RESUMO
Thoracic hematogenic endometriosis is a rare pathology. A clinical course hasn't pathognomic symptoms, because of it, the diagnosis is established due to histological study. The article presented two cases of female patients, who were suffering from thoracic endometriosis. They were hospitalized to the department of thoracic surgery of Municipal multifield hospital No 2 in Saint-Petersburg. The first patient had a posterior mediastinum tumor with asymptomatic disease course. The second patient was with recurrent catamenial pneumothorax.
Assuntos
Endometriose , Pneumotórax , Doenças Torácicas , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/fisiopatologia , Endometriose/cirurgia , Feminino , Humanos , Mediastino/patologia , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/cirurgia , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Doenças Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The efficacy ofreamberin, remaxol, S-adenosyl-L-methionine (ademethionine) and 5% glucose solution was estimated in the treatment of patients with tuberculosis of the respiratory organs and drug hepatotoxicity signs confirmed by higher activity of liver indicative enzymes and nitrogen oxide levels. Remaxol showed a pronounced positive effect on the cytolytic syndrome signs, evident from lower activity of alanine aminotransferase and aspartate aminotransferase. At the same time ademethionine was superior to remaxol in the effect on the cholestatic signs and inferior in the effect on the cytolytic signs. By the effect on the activity of alanine aminotransferase and aspartate aminotransferase, reamberin was inferior to remaxol and superior to ademe-thionine, its effect on the cholestasis markers level vs. the other drugs being superior only to that of 5% glucose solution. As compared to reamberin, ademethionine and 5% glucose solution, remaxol promoted higher integral indices of the host antioxidant protection (total antioxidant capacity and total antioxidant status), that partially explained the drug pronounced hepatoprotective effect.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/complicações , Meglumina/análogos & derivados , S-Adenosilmetionina/administração & dosagem , Succinatos/administração & dosagem , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Doença Hepática Induzida por Substâncias e Drogas/sangue , Feminino , Humanos , Masculino , Meglumina/administração & dosagem , Meglumina/efeitos adversos , Pessoa de Meia-Idade , S-Adenosilmetionina/efeitos adversos , Succinatos/efeitos adversos , Tuberculose Pulmonar/sangueRESUMO
A retrospective analysis of medical history of 1489 patients with spontaneous pneumothorax was made. The patients were hospitalized to the department of thoracic surgery in municipal hospital No 2. According to the data, the incidence rate of primary spontaneous pneumothorax was noted in men during last decade in Saint-Petersburg. The number of patients with secondary spontaneous pneumothorax didn't considerably increase in spite of the growth of incidence of chronic obstructive lung disease. The secondary spontaneous pneumothorax took place in female population two times more, than in male.
Assuntos
Pneumotórax , Doença Pulmonar Obstrutiva Crônica , Adolescente , Fatores Etários , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Recidiva , Fatores de Risco , Federação Russa/epidemiologia , Fatores SexuaisRESUMO
This review is focused on recent advances in development of new vaccines for the prevention of tuberculosis. The main reasons for lack of BCG vaccine efficacy in different populations and geographic regions are presented. Design of new vaccines based on live modified strains of Mycobacterium bovis BCG, attenuated strains of Mycobacterium tuberculosis, recombinant proteins and viral vectors is considered in the specific examples. The usage of the heterologous "prime-boost" vaccination strategy against tuberculosis is discussed.
Assuntos
Vacinas contra a Tuberculose/farmacologia , Tuberculose/prevenção & controle , Vacinação/tendências , Animais , Humanos , Vacinas AtenuadasRESUMO
At present, the conception of the use, efficacy and safety of hepatotropic agents in treatment of drug-induced liver injury, in particular due to antituberculosis drugs is not yet final, which is conditioned by extremely rare clinical trials on the subject adequate to the up-to-date principles of the conclusive medicine. The review presents data on the hepatotoxic effect of antituberculosis drugs, analysis and systematization of the data on the use of hepatotropic agents in liver injury induced by antituberculosis drugs, the principles and characteristics of their clinical use. The mechanism of action of remaxol, a new original hepatotropic agent and the indications of its use are discussed. The experimental findings on the remaxol ability to decrease the antituberculosis drug-induced liver injury through lowering the carbohydrate, albuminous and fatty degeneration and activating the organ reduction are presented. The clinical trials are evident of the most efficient action of remaxol on the signs of toxemia, as well as cytolysis and cholestasis, which along with its antiasthenic and antidepressant action allows to use remaxol as an universal hepatotropic agent in the treatment of diverse drug-induced liver injuries in both the therapeutic and prophylactic schemes.
Assuntos
Antituberculosos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Regeneração Hepática/efeitos dos fármacos , Succinatos/uso terapêutico , Citoproteção/efeitos dos fármacos , Humanos , Fígado/efeitos dos fármacos , Fígado/metabolismoRESUMO
UNLABELLED: The aim of the study---a comprehensive assessment of haemodynamic alterations during pneumonectomy using pulmonary arterial volumeter (PAV) opportunities. MATERIALS AND METHODS: 72 patients were included in the study, (the average age - 51 +/- 3,8 years, body weight - 68 +/- 7 kg), who underwent pneumonectomy about lung tumors under general anesthesia with separate ventilation (on indications - jet high-frequency ventilaton).
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia , Disfunção Ventricular Direita/etiologia , Função Ventricular Direita/fisiologia , Anestesia Geral , Volume Sanguíneo/fisiologia , Feminino , Ventilação em Jatos de Alta Frequência , Humanos , Pulmão/irrigação sanguínea , Pulmão/cirurgia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Artéria Pulmonar/fisiologia , Resultado do TratamentoRESUMO
An analysis of results of treatment of 112 patients with metastases of intrapulmonary colorectal carcinoma (CRC) for the period from 1990 to 2006 has shown that cytoreductive opera tions for excision of the metastases are an effective method of treatment of this category of patients which allows a two times increased survival median as compared with analogous index in the group of patients exposed to palliative chemotherapy. Palliative chemotherapy fails to have statistically significant influence to survival of patients who have ablated intrapulmonary CRC metastases in the volume of complete cytoreduction.
Assuntos
Neoplasias Colorretais , Neoplasias Pulmonares , Pneumonectomia/métodos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/secundário , Neoplasias Colorretais/patologia , Terapia Combinada , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Prognóstico , Modelos de Riscos Proporcionais , Taxa de SobrevidaRESUMO
Results of treatment of 51 patients with intrapulmonary metastases of renal cancer were analyzed. Surgical interventions in volume of complete cytoreduction were made in 31 of them. All the patients were followed-up after operations at the period from 3 through 68 months. A multi-factor analysis has shown that surgical metastasectomy gives reliably better results of treatment of patients with disseminated renal cancer. Regressive analysis in the group of operated patients has shown that involvement of the lymph nodes of the bronchopulmonary group and mediastinum gave reliably worse results of treatment of this group of patients.
Assuntos
Neoplasias Renais/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Cuidados Paliativos/métodos , Pneumonectomia/métodos , Adulto , Idoso , Biomarcadores Tumorais , Antígeno Carcinoembrionário/sangue , Interpretação Estatística de Dados , Feminino , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/fisiopatologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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.
Assuntos
Drenagem/métodos , Pneumonectomia/métodos , Pneumotórax/cirurgia , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/complicações , Toracoscopia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The article gives detailed description of a technique of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. The method is based on the experience of the world leader in surgical treatment of this disease--the clinic of California, San Diego headed by Stuart Jamieson, cardiothoracal clinic Papworth Hospital in the only center in Great Britain, where PE is performed and on the experience obtained by the collective of the Department of hospital surgery of the medical department of the St. Petersburg state University and the City multi-field hospital.
Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Resultado do TratamentoAssuntos
Neoplasias Pulmonares/cirurgia , Complicações Pós-Operatórias , Embolia Pulmonar/cirurgia , Procedimentos Cirúrgicos Torácicos , Idoso , Comorbidade , Feminino , Humanos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Artéria Pulmonar/patologia , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
Lobectomy is the operation of choice for many diseases of pulmonary pathology, lung cancer being the most frequent indication to it. Smoking, as a common etiological factor, leads to a frequent combination of chronic obstructive disease of the lungs (CODL) and lung cancer. The expected disturbance of lung function after operation in such patients can make it not necessary. However, the functional results of lobectomy in CODL patients still remain not studied. The aim of this prospective investigation was to study effects of lobectomy in patients with diseases of the lung parenchyma without hypoventilation or partial atelectasis. 76 patients were divided into 2 groups: 35 patients with CODL and 41 patients without CODL. In patients with CODL after lobectomy the external ventilation function was less affected than in patients without it. The generally accepted formula for the calculation of the postoperative VFE 1 reliably increased the prognosed reduction of this index. Reduction of the indices of the external ventilation function after lobectomy was less pronounced in patients with the medium and severe degree of CODL.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Volume Expiratório Forçado/fisiologia , Neoplasias Pulmonares/cirurgia , Pulmão/fisiopatologia , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Adulto , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pletismografia , Período Pós-Operatório , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicaçõesAssuntos
Pneumotórax , Procedimentos Cirúrgicos Torácicos/métodos , Endometriose/complicações , Feminino , Humanos , Linfangioleiomiomatose/complicações , Avaliação de Resultados em Cuidados de Saúde , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/terapia , Fatores SexuaisAssuntos
Antituberculosos/administração & dosagem , Tumor Carcinoide , Pulmão , Fotoquimioterapia/métodos , Pneumonectomia/métodos , Tuberculose Pulmonar , Broncoscopia/métodos , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/fisiopatologia , Tumor Carcinoide/cirurgia , Esquema de Medicação , Monitoramento de Medicamentos , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Planejamento de Assistência ao Paciente , Tomografia por Emissão de Pósitrons , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/fisiopatologia , Tuberculose Pulmonar/radioterapia , Tuberculose Pulmonar/cirurgia , Adulto JovemRESUMO
The report evaluates prognostic factors derived from the data on survival of 123 patients with isolated lung metastases from solid tumors after performing full-scale cytoreductive surgery. Colorectal carcinoma was diagnosed in 43 patients (35%), renal carcinoma--26 (21%), non small cell lung cancer--25 (20%), melanoma--11 (9%), endometrial carcinoma--9 (7.5%) and breast cancer--9 (7.5 a%). All patients were followed up for 3--150 months (median--16 months). Fifty-eight patients (48%) had died by the time the study started. Median of survival for colorectal carcinoma was 29 mos, renal carcinoma--23 mos, non small cell lung cancer--18 mos, melanoma--13 mos, endometrial carcinoma--70 mos and breast cancer--38 mos. According to the findings on regression results, of prognostic value for such patients are both intraoperative and histologically confirmed evidence of secondary metastases to the lymph nodes as well as relapse-free survival. Median of survival for secondary metastases to the lymph nodes was 21 mos and 67 mos without them (p = 0.04). Three cohorts were identified relating to relapse-free survival: 0-12, 12-24 and more than 24 mos. Median of survival for those groups was 19, 23 and 38 mos, respectively (p = 0.03). Such parameters as tumor site, gender, age or postoperative antitumor pharmaceutical therapy appeared irrelevant as far as survival was concerned.
Assuntos
Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
In the period from 1996 to 2007 operations were fulfilled in 120 patients with isolated pulmonary metastases of solid tumors (68 men and 52 women aged from 22 through 77 years): 46 patients with metastases of colorectal cancer, 28 - with cancer of the kidney, 23 - with non-small cell carcinoma of lung, 7 - with breast cancer, 9 - with endometrium cancer, 7 - with melanoma. Altogether there were 128 operations. The operations have revealed lesion of intrathoracic lymph nodes in 29 patients (24%). In most cases (21 patients) they were lesions of lymph nodes of the lung root and intrapulmonary lymph nodes. In 93% of cases (27 patients) localization of the lesion coincided with anatomical pathways of lymph outflow from the affected part of the lung. The survival rate median of the operated patients who had alterations in the lymph nodes was 21 months, in cases with intact lymphatic system it was 37 months. A conclusion is made of possible secondary lymphatic cancer spread from intrapulmonary metastases of solid tumors and its negative influence on results of treatment that allows recommendation of revision of the lymphatic system of the lungs and mediastinum in all cases of surgical treatment of intrapulmonary metastases, and in a number of cases recommendation of anatomical resections of the lung tissue as operation of choice.
Assuntos
Adenocarcinoma/secundário , Neoplasias da Mama/secundário , Neoplasias Colorretais/secundário , Neoplasias do Endométrio/secundário , Neoplasias Renais/secundário , Neoplasias/patologia , Neoplasias Cutâneas/secundário , Adenocarcinoma/cirurgia , Adulto , Idoso , Neoplasias da Mama/cirurgia , Neoplasias Colorretais/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias/cirurgia , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias Cutâneas/cirurgiaRESUMO
The article presents a generalized experience with treatment of 49 patients with malignant stenosis of the trachea complicated by respiratory insufficiency. Different methods of endoscopic recanalization of the stenosed portion of the trachea are analyzed. Factors are shown influencing the outcome of urgent restoration of patency of the respiratory pathways. Exact indications are proposed on carrying out self-locking stents in patients with malignant damage of the trachea, and the sequence of actions in patients with decompensated stenosis of the trachea of malignant nature.
Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/cirurgia , Estenose Traqueal/etiologia , Acidose Respiratória/etiologia , Idoso , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Estenose Traqueal/diagnósticoRESUMO
Lung transplantation is one of the most difficult fields of contemporary transplantology. The operation was performed on a 53-year-old female who had been suffering from terminal stage COPD. The period of cold ischemia for the right and left lung was 1 hour 30 minutes and 2 hours 25 minutes respectively. The total operation time was 4 hours and 40 minutes. There were no surgical complications. There were no signs of transplant rejection 6 weeks after the operation. The considerable decrease in dispnea and increase in quality of life were registered during the follow-up. FEV1 was increased by 80% and 6 minute walk test distance was increased by 200 meters.
Assuntos
Transplante de Pulmão/métodos , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Aspergilose Broncopulmonar Alérgica/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Federação Russa , Resultado do TratamentoRESUMO
The paper pools the experience gained in the surgical treatment of lung malformations in children and adults, which has been used to develop their current classification. It also presents the outcomes of surgical treatment of acute infectious lung destructions, by taking into account the Marchuk severity index. Modes of surgical treatment of bullous pulmonary emphysema have been provided, which yield minimum postoperative mortality rates (3%). The experience of surgical treatment of 110 patients with cicatrical tracheal stenosis is summarized. The authors also present the results of operations made in 390 patients with Stage III non-small cell carcinoma of the lung, specify indications and procedures for resection of the bifurcation of the trachea when the latter is involved in the tumorous process. They also summarize the experience gained in having performed more than 300 operations in the past 5 years for progressive pulmonary tuberculosis, with 2.7% mortality, and 106 final pneumonectomies for postoperative recurrent pulmonary tuberculosis. The experience with allografting of the trachea (n = 2) and lung (n = 3) is important and little studied in our country.
Assuntos
Cirurgia Torácica/história , História do Século XX , Humanos , Federação RussaRESUMO
A retrospective matched-pair comparison was undertaken to evaluate the surgical and neurological outcomes after open and VATS thymectomy for patients with myasthenia gravis (MG) and thymoma. Ten women and seven men aged 14-77 years were operated upon in St. Petersburg Center of intensive pulmanology and thoracic surgery during the years 1995-2002. Results of two groups were compared: 1 - operated by VATS (9 patients) and 2 - operated via sterno- or thoracotomy (8 patients). The first step evaluated the distribution of age, gender, myasthenia severity, size, type of thymoma and Masaoka's stage. No difference between the groups was found. At the same time, the length of chest tube, blood loss, severity of postoperative pains were significantly lower in the first group as compared with the second one: 1.3+/-0.9 vs 6.2+/-4.5 days; 82.5+/-22.7 vs 557.1+/-212 ml; and 1.9+/-0.8 vs 6.1+/-1.2 points respectively. The number of postoperative complications was almost the same. All the patients were followed up during 24-96 months. There were no thymoma recurrences in the both groups. No statistical differences were found in MG course between the groups. A conclusion is made that VATS removing of noninvasive thymoma is technically feasible and safe for the patients. VATS thymectomy can provide the same results in MG treatment as the open approaches.