[The randomized study of efficiency of preoperative photodynamic].

The authors made a prospective randomized comparison of results of preoperative photodynamic therapy (PhT) with chemotherapy, preoperative chemotherapy in initial unresectable central non-small cell lung cancer in stage III. The efficiency and safety of preoperative therapy were estimated as well as the possibility of subsequent surgical treatment. The research included patients in stage IIIA and IIIB of central non-small cell lung cancer with lesions of primary bronchi and lower section of the trachea, which initially were unresectable, but potentially the patients could be operated on after preoperative treatment. The photodynamic therapy was performed using chlorine E6 and the light of wave length 662 nm. Since January 2008 till December 2011,42 patients were included in the research, 21 patients were randomized in the group for photodynamic therapy and 21--in group without PhT. These groups were compared according to their sex, age, stage of the disease and histological findings. After nonadjuvant treatment the remissions were reached in 19 (90%) patients of the group with PhT and in 16 (76%) patients without PhT and all the patients were operated on. The explorative operations were made on 3 patients out of 16 operated on in the group without PhT (19%). In the group PhT 14 pneumonectomies and 5 lobectomies were perfomed opposite 10 pneumonectomies and 3 lobectomies in group without PhT. The degree of radicalism of resection appears to be reliably higher in the group PhT (RO-89%, R1-11% as against RO-54%, R1-46% in group without PhT), p = 0.038. The preoperative endobronchial PhT conducted with chemotherapy was characterized by efficiency and safety, allowed the surgical treatment and elevated the degree of radicalism of this treatment in selected patients, initially assessed as unresectable.

[Photodynamic therapy in combined treatment of stage III non-small cell lung carcinoma].

The aim of the study was to evaluate the effectiveness of combined treatment of locally advanced lung cancer with the use of neoadjuvant chemotherapy and surgery with the use of pre- and intraoperative photodynamic therapy. 20 patients with IIIa (n=7) and IIIb (n=13) stage of non-small cell lung carcinoma were included. At the time of diagnosis the surgical treatment was decided to abstain because of the trachea invasion in 9 patients, wide mediastinal invasion in 2 patients and contralateral mediastinal lymph nodes metastases in 2 patients; pneumonectomy was not possible due to the poor respiratory function in 7 patients. Neoadjuvant therapy included 3 courses of chemotherapy and endobronchial photodynamic therapy. During the operation, along with the lung resection (pneumonectomy - 15, lobectomy - 5), photodynamic therapy of the resection margins were carried out. No adjuvant treatment was done. Preoperative treatment led to partial regress of the disease in all cases; the goal of surgery was the complete tumor removal. No complications of the photodynamic therapy were observed. 18 surgical interventions were radical and two non-complete microscopically (R1). Postoperative morbidity was 20%, one patient died due to massive gastrointestinal bleeding. The average follow-up period was 18 months: 19 patients were alive, of them 18 with no signs of the disease recurrence. The first experience of the combined use of neoadjuvant chemotherapy and surgery with pre- and intraoperative photodynamic therapy demonstrates safety and efficacy of the suggested treatment tactics.

[Photodynamic therapy in treatment of lung cancer].

The effectiveness of photodynamic therapy was studied in 20 patients with different stages of lung cancer. We used the photosensitizer--PHOTOHEM and gold vapor laser (Auran). Photodynamic therapy was combined with high-energy laser photodestruction of tumors in 7 patients. In late (IIIb and IV) cancers the application of photodynamic therapy has significantly reduced the tumor tissue of bronchial obstruction in 9 out of 12 (75%) patients with improvement of the respiratory function, disappearance of atelectases. Photodynamic therapy was less effective in bronchoscopic signs of infiltrative tumor growth, typical for its peribronchial form. In the early stages of cancer the application of photodynamic therapy allowed complete removal of the tumor. However, 2 out of 8 patients showed signs of residual tumor growth within 1-3 months which disappeared due to repeated treatments with photodynamic therapy.

[Transbronchial biopsy of the lungs in diagnosis of respiratory sarcoidosis].

AIM: To specify diagnostic potentialities of transbronchial biopsy of the lungs (TBB) in respiratory sarcoidosis (RS). MATERIAL AND METHODS: TBB of the lungs was performed in bronchofibroscopy under local anesthesia and TV x-ray control with intake of 4-5 biopsy specimens. RESULTS: Biopsy specimens consisted primarily of alveolar tissue in 62.5% patients, of bronchial wall - in 34.8%, were insufficiently informative - in 2.4% patients. Histological examination of the biopsies detected sarcoid granulemas which served the basis for RS diagnosis in 62.5% patients (stage 1 - 51.1%, stage 2 - 70.4%, stage 3 - in 61.6%). Sarcoid granulemas were detected more frequently in alveolar tissue than in bronchial walls (75.3 and 38.5%, respectively, p < 0.05). In RS stage 1 granulemas in the bronchial walls were found less often than in stages 2 and 3 (56.3, 42.9%, respectively, p < 0.01). CONCLUSION: TBB provides morphological RS diagnosis in 2/3 patients and is a safe method. Obtaining biopsies containing alveolar tissue raises efficacy of TBB, especially in the disease stage 1.

[Laryngobronchofibroscopy in the diagnosis and treatment of acute purulent mediastinitis]. / Laringobronkhofibroskopiia v diagnostike i lechenii ostrogo gnoinogo mediastinita.

Laryngopharynx and tracheobronchial tree were examined in 20 patients with purulent mediastinitis (PM) of different origin. Endoscopically, upper posterior mediastinitis was characterized by swallowing of membraneous wall into the lumen due to pressure outside. The authors recommend diagnostic application of laryngobronchofibroscopy to verify PM following traumas of the respiratory tracts and therapeutic use of the above procedure to treat PM complications; propose to perform nasotracheal intubation using bronchofibroscope as a method of choice in prevention of asphyxia in PM patients provoked by laryngeal edema.

[Conservative treatment of postoperative defects of the bronchial stump and of bronchoalveolar fistulae]. / Konservativnoe lechenie posleoperatsionnykh defektov kul'ti bronkhov i bronkhoal'veoliarnykh svishchei.

Based on their experience with the treatment of 65 patients the authors consider that choice of the method of treatment depends on the bronchus calibre and the fistula size. Good results were obtained when using different variants of bronchus obturation with the application of glue.