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According to results of the study, which included 52 patients with malignant pleural effusion of unknown etiology, it could be concluded that the method of choice in differential diagnosis of pleural effusion is the immunocytochemistry as the most informative method (efficacy 94,2%). Based on own experience of treatment of 137 patients with recurrent malignant pleural effusions, we can say that the first stage of treatment of pleural effusions is carrying out pleurodesis in outpatient conditions. The choice of pleurodesis method, first of all, depends on the aggressiveness of tumor pleurisy: in a case of daily exudation till 300 ml we choose talc pleurodesis, from 300 to 700--bleomycin pleurodesis, more than 700--combined (talc and bleomycin pleurodesis). The overall efficiency of produced pleurodesis is 64.5%.

The development of endoscopic techniques of surgery of patients with early gastric cancer (high and moderately differentiated adenocarcinoma) by endoscopic mucosal resection and endoscopic submucosal dissection with regard to their minimally invasion, high efficiency and quality of life after treatment allowed seriously establishing itself and be accepted for use in worldwide.

There was presented a comparative analysis of the surgical treatment results of 86 patients, suffering chronic pancreatitis, in whom resection and parenchyma-preserving elaborated operations were done, aimed for pancreatic and biliary ducts hypertension elimination. According to histological and histochemical data obtained, there are uniform changes, localized in pancreatic head, corpus and tail: the extended periductal fibrosis with the immune-cell infiltration foci and periductal connective tissue sheath formation. According to the immunohistochemical data obtained, in a fibrous zone there was obtained a big quantity of activated alpha-SMA-positive collagen producing star-like cells and a significant expression of a type IV collagen. Indications for surgical treatment, using parenchyma-preserving procedures, were substantiated, taking into account morphological and clinical data present. The patients quality of life in a late follow-up period (5 years) after performance of a proposed operative procedure (the main group), according to all scales of international questionnaires MOS SF-36 applied, were trustworthy better (P < 0.05), than after resection procedures (control group).

The paper deals with complex treatment for pleural malignancies with concomitant effusions. Cytoreduction and abatement of effusion, protein loss, inflammation, intoxication and pain syndrome were reported after argon-plasma electrocoagulation of the pleura followed by photodynamic therapy and hyperthermal intrapleural chemoperfusion. Stable effusion abatement effect was confirmed in all eight cases by X-ray examination and changes in homeostatic indices and breathing function as well as lowered severity of intoxication and pain. No emergency repeat intervention or pleural puncture was reported.

Data are presented on 30 cases of video-assisted thoracoscopy for different intrathoracic neoplasms in children and adolescents. Indications and contra-indications for use for diagnostic and therapeutic purposes as well as possible complications and their prophylaxis are discussed.

The article is devoted to a combined method of treatment of malignant tumorous lesions of the pleura accompanied by exudative pleurisy. The main result of using the method is cytoreduction, discontinuation of exudation and loss of protein, reduction of inflammation, intoxication and pain syndrome. It results from argonoplasmic electocoagulation of the pleura followed by photodynamic therapy. The treatment was used in 10 patients with a palliative aim. In all cases persistent discontinuation of the accumulation of pleural exudates was obtained that was confirmed by better state of the patient, normalization of homeostasis indices, X-ray examination data, reestablished functions of external respiration, reduced intoxication and pain syndrome. No reoperations or pleural punctures were needed.

An evaluation is presented of the data on use of video-assisted thoracoscopy in the diagnosis and therapy of 45 patients with single circular formations in the lung. Indications and contraindications for the management of benign and malignant single tumors of the lung are discussed alongside a review of the Russian and foreign literature.

Immune status in patients with destructive pancreatitis (DP) in long persisting disease and after performance of operative intervention was studied. Signs of secondary combined immunodeficiency were revealed, manifested by decrease of absolute quantity of all lymphocytes populations by 20-70% and concentration of immunoglobulins in blood serum by more than 40%. Conventional therapy did not influence indexes of immunogramm while using immunoglobulin for intravenous injection (IGII), besides saturation of blood by antibodies, the complement activities are increasing as well as indexes of the phagocytes functional state. Application of IGII had promoted the decrease of the patients state severity, normalization of clinico-laboratory data, causing the mortality lowering (P < 0.05), decrease of the treatment duration of survived patients (P < 0.05).

A new method of surgical treatment of decompensated duodenal stenosis, consisting of duodenoplasty with duodenal ulcer excision, segmentary resection of gastric corpus with preservation of pyloroantral portion and formation of fundocorporoantrumanastomosis on the whole opening, was presented. In 24 patients in late follow-up terms after the operation the rhythmical, portional evacuation of gastric content was observed, the ulcer recurrency was not noted.

Video-assisted thoracoscopy for differential and improved diagnosis was successful in 245 out of 249 patients (98.3%) with various chest neoplasms. Video-assisted surgical procedures were performed in 50 (20%). Complications were reported in 4 (1.6%). The method proved highly-effective as well as fairly safe and sparing.

In 136 patients with surgical diseases the dynamics of the immunity indices and cytological changes of the wound discharge after the operation were studied up. Twenty practically healthy persons had constituted the control group. The most informative immunogram indices, which may be used for the postoperative complications occurrence prognosis, were determined. The results of investigations of the cytological changes in the wound are reflecting the immunoinflammatory reaction adequacy and serve as criterion for the immunotherapy administration substantiation in its efficacy control.

Diagnostic potential of video-assisted thoracoscopy was evaluated in 66 patients (36 males and 30 females) with neoplasms (aged 24-68 yrs). When used in conjunction with biopsy, it confirmed the following diagnoses: lymph proliferative disease (23), mediastinal malignancies (11), sarcoidosis (21), benign mediastinal tumors (7), Castleman's benign lymphoma (2) and mediastinal cyst (2). Clinical diagnosis was substantially changed in 40 (61%) cases as a result of videothoracoscopy application. It has proved precise, fairly safe and conservative; it has a potential in diagnosis of mediastinal tumors.

In 42 patients with complicated duodenal ulcer disease after application of duodenoplasty and selective proximal vagotomy in a planned character an ulcer was not noted, good pyloric function was observed as well as a la carte, rhythmical and timely gastric emptying during (26 +/- 1) min on average.

No ischemic insult, myocardial infarction, death due to cardiovascular pathology was observed in 138 patients, to whom after the operation on the arteries of truncus brachiocephalicus the ticlid was administered. At a comparison group (120 patients) in 3 the myocardial infarction have occurred (one patient died), in 2--an ischemic insult. After the ticlid application the positive late follow-up result was noted in 93.1% patients, without it--in 70.5%. The preparation compliance is good.

Results of surgical treatment of 336 patients with chronic disorder of the brain arterial blood supply were summarized. Surgical tactics provided for maximum brain revascularization by means of simultaneous intervention on two-three arteries. Technical aspects of operative procedures elaborated in clinic are presented. Late follow-up results noted were good in 60.1% and fair--in 25.7%.

The access to the distal part of internal carotid artery before her entrance to the skull cavity was depicted. His advantages are the minimal traumaticity, obligatory manoeuvre of artery taking out from beneath the laryngo-pharyngeal plexus for her complete exploration, the absence of postoperative swallowing and phonation disorders. The access was applied in 32 patients, including 6 in bilateral fashion (with 5-6 mos interoperative interval).

The results of surgical treatment of 112 patients with pathologic tortuosity of the extracranial cerebral arteries have been analysed. Indications and choice of a method for operative intervention are substantiated. Arterial torsion and loop formation were the most severe types of deformity, which often caused impairement in the cerebral circulation.

An access to the initial portion of the vertebral artery which is distinguished by medial relative to the internal jugular vein approach to the subclavian-vertebral arterial segment is described. In its use in 34 patients, no complications which occur in conventional access with the lateral relative to the internal jugular vein approach (diaphragmatic nerve paresis, plexitis, injury to the thoracic duct) were noted.

The results of the use of medicamentous protection of the brain under conditions of modelled ischemia and reperfusion by means of KS-79 preparation are presented. In exclusion of blood flow through the carotid arteries for the period commensurate to that in the clinic, it was established that the use of KS-79 preparation possessing the anti-ischemic and antioxidant properties has pronounced cerebro-prospective action, preserves functional and structural integrity of the brain.

On the basis of experimental and clinical data, the subclinical ischemic brain damage resulting from temporary clamping of the carotid artery during performance of the reconstructive operation has been established. The changes were revealed in sufficient, according to the existing criteria, collateral circulation. Before placing the clamp onto the carotid artery as a preventive method for intraoperative medicamental brain protection, intraarterial administration of piracetam, which possesses anti-ischemic, membrane stabilizing and antioxidant properties, has been suggested.

Studies of the cardiovascular system in 1150 patients were performed by means of angiographic complex of the firm "Thompson" (USA) equipped with a computer "DG-300" (USA). The morphofunctional characteristics of circulation--capacity of vascular bed, elasticity of a vessel, degree of its stenosis, time of circulation and perfusion were studied. Four (0.3%) patients developed complications: 2--bleeding from the femoral artery, 2--cardiac arrest during coronarography.

The results of surgical treatment of 106 patients with occlusive lesions of the brachiocephalic trunk vessels have been analysed. A necessity of reorientation of the conservative approach to the treatment of patients in favour of surgical angioneurology is stressed.

The authors operated on for circulatory disturbances in the upper extremities 216 patients. Differential approach to the choice of a method for surgical correction permitted to achieve excellent and good results in 89% of them.

Based on an analysis of clinical and angiographic data of 334 patients the authors have established that extended alterations of the femoro-popliteal segment are found in 48.9% of cases. The article presents an analysis of reconstructive operations in 154 patients with such occlusions. The reconstruction of the profound femoral artery is found to be the method of choice in such an alteration, in cases of the combination with stenosis of the iliac artery the operation being supplemented with the dilatation of the iliac artery.

The results of surgical treatment of pyloroduodenal stenosis of ulcer etiology at the stage of decompensation in 123 patients are analysed. Choice of a method of operation with regard for the degree of the impairement in motor and secretory gastric functions, intraoperative conditions and severity of the state of a patient is substantiated.