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Purpose . To study the frequency of general surgical diseases development snd their features in patients after heart transplantation (HTx). Methods . From January 2010 to December 2018 it was performed 112 HTx (mean age – 46.7±14.0 years old; 82 – male, 30 – female). During 30 days after HTx 9 patients died. After discharge all recipients (n=98) were included in dispensary observation list. We retrospectively analyzed patients (n=35) who underwent general surgery manipulations in more than 30 days after HTx. All surgical interventions have been done under the reduction of immunosuppression therapy. Results . During 9 years of post-heart transplant follow-up 45 surgical interventions were performed, 7% (n=3) of them due to infectious complications, 31% (n=14) – oncology and others (62%, n=28). Most of manipulations were planned (39 from 45, 87%), the following general surgery interven- tions prevailed: laparoscopic cholecystectomy (n=13) and those to remove inguinal and umbilical hernia (n=12). During the 1st year the frequency of diseases required surgical treatment was 26% (n=11), infectious causes took place in 5 patients, non-infectious – in 6. Subsequently the incidence of infectious complications decreased that could be associated with the minimization of immunosuppressive therapy. Oncology was more frequent long-term after HTx – more than 3 years: among them the development of colon polyps prevailed and all recipients underwent polypectomy. There was no impact of age, gender, causes of chronic heart failure, obesity, immunosuppressive regimen (including the induction) on the frequency of general surgery diseases development (p>0.05). Conclusion . Based on our experience, we proposed an algorithm of examination, the features of surgical tactics and preparation for it in heart transplanted recipients are described. The important role of post-heart transplant follow-up in the timely detection of diseases requiring general surgical care is given.

Patient: Male, 24 Final Diagnosis: Dilated cardiomyopathy Symptoms: Biventricular heart failure • sleep apnea Medication: — Clinical Procedure: Heart transplantation Specialty: Cardiology Objective: Unusual or unexpected effect of treatment Background: Sleep-disordered breathing is common in heart failure (HF), and prolonged circulation time and diminished pulmonary volume are considered the main possible causes of sleep apnea in these patients. However, the impact and interrelation between sleep apnea and HF development are unclear. We report the case of a patient with complete elimination of non-rapid-eye-movement (NREM) sleep-associated mixed apnea in HF after heart transplantation. Case Report: After unsuccessful 12-month conventional treatment with abrupt exacerbation of biventricular HF IV class (according to New York Heart Association Functional Classification), a 26-year-old man was admitted to the hospital. Based on a comprehensive examination including endomyocardial biopsy, dilated cardiomyopathy was diagnosed. Heart transplantation was considered the only possible treatment strategy. Polysomnography showed severe NREM sleep-associated mixed sleep apnea [apnea-hypopnea index 43/h, in rapid eye movement (REM) sleep 3.7/h, in NREM sleep 56.4/h, mean SatO2 93.9%], and periodic breathing. One-month post-transplantation polysomnography did not show sleep-disordered breathing (apnea-hypopnea index 1.0/h; in REM sleep − 2.8/h, in NREM sleep 0.5/h, mean SatO2 97.5%). The patient was discharged from the hospital in improved condition. Conclusions: NREM sleep-associated mixed apnea occurring in severe systolic HF due to dilated cardiomyopathy might be reversible in case of successful HF treatment. We suggest that mixed sleep apnea strongly associated with NREM sleep occurs in HF, when the brain centers regulating ventilation are intact, and successful HF compensation might be highly effective regarding sleep-breathing disorders without non-invasive ventilation. This is important to know, especially with regard to the recently published data of potentially unfavorable effects of adaptive servoventilation in systolic HF, and the lack of other treatment options.

A comparative analysis of surgical treatment of non-small cell carcinoma of lung was made in 64 patients of senile age and more young patients. It was stated, that preference should be given to the partial lung resections (lob- and segmentectomies). The authors recommended to avoid pneumoectomy and typical resection of the lung as non-radical operations accompanied by high rate of local recurrences. The comorbidity background of patients should be thoroughly investigated before planning of surgery. If necessary, a surgical treatment of accompanied vascular pathology should be fulfilled as the first stage before oncology surgery.

An analysis of treatment results was made in 226 patients with multiple isolated intrapulmonary metastases of solid tumors. It appears that surgical removal of metastases was possible in patients with satisfactory functional resources and accurate evaluation in order to validate the indications for surgery. The operation shouldn't result in considerable reduction of quality of life and didn't prevent using other methods of treatment such as medicamental and radiation therapy. The indications to surgical intervention have to be set as individual in consideration of the number of metastases and potential of the patient to undergo the surgery.

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

The immediate and long-term results of cardiac transplantation with a reduction of the left atrium and correction of valvular diseases were performed on 4 patients with atriomegalia and associated valvular disease of the heart. There were no cases of hospital lethality. Within 7 days after operation the patients had a tendency to reducing the mean value of the left atrium. Within 38 months the tendency to normalization of the sizes, volumes and ejection fraction of the left atrium persisted. Cardiac autotransplantation is an effective method of a single stage reduction of the left atrium and correction of valvular diseases.

At the present time heart transplantation is considered to be the operation of choice in treatment of patients with terminal stage of chronic heart failure. Results of the first 5 heart transplantations made in the Federal Center of the heart, blood and endocrinology named after V. A. Almazov are assessed. There were no perioperational lethality and complications at the hospital stage. An analysis of the long-term results has shown effectiveness of heart transplantations in treatment of severe heart pathology.

Results of examination and treatment of 62 patients with spontaneous pneumothorax which appeared against the background of chronic obstructive pulmonary disease during the period from 1998 to 2009 were analyzed retrospectively. Emergent drainage of the pleural cavity was made to all the patients at admission to hospital. Surgical intervention was fulfilled in 28 (45%) patients. Complications at the postoperative period were noted in 54% of the patients. An assessment of occurrence of complications did not reveal their regular increasing along with the degree of bronchial obstruction. Differential approach and selection of high risk patients is considered to be necessary.

The authors investigated the dependence of increasing serum oncomarkers CEA, Cyfra-21, NSE, TU M2-PK on survival in 739 patients with nonsmall cell lung cancer. The tests for the determination of the content of CEA, Cyfra-21, NSE in blood serum have low sensitivity and are of little use for the diagnosis of lung cancer. The tests because of their simplicity and low cost can be used for the detection of groups of patients with preliminarily diagnosed nonsmall cell lung cancer needing additional methods of examination for more exact staging of the disease and exclusion of remote metastases and more active using adjuvant method of treatment. The use of tumor pyruvate kinase can be perspective for clinical oncopulmonology. However, due to its low specificity, further experiences are required for using this oncomarker in the group of patients with nonsmall cell lung cancer.

The test for the determination of the serum carcinoembryonic antigen was found to possess low specificity and to be of little use for the diagnosis of lung cancer. The test can be used for the detection of patients with diagnosed non-small-cell cancer of the lung for more exact staging of the disease and exclusion of distant metastases as well as for more active using adjuvant methods of treatment and for the dynamic observation of the course of the disease.

Twelve patients with severe chronic pulmonary obstructive disease complicated by a strong respiratory failure underwent lung volume reduction operations. An examination of the baseline functional parameters showed a significant outflow obstruction and lung hyperinflation. All the patients selected for the operation had a heterogeneous pattern of emphysema. Air leak from the lung suture was the main problem in the postoperative period. Long-term results were studied in 9 patients. A significant reduction of the respiratory failure and improvement of quality of life of the patients were noted. Significantly increased vital capacity, forced expiratory volume for 1 second, decreased residual volume and bronchial resistance were demonstrated.

Presented are the results of comprehensive CNS examinations in 53 alcoholics with chronic pancreatitis. Related psychopathological and neurological syndromes are specified. Hepatopancreatoduodenal and CNS abnormalities were found directly correlated. The addition of pancreatitis to alcoholism leads to development of encephalomyelopolyradiculoneurotic syndrome.

Psychopathological disturbances in 149 patients with burn disease are described during all stages of the disorder. Certain correlations with the period of burn disease, the depth and affected surface, somatic disturbances, premorbid personality traits, sex and age were demonstrated. Different variants of psychopathological disturbances and their traits in burn trauma in the acute period of burn disease are described. Variants of such disorders persisted in patients with burn encephalopathy in the late period of the disease from one to 20 years.