An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.

The paper considers an approach to solving a problem in the recovery of the cervical esophagus and in the closure of fenestrated tracheal defects in modern reconstructive thoracic surgery. It describes the clinical observation of a patient with postnecrotic cervical esophageal defect, extensive cicatricial stenosis and defect of the trachea. Methods for esophageal segmental plasty using a small intestine autograft, prefabrication, and movement of a graft on the basis of the pectoralis major muscle and free costal cartilages are depicted.

The paper considers an approach to solving a problem in the recovery of the cervical esophagus and in the closure of fenestrated tracheal defects in modern reconstructive thoracic surgery. It describes the clinical observation of a patient with postnecrotic cervical esophageal defect, extensive cicatricial stenosis and defect of the trachea. Methods for esophageal segmental plasty using a small intestine autograft, prefabrication, and movement of a graft on the basis of the pectoralis major muscle and free costal cartilages are depicted.

Surgical treatment of cervicothoracic injuries has a special place in emergency surgery. Trauma of two anatomic regions adds some difficulties to exploration of wound and detection of all injuries. Unrevealed injuries lead to various complications, including fistulas of hollow organs.

AIM:To define the risk factors of complications which are followed by re-operations in patients with cardiac and pericardial wounds and to prevent these complications.MATERIAL AND METHODS:Retrospective and prospective analysis of 1072 victims with cardiac and pericardial injuries for 35 years was performed. Overall mortality was 17.2%. 98 patients died during surgery. Postoperative bleeding was observed in 38 (3.9%) cases.RESULTS:In 28 cases re-operations were performed for bleeding-related complications. Indications for re-thoracotomy were one-time drainage from pleural cavity over 500 ml or bleeding rate over 100 ml per hour for 4 hours. Prevention of postoperative bleeding in case of cardiac and pericardial wounds was developed on basis of analysis of these observations.CONCLUSION:Risk factors of complications requiring re-operation are cardiomyopathy of different etiology, technical and tactical errors during primary intervention and hypocoagulation with massive blood loss. Prevention of these complications includes careful heart wound closure, comprehensive intraoperative control, correction of hemostatic system.

Surgical treatment of cervicothoracic injuries has a special place in emergency surgery. Trauma of two anatomic regions adds some difficulties to exploration of wound and detection of all injuries. Unrevealed injuries lead to various complications, including fistulas of hollow organs.

ABSTRACT. According to most researchers, spontaneous rupture of the esophagus (SRE) occurs relatively rarely, ranging from 1.7% to 17.5% of all cases of damage to the esophagus. Today, there is no one categorical opinion on the effectiveness of various treatments for SRE among surgeons, there are no uniform algorithms for diagnosis and evaluation of the treatment. SRE is a real threat to the life of a patient: SRE mortality rate is up to 75% in the prehospital period and up to 25%-85% in the postoperative period, and depends on the time interval between the rupture of the esophageal wall and the surgery, as well as complications.

It analyzed the diagnosis and treatment results of 123 patients with cervicothoracic injuries for 21 years. The frequency of cervicothoracic injuries among all patients with cervical injuries was 5.7%. Preoperative and postoperative diagnosis included radial and endoscopic methods. The complications rate was 43.6%. The most severe complications were observed in patients with delayed diagnosis of trachea and esophagus injuries.

The results of the diagnosis and treatment of 117 patients with cervicothoracic injuries were analyzed. Different complications were observed in 51 (43.6%) cases. The main reasons contributing to the development of complications included late diagnosis of lesions of trachea and esophagus, acute blood loss, inadequate hemostasis during surgery.

The comparative analysis of 56 immunograms of patients with mediastinitis, caused by the esophagus trauma is represented. The mean values of 9 immunologic parameteres (the so called "norm of the pathology") were set for patients with noncomplicated mediastinitis. A novel method of the immune status evaluation for the patients with the acute surgical conditions and SIRS has been suggested. If early applied, the method allows substantive immunotherapy for such patients.

Treatment results of 38 cases of septic mediastinitis for the last 17 years were analyzed. The frequency of mediastinitis as a complication of the penetrating wound was 0.28%, and of the closed thoracic trauma - 0.1%. Reasons and risk factors of the mediastinitis development have been revealed. The enlargement of the mediastinum on the X-ray allowed the primary diagnostics of suspicion on the mediastinitis in 39.5% of cases. The spiral computed tomography provided information for the further treatment options. The mediastinum drainage was an effective method of treatment, providing the improvement in 69.6% patients after penetrating wound and in 73.3% after the closed thoracic trauma.

Closed chest injury with rupture of the trachea and main bronchi is a rare and extremely life-threatening pathology. In suspected tracheal injury, as well as in severe closed chest injury with the gas syndrome, diagnostic tracheobronchoscopy with possible intubation is indicated in order to isolate the airway lumen from the paratracheal space. Tracheal intubation through a fibrobronchoscope should be considered to be the first aid. Tracheostomy is not the operation of choice and it is indicated only when there is no available technology or experience in intubating the airways under endoscopic guidance. Most small tracheal ruptures in closed chest injury, as well as those of iatrogenic postintubational genesis, may be medically eliminated. A surgeon jointly with an anesthetist and a bronchological endoscopist should determine indications for the operation. The operation should be performed as early as possible. It should be started from the intubation of the airways and the insertion of the end of an intubational tube caudally the rupture. When the breathing circuit is depressurized, all alternative gas exchange maintenance techniques available at an anesthetist's disposal, including high-frequency artificial ventilation and a shunt-breathing system, are indicated, which should provide a patient's safety and surgical comfort.

Overall 1218 patients with lung injuries were treated during 11 years. The rate of deep wounds and injuries of central zone and root of lung was 24.9%. Endoscopic and x-ray methods (especially computed tomography) were used for diagnosis. Surgical tactics depended on type of injury. Resection of lung and pneumonectomy were performed at 10.2% patients, closure of lung wound--at 41.3%. Surgical treatment of lung wound with dissection and revision of wound canal was performed at 42.6% patients with deep injuries. Classified surgical tactics permits to reduce the rate of postoperative pulmonary complications from 62 to 11.6%, and lethality--from 11.2 to 3.1%.

Iatrogenic damage to the trachea in its intubation and during artificial lung ventilation ,is a rare, severe and commonly fatal complication in resuscitative care. The risk for tracheal damage increases in emergency, time shortage and hypoxia in a patient, while intubating with a double-lumen tube, using rigid mandrin guides without a safety limit stop, and having difficulties in intubating the patient due to his/her anatomic features. Fibrotracheoscopy is the principal diagnostic techniques that may cause tracheal rupture, which may be transformed to a therapeutic measure, by placing an intubation tube caudally at the site of tracheal rupture. Among 33 patients, only 6 underwent surgical defect suturing. When the trachea is ruptured, surgery is indicated for respiratory hemorrhage unstopped by inflating the cuff of an intubation tube and, perhaps, associated with the damage to a large vessel; for progressive gas syndrome, extensive rupture of the membranous part with the involvement of the tracheal bifurcation and main bronchus or with the interposition of paratracheal tissues; for a concomitant damage to the esophagus; for rupture of the tracheal membranous part during intubation before thoracotomy or for rupture detected during thoracotomy for another cause. Correct and timely care may eliminate this life-threatening iatrogenic complication, by yielding a good effect.

We have studied NO production, ACE activity and their correlation in pleural fluid of patients with and without lung wound, in the blood serum of the wounded and blood donors. Chest wound was associated with a significant elevation of NO levels in all study groups versus controls. The greatest increase of ACE activity was observed in pleural fluid of patients with a lung wound. There was a negative correlation between NO and ACE in pleural fluid of patients with a lung wound. In all the other groups, a positive correlation between NO and ACE was revealed. ACE overactivity in the pleural fluid may be one of the factors of impaired relationship between NO and ACE in lung wound. Determination of ACE activity in the pleural fluid may serve as a diagnostic criterion of the lung injury.