Uniportal video-assisted thoracoscopic sympathectomy (VATS) is an effective minimally invasive surgical method of choice for the treatment of primary focal hyperhidrosis and blushing syndrome due to uncontrolled operation of the sympathetic nervous system. The aim of this study was to provide an objective assessment of the improvement in the quality of life of patients with primary focal hyperhidrosis and blushing syndrome after bilateral monoport video-assisted thoracoscopic sympathectomy. Materials and methods. The results of surgical treatment were performed for 62 patients aged 17 to 42 years, 26 men and 36 women with a diagnosis of primary focal hyperhidrosis of the extremities and blushing syndrome. All patients underwent bilateral uniport video-assisted thoracoscopic sympathectomy. Patients are divided into 3 groups depending on the level of coagulation of the sympathetic trunk: the first group of the study (n = 9) includes patients after bilateral uniport sympathectomy at the level of R3 (isolated palmar hyperhidrosis), the second (n = 31) - at the level of R3-R4 (palmar and axillary hyperhidrosis), the third group (n = 22) - at the level of R2 (blushing syndrome). Results. In this study, coagulation and separation of the sympathetic trunk through a single port using a silicone port was performed. An excellent clinical result was achieved due to the minimally invasive operation - all 62 patients (100%) were satisfied with the achievement of a rapid stable effect. According to the results of the Dermatology Life Quality Index DLQI (1 month after surgery), the best quality of life measures were observed in patients who underwent separation of the sympathetic trunk at the R3 level – improvement from 20.3 ± 5.9 points to 0.8 ± 0.8 points. After the operation at the R3-R4 level scores the quality of life decreased from 22.77 ± 5.4 points to 2.3 ± 1.3 points, and at the level of R2 - from 16.5 points (QI 14 points - QIII 20 points) to 2 points (QI 1 point - QIII 3 points) p <0.001). There was a difference in quality of life measures in our three groups of patients according to the severity of the disease before surgery. The lowest quality of life was determined in patients with the 4th degree of severity (33 people) and was 26.0 points (QI 23.0 points - QIII 27.3 points) compared with patients with 2d and 3d degrees of severity, 10.0 points (QI 7.7 points - QIII 10.0 points) and 17.0 points (QI 14.0 points - QIII 19.5 points) respectively (p <0.001). After a single-port VATS in three groups there was an increase in quality of life measure, regardless of the severity of the disease before surgery. Conclusions. The most highly specific tests that allow to determine an objective assessment of the severity of the disease and a real assessment of the effectiveness of surgical treatment for hyperhidrosis was TEWL-metry, for blushing syndrome – capillaroscopy. VATS is an effective method of treating patients with hyperhidrosis and blushing syndrome, which significantly improves the quality of life according to the results of the Dermatological Index of Life Quality DLQI (p <0.001) questionnaire.

BACKGROUND. At present radiological criteria for diagnosis of viral pneumonia associated with SARS-CoV-2 have been defined. However, with the further course of the pandemic, physicians began to observe more and more often destructive processes developing in the lungs of patients with non-hospital pneumonia of viral etiology (COVID-19). Due to the development of surgical complications (pneumothorax, pneumomediastinum, vanishing lung syndrome) the question of their differential diagnostics with purulent-destructive lung diseases became actual. OBJECTIVE. To show the possibilities of differential diagnostics of infectious lung destruction (ILD) with cyst-like changes in the lungs at COVID-19 using clinical examples and data of computed tomography (CT) scan of the chest and pathomorphological study. MATERIALS AND METHODS. CT of the patients with ILD (lung abscess) and 90 patients with non-hospital pneumonia of viral etiology (COVID-19), who were treated in the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine were analyzed. RESULTS AND DISCUSSION. There were analyzed 90 CT scans of the whole body of patients with non-hospital pneumonia of viral etiology (COVID-19); among them 27 cases (15 male and 12 female, aged from 23 to 78 years) with radiological signs of vanishing lung syndrome were revealed, which made 30 % of all patients with a complicated course of the disease. Chest CT findings and pathomorphologic findings in cyst-like changes in patients with COVID-19 were compared with those in patients treated for lung abscess. CONCLUSIONS. Clinical picture, pathogenesis and pathomorphological changes of pulmonary parenchyma at ILD differ greatly from non-hospital pneumonia of viral etiology (COVID-19) and form specific changes, which are revealed by chest CT. Necessary development of indications for surgical treatment in vanishing lung syndrome which occurs in patients with complicated course of COVID-19.

Background. Pleural empyema (PE) is the presence of pus in the pleural cavity. The causes of PE include the diseases of adjacent organs (75 %), direct contamination of the pleural cavity during injuries or operations (20 %), and hematogenous dissemination of infection (5 %). Objective. To describe the modern views on the treatment of EP. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Radiography, computed tomography, and ultrasound can be used to diagnose PE. To detect PE, radiography should always be performed in two projections, paying special attention to the posterior sinus and the space above the diaphragm. Computed tomography shows pleural layers’ separation and a “pregnant woman” symptom. Ultrasound can distinguish fluid, pleural thickening and pulmonary infiltration, as well as determine the optimal point for puncture. The ultimate goals of PE treatment include the obliteration of the pleural cavity or creating conditions for the formation of a sterile residual cavity. In case of acute PE, drainage, washing, and antibiotic therapy are applied; correction of concomitant diseases is carried out. Drainage of the pleural cavity should be preceded by a puncture of the pleural cavity to obtain pathological contents. The appearance and odor of the fluid obtained by puncture are the most important indicators of the pathology. Drainage can be performed at the point where the pus was obtained, or in the VII-VIII hypochondrium along the posterior axillary line. Drains from polyvinylchloride with a diameter of 6-8 mm are applied. The length depends on the task. Videothoracoscopy is a modern method of treating PE. This method is minimally invasive, removes fibrin and pus, destroys adhesions, connects cavities and provides drainage at the optimal point. To wash the pleural cavity, it is advisable to use decamethoxine or povidone-iodine. With regard to antibiotic therapy, levofloxacin or third-generation cephalosporins are used in combination with an antianaerobic drug, or carbapenems or glycopeptides. Conclusions. 1. PE is often a secondary infectious process caused by adjacent structures’ infection. 2. Pleural cavity sanitation during videothoracoscopy and drainage are the main methods of PE treatment. 3. Antibiotic therapy and pleural lavage are integral components of PE treatment.