after symptomatic surgery, the former should be recommended for use in clinic.

Efficacy of gel DAM+ in bronchial surgery was evaluated in experimental and clinical studies. In clinical practice DAM+ was used for treatment of 22 patients with insufficiency of bronchial stump, and in 12 patients with high risk of stump insufficiency this gel was administered into submucosal layer before stump closure. It is demonstrated that administration of DAM+ gel into submucosal layer is simple and effective method of treatment and prophylaxis of bronchial stump insufficiency.

An experience with diagnostics and surgical treatment of 291 patients with complicated course of lung cancer is described with special reference to specificities of the clinical course, preoperative management and operation technique. It was shown that the purposeful preoperative management allowed the assessment of the patients, previously thought to be inoperable, to be revised in 25% of cases, and the frequency of postoperative complications and lethality to be reduced to 14 and 3.5% respectively. The 5 year survival of lung cancer patients with paracancrous alterations was 20.7%.

Incidence of lung cancer associated with secondary paracancerous changes is known to range 13.7-30%. Since they reveal such clinical symptoms as pneumonia or empyema, most out-patients with complicated cancers are referred to general wards. Inflammatory parenchymal pathology may be conducive to false-positive or -negative diagnosis even when highly-sophisticated radiation procedures are used.

The work presents an experience with the diagnosing of synchronous tumors of double localization in 256 patients. Operations were performed on 146 of them. Single-stage operations were made in 55 cases. When performing single-stage operations, 20 patients were found to have cancer of the lung with distant metastases or cancer of other localization with a metastasis in the lung. In the other 35 patients the diagnosis of true polyneoplasia was made followed by radical operations. Advantages of single-stage operations are shown, performing the first stage of the operation on the lung being substantiated. The five year survival after surgical treatment of multiple primary cancer was 15%.

A total of 21 patients (aged 30-72) with bronchial stump fistulas (307 mm) were treated by a newly developed method of treatment of purulent-destructive pulmonary diseases. This technique represents a gradual narrowing of the bronchial fistula lumen due to infiltrate formation in the submucosal bronchial layer. The volume formation substance biopolymer "DAM+", hydrogenous biopolymer with ions of silver "Argiform" for endoprosthesis of the soft tissues, is injected into the submucosal bronchial layer. It is necessary to make 5-20 fibrobronchoscopies for bronchial fistula healing. No complications occurred as a result of this treatment. The healing of bronchial fistula and bronchial stump epithelization were found in 18 patients.

The authors present an experience with diagnosing and treatment of 16 patients suffering from lung cancer with solitary metastasis into the brain. The examination performed has shown that in 7 out of 16 patients the surgical treatment was found to be not expedient. This solution was based on the detection of an extensive spread of lung cancer: multiple metastasis outside the thoracic cavity and the brain or inside the brain, and in one case--due to a considerable reduction of indices of the functional and reserve capacities of respiration and blood circulation. Single-step operations were carried out in 9 patients with lung cancer with a solitary metastasis into the brain (resection of the lung with an ablation of the brain metastasis). Out of the 9 patients operated on 6 patients survived for as long as 1.5 to 2 years, one patient lived longer than 4 years. Two other patients operated upon in June 2003 and March 2004 are still alive and feel much better. Satisfactory results of treatment of these patients show such methods to be expedient.

Surgical treatment of 135 patients with multifocal and metastatic cancer of the lungs and other organs is analyzed. The absence of absolute differential diagnostic differences between true poly-neoplasia and synchronous or metachronous solitary metastases leads to extension of indications to surgical treatment of these patients. Surgical procedures were performed in 109 patients, 37 (33.9%) of them were one-stage. One-stage procedures meet the requirements of radical surgery and are most preferable biologically and clinically. These surgeries decrease treatment duration, prolong survival to 3-5 and more years in many patients. As cytoreductive operations, one-stage resections improve the condition of the patients, enable effective polychemotherapy.

The article presents the authors' experiences with treatment of 292 patients with spontaneous pneumothorax. Results of the suction drainage (188 patients), thoracoscopy and talc pleurodesis (43 patients), videothoracoscopic surgical treatment and pleurodesis (61 patients) are compared. The proposed algorithm allowed to make recurrences 2.8% rarer, the indications for tracheotomy appeared in 1.7% of the patients.

The article presents experiences with diagnosis and treatment of 43 patients with synchronous primary-multiple cancer of the lung with localization of one and more tumors in the lung which makes 4.8% of the number of the examined and treated patients with lung cancer in the clinic of thoracic surgery of the Military Medical Academy during 1995-2003. In 10 patients with primary-multiple cancer the injury of the lungs was combined with a tumor of the gastro-intestinal tract, in 13 with cancer of the urinary system, in 19 patients the synchronously developing tumor was localized in the lungs with a bilateral affection and in 1 case in different lobes of one lung. Surgical operations on 24 patients with primary-multiple cancer with the involvement of lungs were performed at one stage on each of the organs involved. Satisfactory results of treatment of these patients confirm the expedience of such strategy.

An experience with treatment of 53 patients with intrapulmonary metastases of malignant tumors of different nature included 65 surgical interventions, among them there were bilateral operations and reoperations. During the postoperative period complications took place in 5 cases (9.1%). After the operations there were no lethal outcomes. Long-term results of the surgical treatment of intrapulmonary metastases insignificantly differed from those of surgical treatment of primary lung cancer. The surgical treatment is thought to be an expedient method of treatment of intrapulmonary metastases in patients without recurrent tumors, late metastasis of another localization, satisfactory condition of the patient. High effectiveness of thoracoscopic methods for treatment of metastatic lesions of pleura is also noted.

A 10 year experience with dealing with the problem of surgical treatment of patients with lung cancer complicated by paracancrosis is described. Paracancrosis is characterized by the appearance and manifestation of different inflammatory and pyodestructive alterations in the thoracic cavity resulting from the tumor. The paracancrosis pathogenesis, its clinical symptoms, methods of diagnosis are described. The specific features of surgical treatment of patients with lung cancer complicated by paracancrosis are shown as well as the results of 5-year follow-up.

On the basis of classificating components of the TNM system 1720 patients with "later" stages of the development of lung cancer were selected from 3000 patients with this disease operated upon in the clinic for many years. Specific features of performing extended and extended combined operative interventions, treatment at the postoperative period are described and substantiated. After their discharge from the hospital correspondingly 26% and 21.5% of the patients who had the IIIA stage of the disease are alive for more than 5 years, that convinces in expediency of their surgical treatment.

An analysis of results of examination and treatment of 59 patients with a prolonged duration of acute abscesses of the lungs has shown the influence of immune disorders on the dynamics of the development and outcome of pyo-destructive disease in the lung. The indications to local immunosubstituting therapy were determined. A new original method of administration and a scheme of prescription of the medicine Betaleukin are proposed. Clinical efficiency of the method proposed is shown. The local immunocorrection used in the complex treatment of patients with acute abscesses of the lungs allows to get recovery of 89% of the patients.

Various aspects of classification of surgical operations in cancer of the lung are presented. The authors suggest their supplement and changes in systematization of surgical interventions in malignant tumors of the lungs published by V.I. Chissov et al. (1995). Basing on the study and analysis of many years experience in surgical treatment of patients with advanced stages of lung cancer in the clinic of thoracic surgery of the Military Medical Academy, the authors suggest classification of combined operations which takes into account both a character and an extent of an extrapulmonary spread of the tumors and thus reflects peculiarities and a high degree of traumatism of surgical intervention and allows to approach more differentially to the assessment of initial and long-term results of surgical treatment of patients.

Experience of treatment of 782 injured persons with combined thoracic trauma was summarized. Of the total number of injured persons with pulmonary contusion 177 (control group) were treated using conventional methods and 165 (basic group)--an early active operative tactics. Of the total number of injured persons in 150 with heart contusion (basic group) the cardiotropic therapy conduction was started from the hospitalization moment and in 134 (control group)--from the second day and later. Mortality while pulmonary contusion in control group was 43% and in the basic one--31%; in the heart contusion--46 and 12% accordingly.

In 32% of patients operated on the lungs various changes in the tracheobronchial tree develop as early as during the surgical intervention. They are of determining significance in pathogenesis of postoperative disorders in the external breathing function. Bronchoscopy is the most effective method of diagnosis and of timely correction of these disorders during operation on the lungs.

The causes of lethal outcomes (n = 60) and postoperative complications which occurred in 26.1% of 610 patients operated on for lung cancer were investigated with due consideration for the regularities of thermodynamics of nonequilibrium processes and theory of disasters. A total systems pathological inflammatory reaction, which augments the injury by many times and develops as a result of inadequate anesthesiological protection, underlies the development of the most unfavorable variant of response to surgery leading to life-threatening complications, such as pneumonia, thromboembolism, or ulcerative hemorrhages.

The concentration of antibiotics in the pulmonary tissue, regional lymph collectors was studied after direct and indirect endolymphatic infusions. The effectiveness of indirect endolymphatic antibiotic therapy is shown for treatment of purulent diseases of the lungs.

High curative efficiency of prolonged transbronchial catheterization of destruction cavities of the lung is shown on the basis of results of treatment of 80 patients. Possible risk factors and preventive measures in using this method are described.

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.

The paper considers the main issues of a primary emergency radiology in thoracic and abdominal gunshot injury proceeding from some practical experience gained in examining and surgically treating 271 victims with this injury. It defines specific indications to examine either anatomic region and expediency of applying various radiation techniques and procedures. Recommendations are given on the optimum scope of radiology to solve different diagnostic problems. By and large, principles and policy of radiation study are defined in thoracic and abdominal gunshot injuries.

A generalized experience with treatment of more than 1000 patients with wounds of the chest is presented. Bullet wounds prevailed. Methods of treatment of penetrating wounds of the chest are described.

In the clinic one-stage operations for cancer of the esophagus of different localizations and cardia were performed on 63 patients. The substitution of the removed esophagus was fulfilled with an isoperistaltic tube made from the greater curvature of the stomach with anastomosis on the neck or in the pleural cavity. After intrapleural plasty lethality was 21%, after total one with extracavital esophagogastroanastomoses--14%. For prevention of ischemic complications an intraoperative assessment of viability of the transplant was performed with the help of microphotoplethysmography. The authors have shown the advantage of endolymphatic route of administration of cytostatic in 25 patients as compared with the intravenous one.

The authors have studied the peculiarities of diagnosis and the results of treatment in cases of penetrating chest gunshot wounds combined with heart contusions. It was found out that heart gunshot contusions had a quite definite clinical picture, which almost was corroborated by ECG examinations. Diagnostic ultrasound is a matter of great importance in such cases. The clinical experience proves that cardiotropic therapy must be started as soon as possible in order to prevent the development of cardiogenic shock. Hyperbaric oxygenation, if started at an early period, has a solid favourable effect.

Pleuropulmonary complications in 50 patients who underwent operation for esophageal carcinoma with simultaneous esophagogastroplasty were most frequent (59%) and serious and accounted for up to 60% of all causes of early postoperative mortality. In operations through a transthoracic approach these complications occur more frequently (75%) than in operations without thoracotomy (48%). The possible causes and measures for the prevention of pleuropulmonary complications in the pre-, intra-, and postoperative periods are discussed. Particular attention is focused on the acute respiratory insufficiency syndrome during resection of the esophagus without thoracotomy. It is concluded that this serious pathological condition can be avoided by a complex of preventive and therapeutic measures carried out in all stages of treatment.

The analysis of penetration wounds accompanied by lung hurts has shown that the contusion of lung parenchyma had a quite definite clinic characteristic. The gravity of breathing disorders always depends on the volume of lung affection and blood losses. A successful treatment of lung contusions depends upon an early application of adequate measures, in which artificial lung ventilation performs a leading role.

The authors have studied peculiarities of surgical tactics for mine-burst wounds. An analysis of the observations performed has shown that the associated and multiple character of the burst trauma sets a number of medico-diagnostic tasks which require the physicians to find nonstandard solutions. First of all they are concerned with the specific preoperative preparation and a determination of the sequence of operative interventions.

In experiments on 20 dogs the authors studied haemodynamics and the myocardial contractility after severe contusion of the heart treated by counterpulsation with intraaortic balloon pump. The heart contusion leads rapidly to a marked decrease in the contractile function of the myocardium and to the development of the hypodynamic syndrome. If untreated, the trauma leads to ventricular fibrillation and death of animals 1-1 1/2 h after contusion. Counterpulsation started 30-45 min after trauma and lasting 1 1/2-2 1/2 h prevented ventricular fibrillation and improved the myocardial function.

Exact indications for urgent, early and late thoracotomy are given on the basis of a great clinical experience of the authors. Specific features of the operation, principles of the management of postoperative patients are described. The general postoperative lethality from chest injuries of the patients was 9.5%.

An analysis of results of treatment of 43 victims with knife and gunshot wounds of the heart has shown that treatment of the trauma disease in these patients is dependent on the trauma mechanism, character and localization of the myocardium wounds and intensity of bleeding. These factors taken into consideration will improve results of the treatment. General lethality among patients with injuries of the heart made up 25.5%.

Under observation were 17 patients with typhoid peritonitis. The authors describe some specific features of the clinical course of this complication. The necessary method of treatment is thought to be an urgent operation with suturing the perforated ulcer and peritonization of all the ulcers found or a resection of the injured portion of the intestine, peritoneal dialysis, drainage of the thoracic lymph duct and intensive transfusion therapy in the postoperative period. Eleven patients recovered, six patients died.

An analysis of clinical observations shows the successful treatment of most patients with open pneumothorax to be possible under conditions of urgent suturing of the wound defect of the chest, drainage of the pleural cavity and antishock therapy. Thoracotomy is necessary for a small amount of the patients.

On the basis of their experience with the treatment of such patients the authors describe modern principles of the treatment of penetrating wounds of the breast with special reference to indications for thoracotomy, treatment of lung contusion, posttraumatic empyema of the pleura.