[Intraoperative ultrasound investigation and laser spectroscopy for diagnosis of cancer in patients with lung tumors].

The experience in more than 2000 surgeries on the lungs is analyzed. Recently intraoperative ultrasonic and laser autofluorescent spectroscopic revision of tumors of the lungs and mediastinal organs is successfully used. Intrasurgical ultrasonic examination of the lungs permits to detect the structure and diffusion of primary lung tumor (invasion of vessels) that influences policy of treatment. Optical spectroscopy permits one to carry out intraoperative rapid diagnosis of benign and malignant lung tumors.

[Severity levels of intraoperative injury in patients with diffuse disseminated pulmonary syndrome].

Differential diagnosis of diseases manifested with lung diffuse dissemination syndrome is very difficult. Final diagnosis is possible only after pathologic examination of specimens taken during diagnostic surgical procedures. Results of open and videothoracoscopic lung biopsy at 107 patients are analyzed. Assessment of surgical trauma was based on respiratory function, neuroendocrine system response and doses of analgesics in postoperative period.

[Ultrasonic technologies in diagnosis and treatment of patients with surgical diseases of lungs and pleura]. / Ul'trazvukovye tekhnologii v diagnostike i lechenii bol'nykh s khirurgicheskimi zabolevaniiami legkikh i plevry.

The results of complex examination and treatment of 376 patients with different diseases of the lungs and pleura were analyzed. High-frequency ultrasound was used in 256 patients for diagnosis of lungs and pleura surgical diseases, 412 ultrasonic examinations were performed. Intraoperative treatment of pleura with low-frequency ultrasound was carried out 134 times for prophylaxis and treatment of acute postoperative pleura empyema in 120 patients operated on for malignant tumors and chronic purulent diseases of the lungs. High efficacy of high-frequency ultrasound for diagnosis of pleura empyema, diffuse and encapsulated pleurisy is demonstrated. Ultrasound-assisted pleural punctures an transthoracic aspiration biopsies permit to avoid complications. Ultrasonic examination of the lungs during surgery in patient suspected of lung cancer permits to study tumor structure. Treatment of pleura with low-frequency ultrasound and combination of this method with photodynamic therapy promote reliable sanation of pleural cavity. Limited rethoracotomy and treatment of pleura with low-frequency ultrasound is the method of choice in the treatment of acute postoperative empyema when there is no effect of conservative treatment.

[Prognosis of outcome of radical surgery in patients with lung cancer associated with severe complications and concurrent diseases]. / Prognozirovanie iskhodov radikal'nykh operatsii u bol'nykh rakom lëgkogo s tiazhëlymi sochetannymi i konkuriruiushchimi zabolevaniiami.

From 1981 to 2001 (20 years) 1307 patients with lung cancer underwent surgery. Postoperative lethality was 1.7% (after 635 pneumonectomies it was 2.4%, after 672 lob- and bilobectomies--1.2%). Medical histories of 171 operated patients with severe concomitant diseases was studied to analyze surgical outcomes depending on such important factors as age, concomitant diseases, surgical trauma. It is demonstrated that age of patients is not a factor of postoperative prognosis, but concomitant diseases and surgical trauma (i.e. pneumonectomy) are important factors of it. Results of surgery in the group of patients with four and more concomitant diseases after pneumonectomy were most unfavorable (lethality was 22.9%). In less severe surgical trauma (lobectomy) results of surgery were more favorable. It is concluded that surgery in patients with a lot of concomitant diseases must be less radical to obtain lower lethality. Radicality of treatment in these patients is ensured due to complex chemo- and radiation therapy after surgery.

[Combined use of low-frequency ultrasound and photodynamic therapy in the prevention of postoperative pleural empyema]. / Sochetannoe primenenie nizkochastotnogo ul'trazvuka i fotodinamicheskoi terapii dlia profilaktiki ostrykh posleoperatsionnykh émpiem plevry.

Results of surgical treatment of 20 patients with malignant lung tumors operated in N.N. Burdenko faculty surgical clinic were analyzed. The authors have developed the method of prophylaxis of acute postoperative pleural empyemas patented in Russian Federation. This method is: after main stage of operation (lob- or pneumonectomy) pleural cavity in filled with antiseptic solutions (furacillin 1:5000, 0.02% chlorgexidin). 5 ml of photosense (sulfured ftalocyanin of aluminium) were injected in pleural cavity, after it pleural cavity is treated by low-frequency ultrasound. After it the antiseptic is removed and pleural cavity is irradiated by red light with use of KAMIN-VIDEO lamp. In all the 20 operated patients who had undergone sanation of pleural cavity by low-frequency ultrasound and it irradiation by KAMIN-VIDEO lamp the postoperative period was uncomplicated.

[Complex use of ultrasound in the diagnosis and treatment of surgical diseases of the lung and pleura]. / Kompleksnoe primenenie ul'trazvuka dlia diagnostiki i lecheniia khirurgicheskikh zabolevanii legkikh i plevry.

Since 1980 the N.N. Burdenko Faculty Surgical clinic, I.M. Sechenov Moscow Medical Academy, has been using a combination of high- and low-frequency ultrasounds for the diagnosis and treatment of surgical diseases of lung and pleura in 156 patients for the diagnosis of pleuritis of various genesis, in 40 patients for transthoracic aspiration biopsy of lung tumors in the preoperative period, in 156 patients for pleural puncture and drainage, in 40 patients for the intraoperative differential diagnosis of peripheral lung tumors and for the inspection of hematogenic and lymphogenic metastatic areas, in 100 patients for intraoperative prophylaxis, and in 20 patients for the treatment of acute postoperative pleural empyema. Ultrasound was demonstrated to be of high informative value in diagnosing different pleuritis. Transthoracic aspiration biopsy was shown to have some advantages over standard methods: use of needle catheters for pleural puncture permits one to avoid serious complications (pneumothorax, bleeding, etc). Ultrasound was used in intraoperative diagnosis of peripheral lung tumors for the first time. The use of low-frequency ultrasound for the intraoperative prevention of acute postoperative pleural empyemas promotes reliable sanitation of the pleural cavity, as confirmed by bacteriologic control data. Timely rethoracotomies with low-frequency ultrasound treatment of the pleura promote more rapid inflammation elimination in the pleural cavity and prevents irreversible complications.

[Endobronchial laser therapy in complex preoperative preparation of patients with lung diseases]. / Endobronkhial'naia lazernaia terapiia v predoperatsionnoi podgotovke bol'nykh s zabolevaniiami legkikh.

The method of endobronchial laser therapy with the use of photosensitiser-photosense (phthalocyanine aluminum)--was used since 1998 for the first time in faculty surgical clinic, as preoperative preparation in 36 patients with surgical diseases of the lungs (malignant and benign tumors and chronic inflammatory diseases). The method aimed at elimination of postoperative pyogenous complications and improvement of the respiratory system functional. The method consists in introduction into the organism by various ways the photosensitizing preparation photosence, followed by irradiation of the right and left parts of bronchial tree by low intensity laser light, (wave length 675 mm) through dispersing light guide, introduced through the flexible bronchoscope to the areas of the ostia of the lobar bronchi. 3 ways of introduction of the photosensitizer were used: endobronchial (9 patients); aerosol (22 patients); combination of the endobronchial lavage and intravenous injection (5 patients). The duration of the procedure of irradiation made up 5 min. at each side of the bronchial tree, the power density being 85 mV/cm2. The procedure was repeated twice for 2 days. The following results were obtained: antibacterial effect; reduction of endoscopic and morphological features of inflammation of the bronchial mucosa; stimulation of local immunity; decrease of the tumor aggression (according to histological examination); the appearance of the tumor destruction areas; lavering of Ki-67 and bcl-2, increase of c-bax; the improvement of the respiratory system functional; positive dynamics of clinical status (a decrease of cough, dispnea, quantity of mucus discharge and haemoptysis). The perspectiveness of the method is stressed as a preoperative preparation in patients with surgical diseases of the lungs.

[Long-term results of balloon dilatation in the treatment of esophageal achalasia]. / Otdalennye rezul'taty ballonnoi dilatatsii pri lechenii akhalazii pishchevoda.

25 patients (aged from 32 to 58 years) with achalasia of the esophagus during 1985-1997 years underwent balloon dilatation of the esophagus. 18 patients had stage IV, 5--stage III and 2--stage II of the disease. Mean diameter of the stricture's area in the esophagus made up. 7.2 +/- 2.0 mm. Balloon dilatation was performed in 4 patients by 2-4 balloons d = 10 mm in one stage, and in the test patients by balloon "Rigiflex" d = 40 mm. 2-3 procedures were carried out with the interval 7-10 days. In all cases balloon dilatation was successful. Mean diameter of the esophageal lumen after dilatation has increased to 16.0 +/- 2.5 mm. In 2 patients with IV stage of the disease relapse was detected within 6-8 months. 5 year follow-up results were satisfactory in 4 patients, from 5 to 10 years--in 14 patients, and over 10 years--in 5 patients. Prolonged clinical follow-up (for 7.5 years) demonstrated complete absence of dysphagia and normal regime of nutrition. Balloon dilatation is safe, available and effective method of nonoperative treatment for achalasia of the esophagus.

[Carcinoids of lungs]. / Kartsinoidy legkikh.

The analysis of the results of the examination and treatment of 29 patients with carcinoids of the lungs has been carried out for 1984-1995. Peripheral carcinoids were detected in 59% of cases, of the tumor in the main and lobar bronchi was revealed in 41% of cases. The analysis showed that there are no symptoms, pathognomonic for carcinoids of the lungs; carcinoid syndrome was not detected in any patient. The examination (roentgenography and CT of the lungs, bronchoscopy) has not provided any objective, differential diagnostic criteria for carcinoids, cancer and benign tumors of the lungs. Morphological examination of the removed tumors allowed all the carcinoids to be divided in two types: typical (benign neuroendocrine tumor) and atypical (well differentiated neuroendocrine carcinoma). The final differentiation is possible only after conduction of thorough histological, electron microscopy and immunohistochemical examination. The principal method of carcinoids treatment is surgical one. The optimal surgical procedure is pneumonectomy or lobectomy with lymphadenectomy. Atypical resection of the lung without lymphadenectomy in peripheral location of the tumor is justified only in early stages of the disease and in cases of morphological verification of benign character of neuroendocrine tumor. Late results were followed up in 27 patients. In the group of patients with atypical carcinoids in terms of 6 to 12 months 3 patients died from progressing of the main disease. There were neither lethal outcomes nor signs of relapse of the disease in the group of patients with typical carcinoid. The terms of follow up were from 1 year to 12 years.

[Significance of spectral-fluorescence analysis in the diagnosis of surgical lung diseases]. / Znachenie spektralno-fliuorestsentnogo analiza v diagnostike khirurgicheskikh zabolevanii lëgkikh.

The work analyses the results of spectroscopy conducted at the Faculty Surgical Clinic of the Moscow Medical Academy in 105 patients with various pulmonary diseases. Sixty-four patients had carcinoma of the lung, 9 had benign tumors, and the rest had inflammatory diseases and tuberculosis of the lungs. He-Ne laser (wave length 633 nm) was employed. The radiation was recorded with a multichannel spectrum analyzer with the use of a specially designed fiber-optical catheter. The system provided for normalization of the spectra according to the intensity of the laser component scattering. The spectroluminescence characteristics of normal and inflammatory pulmonary tissue and of lung tumors were studied during bronchoscopy, during and after the operation. Analysis of the results showed the high specificity and sensitivity of the spectra of malignant pulmonary tumors. Essential differences between the spectral characteristics of normal pulmonary tissue and those of carcinoma were noted. The dependence of reduced intensity of tissue fluorescence on the distance from the visible tumor border was studied, maximum fluorescence was encountered not on the surface of the tumor or inside it, but at a distance of 1-3 cm from the border of the tumor. Increased tissue fluorescence in suppurative diseases and benign tumors of the lungs was not recorded. Laser fluorescence spectroscopy may be recommended in bronchoscopy for widening its diagnostic possibilities and in intraoperative differential diagnosis of lung carcinoma, benign tumors, tuberculomas, and chronic abscesses during diagnostic thoracotomy.

[Use of immunomodulators and low-frequency ultrasonics for prevention of acute postoperative pleural empyema]. / Primenenie immunomoduliatorov i nizkochestotnogo ul'trazvuka dlia profilaktiki ostroi posleoperatsionnoi émpiemy plevry.

Many methods for the prevention of acute postoperative pyothorax have been suggested, but no tendency towards a reduction of its frequency has been noted in the recent years. A group of 100 patients with various diseases of the lungs (malignant tumors, abscesses, bronchiectases) was examined. They were divided into 3 groups according to the degree of the risk of development of acute postoperative pyothorax: with increased, moderate, and high risk. The first group consisted of 20 patients who were given small doses of immunomodulators Dibazole and Dekaris in the pre- and postoperative periods. Control of the immunity indices was conducted in the preoperative period and on days 14 and 21 after the operation. Intraoperative treatment of the pleura with low-frequency ultrasound was applied in the second group of 40 patients. Fourty patients of the third group were treated by a complex of both of the above-mentioned preventive methods. The control group was made up of 347 patients with a similar condition but not treated by the special methods of prevention. All of the 447 patients underwent radical operations. Analysis of the results of the study showed that acute postoperative pyothorax developed in 8.65% of patients in the control group in which immunoprophylaxis and intraoperative treatment of the pleura with low-frequency ultrasound were not applied. Acute postoperative pyothorax developed in 1% of cases in the main group.

[Prognosis and prevention of postoperative empyema after radical operations on the lungs]. / Prognozirovanie i profilaktika posleoperatsionnykh émpiem plevry pri radikal'nykh operatsiiakh na legkikh.

A system of individual prediction of postoperative pyothorax was elaborated from analysis of the case records of 347 patients with carcinoma and chronic pyogenic diseases of the lungs. The authors identified 10 groups of risk factors which may aggravate the course of the postoperative period. Prognostic coefficients were determined for each one of them and their role in the development of pyothorax was specified. The complex of preventive measures in patients at a high risk of postoperative pyothorax was reinforced by intraoperative treatment of the pleura by ultrasonics, which improved the results of surgical treatment of patients with pulmonary diseases.

[Comparative evaluation of invasive methods of examination of pulmonary coin lesions]. / Sravnitel'naia otsenka invazivnykh metodov issledovaniia pri sharovidnykh obrazovaniiakh legkikh.

The results of examination of 575 solitary spherical structures in the lungs are analysed. Comparative evaluation of various methods of examination showed that transthoracic aspiration biopsy conducted under the control of computered tomography by means of two thin needles has advantages over radiological examination, cytological examination of sputum, and bronchofibroscopic biopsy. The authors developed a diagnostic algorithm used in a patient with a solitary spherical structure in the lung.