Differential diagnostics of tumors of anterior mediastinum is one of the most difficult problems of thoracic surgery and oncology. The authors conducted a retrospective analysis of the results of transthoracal puncture biopsy under ultrasonic induction in 44 patients with the tumors of the anterior mediastinum. Transthoracal biopsy was carried out using the device for biopsy (Multiple Biopsy Device-MBD-23) and ultrasonic scanner (Voluson 730 Expert), the patients being under intravenous (38 patients) and under local (6 patients) anesthetization. The diagnosis was made as a result of morphological research in all 100% of patients, the biopsy being performed the second time in one patient. The general information value of puncture biopsy under ultrasonic induction was 98%. A complication (localized pneumothorax, cupping off by itself) took place only in one of the follow-up study (2%). The analysis of presented material let the authors make a conclusion that transthoracal puncture biopsy under ultrasonic induction is a safe and highly informative method of diagnostics of tumors of the anterior mediastinum in selected patients.

An analysis of results of 18 laryngotracheal resections in patients after prolonged artificial pulmonary ventilation with circular, A-shaped or mixed forms of stenosis has shown that one-stage sleeve resection of the larynx below the glottis and upper third of the trachea with the formation of primary anastomosis is possible without placing a stent when they have cicatricial lesion. In patients with laryngotracheal stenosis the sleeve laryngotracheal resection is recommended with primary thyrocricoid tracheal anastomosis as a comparatively safe and effective reconstructive operation giving good immediate and long-term results.

The authors present the results of a study of the baseline condition, the parameters of external respiratory function, gas exchange, and hemodynamics in 42 patients with tracheal cicatricial stenosis (TCS). The impact of transcatheter normofrequency artificial ventilation (AL) on the respiratory and circulatory parameters was studied during surgical TCS removal. The baseline impairments were identified in the external respiratory system and in the hemodynamic provision of breathing processes, which corresponded to first-second grade respiratory failure disorders, despite preoperative tracheal bougienage elimination. Normofrequency and high-frequency AL is the method of choice in treating patients with concomitant respiratory diseases.

Surgical policy for scarry tracheal stenosis is analyzed. In the years 1998-2003 in the clinic there were 32 circular resections of the trachea. More than 5 cm of the tracheal segment was ablated in 15 of the cases. The initially performed endoscopic treatment including bougieurage and trachea endoprosthesis was carried out in 19 patients. The immediate and long-term results were satisfactory in all cases that allowed the authors to recommend the one-step circular resection of the trachea as a method of choice for the treatment of lengthy scarry stenoses of the trachea.

Mycotoc aneurysms (MA)--a rare and extremely dangerous lesion of the aorta. CT, MRA and aortography were used to diagnose MA of the thoracoabdominal areas in 2 men of 64 and 67 years of age. The clinical picture included: fever with shivering with the temperature 38-39 degrees C and increasing pains in the inferiothoracic and lumbar areas of the spine. Hemoculture was positive in 1 patient only. The patients were operated on. Shunting of the aorta from the inferiothoracic to infrarenal segments was performed in one patient with the exclusion of the involved portion and resection of MA. Metalloosteosynthesis of the spine due to destruction of LI-LII and compression of the spine were performed in the second patient followed by analogous shunting of the aorta and visceral arteries with the resection of the aneurysm. To prevent infection of the prostheses the shunts were wrapped up with a piece of the greater omentum. One patient died two months later from recurrent sepsis. The other one is alive, within 28 months the shunts are patent, there are no signs of a reinfection.