Search

The article is devoted to the study of the content of heavy metals and radionuclides in soils of the environments of the Severodvinsk industrial district (Northwest Russia). The city of Severodvinsk is the largest industrial center for the Navy in North-western Russia. Soil samples were taken in the vicinity of the Severodvinsk industrial region in the areas where there are summer cottages and gathering places for wild berries and mushrooms collected by local residents. Heavy metal content studies were performed by ICP-MS. Measurements of the activity of radionuclides were carried out via the low-background semiconductor gamma-ray spectrometry method with a detector of especially pure germanium. Assessment of the degree of soil pollution with heavy metals was performed using geo-accumulation index parameters (Igeo), contamination factor (Cf), degree of contamination (Cd), enrichment factor (EF), and ecological risk index (ERI). The radiation safety parameters of the Severodvinsk industrial region soils were calculated, as were the absorbed dose rate of gamma radiation DR, the equivalent of radium Raeq, and the external hazard index Hex. The sources of soil pollution are natural (geogenic) and anthropogenic (enterprises of the military-industrial complex, city heating systems, transport). The studies found a low level of heavy metal pollution and radionuclides in the soils of the environments of the Severodvinsk industrial region. Soils can be used by local people to grow food at their summer cottages. Also, the studied area is favorable for the collection of wild mushrooms and berries. However, closer attention should be paid to certain parts of the territory, since for some metals (As, Mn, Cd, and Pb) an increase in the parameters of the degree of soil pollution (Igeo, Cf, Cd, EF, and ERI) is observed.

The Suhoe Sea Gulf is a unique White Sea water body. Taking into account the risk of contamination of the White Sea with radionuclides as a result of the activities of the domestic and foreign nuclear industry and considering the plans to construct a deep-water part of the Arkhangelsk port on the Kuya River, the content and distribution patterns of natural and man-made radionuclides in the bottom sediments of the Suhoe Sea Gulf need to be studied. The specific activity of radionuclides was measured using a PROGRESS-2000 gamma spectrometer. Statistical processing of the data was performed using the STATISTICA (data analysis software system), version 10 software by StatSoft, Inc. (2011). The average specific activity of226Ra,232Th and40K was 6.5 ± 1.4, 14.2 ± 4.3, 416 ± 89, accordingly.134Cs and137Cs were detected in 4 and 5 samples with a mean specific activity value of 3.3 ± 1.6 and 3.5 ± 1.1, respectively. The highest specific activity values of40K are confined to the pelitic deposits. The main driving force in the processes of accumulation and redistribution of232Th is gravitational water accumulation and mechanical transfer. The measured values of the specific activity of radionuclides do not exceed those previously determined by other authors in the bottom sediments of the White Sea. Correlation analysis showed a significant relationship between the content of134Cs and137Cs (0.77, p = 0.05),232Th and40K (0.67, p = 0.05) and137Cs and40K (0.84, p = 0.05). Factor analysis allowed two groups of radionuclides to be identified, their content being is determined by different processes:134Cs,137Cs, and40K are jointly controlled by the most powerful factor (50%) and232Th is affected by the weaker factor (29 %). Both factors are based on natural processes of radionuclide receipt and redistribution: the first factor reflects the ability of bottom sediments to adsorb40K and isotopes of cesium, which are similar in chemical properties, and the second one reflects the natural process of removal by rivers of232Th with terrigenous material.

OBJECTIVES A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. METHODS A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. RESULTS We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. CONCLUSIONS Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

Introduction: Bronchial fistula (BF) after pneumonectomy – is a serious complication, associated with high mortality. Since the introduction in clinical practice the less invasive techniques for BF closure, namely vascular occluders, amplatzer sets, the abilities of BF closure have been rising. But the main issue for BF closure by the occluders is a proper selection of the device size, which defined by the BF features. Aims and Objectives: The aim of our study was to define the best method of BF measurement. Methods: Under a local anesthesia and bronchoscope control catheter sizing balloon was put in BF in such manner that x-ray plaque set up in the center of BF. Balloon was inflating by liquid contrast until the moment of waist appearing under X-ray control. Once the waist appeared, inflation of balloon was stopped and we measured the length and width of balloon waist in two projections. The size of amplatzer waist should be 30% bigger the BF size. Results: In such way we measured BF sizes in 8 of 13 patients, and these patients were successfully subjected to the procedure of occluder installation. In 5 of 13 patients the BF sizes were measured by fibrobronchoscopy (FBS) and CT-scans, and all of these 5 patients needed occluders reinstallation. Later we measured the sizes of these BF by sizing balloons and we found new sizes 30-50% bigger as compared with initial sizes, measured by CT and FBS. Reinstallation of occluders in these patients was successful and resulted in fistula closure in all cases. Conclusions: Of all the measurement methods we used, the measurement with the help of the sizing balloon and X-ray C-arm appeared to be the most accurate. The BF closure by occluders installation by this way was safe and reliable.

To analyze the results of thoracic sympathectomy for hyperhidrosis.The study included 166 patients aged from 15-51 years. There were 118 women and 48 men. Isolated palmar hyperhidrosis was observed in 46 patients, axillary - 46 patients, palmar-axillary - 74 cases. Video-assisted thoracic bilateral sympathectomy was performed. In patients with palmar hyperhidrosis, sympathetic chain was transected between the ribs II and III, axillary and palmar-axillary hyperhidrosis - between the ribs III and IV.Intraoperative injury of intercostal artery occurred in 1 case. Cautery was effective. Postoperative complications occurred in 4 (2.4%) patients (pneumothorax followed by drainage for up to 2-3 days). Symptoms of hyperhidrosis disappeared early after surgery in all cases. Long-term results were followed in 47 patients. Persistent positive effect and patient satisfaction with postoperative outcome were noted in 44 (93.6%) cases. Recurrences occurred in 2 patients with palmar hyperhidrosis and 1 patient with axillary hyperhidrosis for the period from 2 weeks to 6 months. Compensatory sweating developed in 26 (55.3%) patients (within several weeks up to 6 months). Mild compensatory sweating occurred in 17 patients, moderate - 8 patients, severe - 1 patient. Compensatory sweating was more common in patients with axillary and palmar-axillary hyperhidrosis compared to those with isolated palmar hyperhidrosis (An effectiveness of thoracic sympathectomy for hyperhidrosis is obvious. Compensatory sweating is the main undesirable consequence of this surgery. Prediction and prevention of compensatory sweating are not possible. It is imperative to warn the patient about possible compensatory sweating.Изучить результаты грудной симпатэктомии при лечении гипергидроза.В исследование включено 166 пациентов (женщин 118, мужчин 48) в возрасте от 15 лет до 51 года. Изолированный ладонный гипергидроз был у 46 пациентов, подмышечный — у 46 и ладонно-подмышечный — у 74. Симпатэктомию выполняли видеоторакоскопическим способом одномоментно с обеих сторон. При ладонном гипергидрозе симпатическиий ствол пересекали между II и III ребрами; при подмышечном гипергидрозе и ладонно-подмышечном — между III и IV ребрами.Интраоперационное осложнение — повреждение межреберной артерии было в 1 случае. Кровотечение остановлено электрокоагуляцией. Послеоперационные осложнения случились у 4 (2,4%) пациентов — это был пневмоторакс, потребовавший сохранения дренажей до 2—3 сут. Явления гипергидроза во всех случаях были купированы сразу же после операции. Отдаленные результаты прослежены у 47 человек. Стойкий положительный эффект в виде устранения гипергидроза и удовлетворенности пациента от проведенной операции отмечены в 44 (93,6%) случаях. Рецидив возник у 2 пациентов с ладонным гипергидрозом и у 1 — с подмышечным гипергидрозом в сроки от 2 нед до 6 мес. Компенсаторная потливость развилась у 26 (55,3%) пациентов. Сроки развития компенсаторной потливости — от нескольких недель до полугода. Легкая компенсаторная потливость была у 17 пациентов, умеренная — у 8 и тяжелая — у 1. Компенсаторная потливость чаще развилась у пациентов с подмышечным гипергидрозом + ладонно-подмышечным гипергидрозом, нежели у лиц с изолированным ладонно-подмышечным гипергидрозом (Эффективность грудной симпатэктомии при гипергидрозе несомненна. Компенсаторная потливость — основное нежелательное последствие этой операции. Предсказать и предупредить возникновение компенсаторной потливости не представляется возможным. Предупреждение пациента о возможной компенсаторной потливости является строго обязательным.

Introduction: Clinical situations and anatomic variants in tracheal stenosis (TS) are quite various so different approaches for artificial lung ventilation (ALV) during tracheal resection are required. The choice of the method of ALV depends on the extent of the lesion, the width of the lumen of the stenotic area, the presence of tracheostomy, and the stage of the operation. Aims: The aim of the study is to elaborate tactics of ALV which should provide good conditions for the surgeon as well as proper gas exchange at every stage of the operation. Methods: The tactics of ALV was developed during circular resection of the trachea in 52 patients with TS located in cervical part of the trachea. Orotracheal tube was inserted in any case. At the stage of trachea dissection and preparation for resection convective mandatory ventilation (CMV) was conducted when the orotracheal tube could be passed distal to the lesion. If the diameter of the stenotic area was too small the catheter was passed from the tube via the stenosis, and high frequency jet ventilation (HFJV) was conducted. The regimen of HFJV was selected to prevent barotrauma and hypoxemia. In the presence of tracheostoma CMV was conducted via the stoma. At the stage of anastomosis suturing the HFJV regimen was continued via the cateter. After the anastomosis completion the tube was passed to the distal trachea, and CMV was continued. Results: No complications occurred during the operation. A proper gas exchange was provided. Conclusions: The combination of CMV and HFJV provided proper conditions for surgical manipulation and adequate gas exchange at any stage of tracheal resection irrespectively of the duration of open airways period.

To present treatment of bronchial fistulas by using of occluders.For the period from March 2015 to October 2016 Atrial Septal Defect (ASD) occluders have been used for bronchial fistulas occlusion (Lepu Medical Technology Co., Ltd.; Lifetech Scientific Co., Ltd.). These are devices designed to close ventricular and atrial septal defects. The procedure was performed in 8 patients with main bronchus fistula occurred after pulmonectomy for tuberculosis in 5 patients and lung cancer in 3 patients. Fistulas' dimensions were 6-26 mm. The procedure was performed with double visualization from pleural cavity (through the thoracostomy and port-assisted approach) and from bronchial lumen.Seven out of 8 patients are currently alive (1 patient died from advanced tuberculosis of single lung). Occlusion is adequate in 6 patients, air drainage around around the occluder is noted in 1 patient. In 1 patient esophageal-pleural fistula occurred besides bronchial fistula. There was significant 2-3-fold decrease of residual pleural cavities volume and output volume. Patients feel satisfactory.Введение. Хирургические методики по закрытию свищей не всегда эффективны в силу тяжести состояния пациента. Для закрытия свищевого хода используется много разновидностей устройств, однако наиболее перспективными являются окклюдеры. материал и методы. С марта 2015 г. по октябрь 2016 г. для окклюзии свищей применялись ASD (AtrialSeptalDefect)-окклюдеры фирм 'Lepu Medical Technology Co., Ltd.'; 'Lifetech Scientific Co., Ltd.'), устройства, предназначенные для закрытия дефектов межжелудочковой и межпредсердной перегородок. Процедура была выполнена 8 пациентам со свищами главного бронха после пульмонэктомии, выполненной у 5 пациентов по поводу туберкулеза и у 3 - по поводу рака легкого. Размер свищей от 6 до 26 мм. Процедура выполнялась посредством двойной визуализации из просвета плевральной полости (через торакостому и через порт) и из просвета бронхов. Результаты. Из 8 пациентов на настоящее время живы 7 (1 пациентка умерла от прогрессирования туберкулеза в единственном легком). Сброс воздуха по свищу отсутствует у 6 пациентов, просачивание воздуха вокруг окклюдера отмечается у 1 пациента. У 1 пациента, помимо свища бронха, образовался пищеводно-плевральный свищ. Остаточные плевральные полости значительно уменьшились в объеме в 2-3 раза, количество отделяемого уменьшилось. Пациенты чувствуют себя удовлетворительно.

Background Mediastinal tumors can reach a huge size and give rise to serious surgical and oncological problems. Methods A review of 18 patients with huge mediastinal tumors was performed. Ages ranged from 16 to 61 years, and 10 were male. In 4 cases, exploratory thoracotomies had been undertaken in other hospitals; in one patient, the tumor recurred after incomplete resection. We performed a median sternotomy in 17 patients and a lateral thoracotomy in one. Radiotherapy and platinum-based chemotherapy was administered in cases found to be malignant. Results In 15 patients, the tumor was removed completely. In one patient, the operation was palliative because of vena caval and atrial invasion, and another had exploration only; biopsies revealed malignant transformation in these 2 patients. The blood loss was 425–2530 mL (average 690 mL); bleeding was fatal in one patient. Tissue diagnosis showed mature teratomas in 10 patients. Foci of malignant transformation were found in 5 cases. Chemodectoma was found in one patient, and thymoma in two. Patients with mature teratomas are free of disease. Two patients with malignant teratomas died from tumor recurrence despite irradiation and chemotherapy. Conclusions Clinical and oncological problems lie in the fact that malignant transformation of the tumor is diagnosed only after surgery. Extensive blood loss is a crucial surgical problem. Median sternotomy is the optimal operative approach. Surgical treatment of mature mediastinal tumors results in good outcomes unless malignancy is detected.

The radiological state of the land and water areas constantly attracts public interest. Specially protected natural reservations deserve special attention when it comes to studying radiological conditions. This study presents findings of radioecological investigations conducted in the Kostomuksha State Nature Reserve in 2012 – 2015. The Kostomuksha Mining Company, which is developing the Kostomuksha iron ore deposit was identified as a potentially hazardous facility that might affect the radioecological situation in the naturel reserve, since production of iron ores at the deposit involves extraction to the ground surface of acid rocks characterised by a naturally high content of radioactive elements (granitic gneiss). Furthermore, several sources of radioactive radon gas have been identified within the reserve boundaries. The study included investigation of natural and anthropogenic radioactivity in the environmental components of the nature reserve and adjacent territories, including soil, plants, bottom sediments, ambient air and natural waters. It was found that development of the Kostomuksha iron ore deposit and operations of the mining and processing plant do not exert any considerable impact on the radiological situation in the nature reserve. Data obtained during the study indicate that the overall radiological situation in the reserve is acceptable and meets the relevant radiation safety standards. High levels of radiocesium were found in the moss and bottom sediments of the nature reserve, which requires additional research to determine a wider pattern of distribution of anthropogenic radioactivity across the adjacent territories and to study the processes of buildup and migration of radionuclides in aquatic organisms of Kamennoye Lake.

Background: Pneumonectomy (PE) in pulmonary tuberculosis (PTB) and aspergillosis has to be performed in cases with multiple lung cavities or destroyed lung mainly in patients infected by drug resistant microorganisms. All that resulted in a high risk of the surgery. The aim of the study is to analyze our own experience and review the available literature on this issue. Methods: The data of 64 patients subjected to PE during last 10 years is presented. Male/female ratio is 36/28. Average age is 44.7 years. Multi-drug resistance (MDR) and extensively drug resistance (XDR) was in 40 and in 20 patients respectively. Right PE was performed in 30 patients and left in 34. Bronchial stump was closed by stapling and by manual suturing in 25 ones, and in 39 patients respectively. Individual chemotherapy according to drug susceptibility test results was conducted before and after the operation. Results: Overall complication rate was 31.3% including bronchopleural fistulas (BPF) rate 14.1%. Hospital mortality rate was 6.2%. All patients with postoperative had mycobacteria tuberculosis (MBT) in their sputum specimens before the operation (P Conclusions: Our experience and data available in the literature show that PE in PTB and aspergillosis can be performed with acceptable results. It should be emphasized that in these groups of patients this operation remains the only chance to be cured.

Introduction: The possibilities of forming effective regimes of chemotherapy when exists XDR of MBT culture are significantly restricted. The experience of using such drugs as linezolid and bedaquiline in present time is not enough. Aims: Estimate effectiveness and safety of six monthpolychemotherapy course including bedaquiline and linezolid. Methods: We performed a prospective nonrandomized multicenter investigation. There were 32 patients(9 m/23 f) with XDR TB, the age of patients varying There were 12,5% of firstly revealed patients and 87,5% of patients after previous ineffective therapy. 12,5% of patients had length of disease less than 1 year, 68% of patients had length of disease from 1 to 3 years and 19,5% of patients had length of disease more than 3 years. All patients, included in investigation had MBT+ in their sputum. All the patients had cavitary lesions in lung tissue and 65,6% of patients had double lung lesions. Six month chemotherapy course included 4 drugs of first or second line according to susceptibility in combination with bedaquiline and linezolid. Results: It was 31(96,9%) patients who finished 24 weeks course. Among them 83,9% of patients became MBT negative; 77,4% of patients had significant positive X-ray dynamics; 43,7% had closure of cavitary lesions. 7(22,6%) patients were successfully prepared for surgery and were operated later. We had 1 side effect – enlargement of QT-interval more than 520 ms, this patient was exclude from investigation. Conclusions: Including of bedaquiline and linezolid combination in complex therapy of XDR TB is highly effective and well tolerated by patients.

Fistula of bronchial stump developed in 246 (9.4%) cases of 2614 patients who were underwent pneumonectomy for lung cancer in 1964-2013. Mortality rate in case of bronchial fistulae was 17.9%. It was analyzed causes of this complication, an important role of infection for its development was emphasized. So prevention of wound infection is main prophylactic action. Postoperative pneumonia and bleeding are considerable risk factors. Clinico-anatomical type of tumor, stage and technique of bronchial stump treating don't affect incidence of fistulae. Bronchial stump covering is important intraoperative preventive measure. Treatment of this complication includes early drainage and pleural cavity sanitation and isolation of fistula from pleural cavity. Endoscopic procedures (impact with silver nitrate, trichloroacetic acid, laser) are preferred to solve the last problem. It allowed to achieve fistulae healing in 58.1% of cases.Из 2614 больных, которым выполнена пневмонэктомия по поводу рака легкого в период с 1964 по 2013 г., у 246 (9,4%) оперированных развился свищ культи главного бронха, летальность при этом составила 17,9%. При анализе причин возникновения этого осложнения выявлено, что значительную роль в его развитии играют инфекции, в связи с чем основной профилактической мерой признается предупреждение развития раневой инфекции. Кроме того, существенными факторами риска являются послеоперационные пневмонии и кровотечения. Клинико-анатомическая форма опухоли и способ обработки культи бронха не влияют на частоту образования свищей. Важной мерой профилактики во время операции является укрытие культи бронха. Лечение этого осложнения заключается в скорейшем дренировании и санации плевральной полости и разобщения свищевого сообщения с плевральной полостью. Для решения последней задачи предпочтительными являются эндоскопические процедуры (воздействие нитратом серебра, трихлоруксусной кислотой, лазером), которые позволили в 58,1% добиться заживления свищей.