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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.

Aim: To assess an efficacy of diagnostic and curative bronchoscopy in patients with purulent-destructive pulmonary diseases., Material and Methods: Diagnosis and treatment of 34 patients with purulent-destructive pulmonary diseases including small-focal destruction (14) and lung abscesses (19) were analyzed. 33 patients underwent diagnostic fibrobronchoscopy (FBS) with brush and transbronchial biopsy. Curative endoscopy included bronchial tree sanation, peribronchial administration of antibiotics (5) and transbronchial drainage of abscess (14)., Results: Atrophic bronchitis and cicatricial deformity of the 2-3rd segmental bronchi were revealed in 81.8% and 15.2% respectively. Transbronchial biopsy confirmed malignant neoplasms (15.2%) and pulmonary tuberculosis (6.1%). Peribronchial administration of amikacin in patients with small-focal pulmonary destruction and transbronchial drainage of abscesses accelerated pulmonary tissue repair and complete recovery., Conclusion: Transbronchial biopsy in patients with destructive pulmonary diseases verifies pathological process and excludes malignant and specific pulmonary damage. Complex use of endoscopic methods is associated with positive clinical result in all patients with pulmonary destruction.

Aim: To improve treatment of patients with cicatricial tracheal stenosis using different methods of recanalization and circular resection., Material and Methods: Analysis involved 57 patients with cicatricial tracheal stenosis including 2 post-traumatic cases, 27 post-intubation cases, 25 cases after tracheostomy and 3 restenoses after previous circular resection. There were 5 cases of tracheal stenosis combined with tracheoesophageal fistula, 1 patient with chest nodular goiter, 8 cases of unclosed tracheostomy and 3 patients with long-existing laryngotracheal fissure. There were 25 women and 32 men aged 15-65 years. Stenosis length ranged from 3.0 to 4.5 cm in 66.6% of patients. There were 13 (22.8%) patients with subcompensated stenosis (d=0.5-0.7 cm) and 44 (77.2%) cases of decompensated stenosis (d<0.5 cm) combined with suppurative tracheobronchitis that required endosurgical recanalization with stenting or balloon dilatation. 45 patients underwent upper tracheal third resection, 9 - middle third resection, 3 - upper third and cricoid cartilage resection. Length of excised segment was 2.5-9.5 cm. Simultaneous suturing of esophageal anterior wall defect was performed in 5 cases., Results: Complete recovery of tracheal lumen was achieved in 54 patients (93%). Restenosis occurred in 4 (7%) cases (3 of them underwent repeated resection with good results and 1 - stenting)., Conclusion: Circular resection is optimal treatment of cicatricial tracheal stenosis. Endosurgical recanalization is preparatory method prior to radical surgery.

The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

It was done the retrospective analysis of the endoscopic hemostasis effectiveness in 207 patients with gastroduodenal bleeding in the period from November 2011 to April 2013. The differential approach to the choice of hemostasis methods and consistency of their application were developed. It was done the comparative analysis of two- and three-stages combined hemostasis results. The analysis included the infiltration of the submucosal layer by 0.01% solution of adrenaline, argon-plasma coagulation and hemostatic glue applique.

The article deals with results of fiberoptic bronchoscopy using during treating of patients suffering atelectasis. According to the research atelectasis is likely to advance in the first three days after serious patients have been admitted to the intensive therapy unit or after operative treatment. Left-sided atelectasis is half as widespread again the right-sided one. The research highlights the effectiveness of atelectasis X-ray diagnosis. Fiberoptic bronchoscopy in almost all the cases allowed diagnosing the degree of tracheobronchial tree obstruction and its causes. Single suction fiberoptic bronchoscopy leads to normalization and encouraged positive dynamics in 76% of all the cases (57 patients). Repeated endoscopic sanation in the first two days was necessary for 25 patients (25.3%) with unresolved or reoccurring atelectasis. The effectiveness of second research was to 84%. It's important to add that mostly patients with serious chest injury were subjected to unresolved or reoccurring atelectasis. And mainly in these cases blood was seen through the tracheobronchial tree lumen.

The goal of the study was to assess of efficacy of endoscopic diagnosis, prevention and treatment of intubation related larynx and tracheal injuries in patients with acute neurosurgical pathology and prolonged mechanical ventilation. 199 patients with different neurosurgical pathology were enrolled in the study group. Mean age was 50 +/- 14. Control group consisted of 399 patient. Mean age was 43 +/- 12. Clinical state of patient from both group were similar. Endoscopic method in the study group included revision of airways via nasal route with tracheostomy tube inserted. Larynx and tracheal injuries by endoscopy were identified in 42 patients (33.6%) in the study group and in 12 patients (7.6) in the control group. Such injuries weren't mentioned in 83 patients in study group and in 146 patients of the control group. Tracheal stenosis was developed in the study group in 0,8% of patients, which is by 7,9 times lower than in the control group (6.3%). We consider that this result was achieved due to our approach to treatment and prevention of tracheal stenosis.

The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10-32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.

The results of the single-stage surgical treatment of 54 patients with the complicated forms of colon cancer were analyzed. All patients had radical operations with the formation of primary intestinal anastomosis. For the improvement of the results we have optimized the algorithm of the diagnostics and treatment of such patients, including the endoscopic colon decompression with its recanalization and colic stasis liquidation. The approach to the colon cancer, complicated with the intestinal bleeding was also optimized by the use of intensive hemostatic and substitutional therapy. The optimal use of the described above methods allowed the single-stage radical endosurgical treatment of the patients.

Aim of the Study: to assess the results of using endoscopic techniques to achieve hemostasis for the control of bleeding and the prevention of recurrent bleeding from esophageal and gastric varices in the patients with primary liver cancer and metastatic liver lesions., Materials and Methods: in the period of 2009-2011,7 patients with primary liver cancer or metastatic liver lesions complicated by gastro-esophageal bleeding were treated in the Sklifosovsky Clinical and Research Institute for Emergency Medicine. The sources of bleeding were esophageal varices in 6 patients, gastric varices in 1., Results: a diagnostic esophagogastroduodenoscopy (EGDS) revealed, besides the varices, an erosive hemorrhagic gastritis in 4 patients, a ruptured mucosa of cardio-esophageal transition in 1, an erosive hemorrhagic gastritis and a liver tumour invasion in the stomach antrum in 1. The hemostasis achieved by means of paravasal injections with a 20% glucose solution was efficient in 2 of 3 patients. The endoscopic ligations of esophageal varices were performed in 3 patients. Five patients died from the underlying disease progressing. In one of them, the cause of death was a recurrent bleeding from esophageal varices., Conclusions: in the patients with primary liver cancer and metastatic liver lesions, the use of mini-invasive endoscopic techniques is more appropriate, because the surgical treatment of this patient population carries a very high risk.

The results of 36 endoscopic procedures performed because of clinical signs of the gastrointestinal bleeding to the patients, hospitalized with traumatic fractures of pelvis and lower limbs, were analyzed. The acquired data allowed to reveal the terms of bleeding development and the efficacy of the endoscopic hemostasis, as well as substantiate the need of antisecretory treatment for the curtain age category of patients.

Results of diagnostic and treatment of 156 patients with pulmonary hemorrhage, caused by the closed thoracic trauma, were analyzed. All patients had lung bruise, 101 of them had lung rupture. 115 (73.7%) patients demonstrated hemopneumothorax, bleeding was diagnosed in 86 (55.1%) cases and mediastinal emphysema was diagnosed in 52 (33.3%). Pulmonary hemorrhage developed more often by polytrauma of the chest, rather then by solitary lesions. Spiral computed tomography proved to be the best diagnostic means of thoracic trauma. Surgical tactics was defined mainly by the severity of intrapleural or pulmonary bleeding. Conservative treatment allowed successful recovery in the majority of patients. Only 5.1% of patients required surgery. High level of septic complications of pulmonary hemorrhage was registered/ Pneumonia developed in 28.8% and lung abscess was diagnosed in 14.1% of patients. The lethality rate was 9.6%.

In article is shown the results of investigation of motility function of esophagus in 18 patients with pharyngoesophageal obstruction. 16 patients were operated. The essence of method was in simultaneous registration of UES intracavitary pressure and impedance. We discovered that all patients have both not opening of for the swallow and disturbances of sphincteral function of LES and contractive activity of thoracic esophagus. Dynamic of this parameters in 7 operated patients was monitored. Obtained data were analyzed according to clinical results of surgery.

Data of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients. Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8. 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years. Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.

Analysis of the clinical and laboratory parameters in patients with acute poisoning by cauterants has demonstrated that inclusion of the antioxidant mexidole into the package of therapeutic measures is effective in treating the above pathology. This is supported by the reductions in the proportion of fatal outcomes by more than twice and in the incidence of pneumonia complicating the course of the underlying disease, as well as by the increase in the rate of regeneration of ulceronecrotic defects in the gastrointestinal tract and by the decrease in the number of gastric cicatricial deformities when mexidole is locally used.

Intragastric pH-metry and esophagogastroduodenoscopy has been performed in 64 patients with chemical burn of the esophagus. It has been revealed that 51.6% patients had hyperacidity, 25% - normacidity, and 23.4% - hypoacidity. Gastroesophageal reflux has been diagnosed in 50% patients according to pH-metry examination and in 80-100% patients according to esophagogastroduodenoscopy, duodenogastric reflux - in 25 and 34.4% cases, respectively. A direct correlation exists between gastroesophageal reflux and basal gastric acidity, severity of chemical burn of the esophagus. It is concluded that antisecretory therapy is mandatory in complex treatment of patients with chemical burn of the esophagus.

Esophagogastroimpedancemanometry conducted in 40 patients with chemical bums of the stomach (CBS) in acute and early postburn periods has revealed that CBS affect motor function of the cardia in 95% patients. This motor cardial dysfunction results in erosive and erosive-ulcerous reflux-esophagitis in 22.5% patients. Motor dysfunction of the cardia and esophagitis depends both on CBS severity and time since the trauma. Gastroesophageal reflux in CBS patients is triggered by intragastric hypertension accompanied with lowering of the esophageal-gastric pressure gradient provoking motor dysfunction of the esophagus and reduction of the esophageal clearance.

Intragatric pH-metry made in 80 patients with chemical gastric burn (CGB) in the acute and early postburn periods revealed that in 17% of the victims, gastric acid secretion remains normal, 51.2% of cases showed its increase (hyperacidity) whose maximum rates (100%) are detected in patients with extensive CGB of the third degree and whose minimum rates (20%) were found in those with fourth-grade CGB. Hypoacidicity was diagnosed in 31.2% of the patients. A significant (1.7-6-fold) enhancement of acid secretion was observed during stimulation, which suggests the compensated hyperfunction of intact gastric mucosal portions and supports the fact that the values of basal acidicity are leveled by bile reflux duodenogastritis. The latter was diagnosed by pH-metry data in 63.8% and by esophagogastroduodenoscopy (EGDS) in 87.5% of cases. The detection rate of reflux gastroesophagitis (RGE) was also higher by EGDS than that by pH-metry: 42.5 and 26.3% of cases, respectively. The lowest detection rate of RGE was noted in patients with fourth-degree CGB whereas the endoscopic signs of reflex esophagitis (RE) were most pronounced: erosive and ulcerative RE was diagnosed in 28% of cases.

The experiences with endoscopic examinations of 140 patients with gastroesophageal reflux followed by the development of reflux-esophagitis (RE) of different degree are presented. The authors describe the complicated and uncomplicated forms of RE. The uncomplicated forms include RE with unimpaired integrity of the epithelium, erosive RE, erosive-ulcerous RE. The complicated forms include peptic ulcer of the esophagus, peptic stricture and Barrett esophagus. The degree of RE was found to depend on the character and degree of impairment of the obturating function of the cardia. The morphological examination of the esophagus mucosa was performed in 35 patients. Morphological heterogeneity of the so called "catarrhal RE" was shown that makes the expedience of using this term in clinical practice doubtful. Exact endoscopic and morphological criteria of the differential diagnostics of erosive and erosive-ulcerous RE, erosive-ulcerous RE and peptic ulcer of the esophagus are described.

The results of 424 biopsies obtained at fibrobronchoscopy (FBS) from 45 patients with inhalation trauma (IT) are presented. The standard and endoscopic laser treatment (ELT) have been used (24 and 21 patients, respectively). It is demonstrated that precise visual assessment of IT severity is possible under dynamic endoscopic observation only. Healing of mucous defects of the tracheo-bronchial tree was shorter in the ELT group. Morphologically, early and continuous ELT was not associated with signs of severe purulent inflammation and, therefore, produced no early additional, damage to the wall. This may explain accelerated formation of the granulation tissue at the ulcer bottom and epithelization at the margin areas.

Experience in endoscopic examination and treatment of 282 patients with isolated and combined chemical burn of the esophagus (CBE) of different severity is presented. Endoscopic treatment, performed in combination with chemotherapy, consisted in irradiation of burn surface with low-energy laser 'Mustang' through the canal of the endoscope. The procedure was performed 3 times a week up to complete epithelization of burn ulcers. Both in primary esophagogastroduodenoscopy and in repeated examinations sphincter function of the cardia, presence and sizes of axial hiatal hernia, changes of esophageal mucosa and presence of gastroesophageal reflux were analyzed. It is demonstrated that CBE was associated with dysfunction of the cardia in more than 90% cases. Rate of erosive and ulcerous reflux-esophagitis was 24.6-34%; cicatrix stricture of the esophagus - 6.3-12.2% in isolated and combined CBE, respectively. Severity of reflux-esophagitis and its complications was determined by severity of chemical burn.

One hundred and forty patients with clinical symptoms of gastroesophageal reflux disease were examined. Instrumental examination included esophagogastroduodenoscopy (140 patients) with target biopsy (44 patients), x-ray study of the esophagus and stomach (95), intragastric pH-metry (74), esophagomanometry (67). It is demonstrated that all the patients with clinical picture of gastroesophageal reflux disease suffer from reflux-esophagitis (RE) of various severity. Definite morphological equivalents correspond to each of endoscopic forms of RE. Complex instrumental diagnosis of RE must include intragastric pH-metry and esophagomanometry in line with esophagogastroduodenoscopy and morphological study. It is necessary to perform x-ray study in peptic strictures of the esophagus and in combination of RE with large axial hiatal hernias. Cardial or cardial-fundal hiatal hernia, increase of intragastric pressure and hyperacidity promote development of the most severe (destructive) forms of RE.

The treatment of patients with burn injuries of the tracheobronchial tree is a pressing problem today, because of rather high prevalence of this injury and high mortality (90%). Clinical signs during the first 24 h do not allow evaluating the severity of the injury. Based on analysis of case histories of 24 patients, the authors sum up results of complex examinations including fibrobronchoscopy, microbiological, and histological studies. Fibrobronchoscopy precisely showed the degree and extension of airway involvement in burn injuries, while accessory microbiological and histological studies help timely predict the development of pyoseptic complications. Endoscopic methods of therapy promote a more rapid reduction of inflammation and healing of erosive ulcerative involvement of the tracheobronchial mucosa.