[Causes of resistant pleural effusions and efficiency of chemical pleurodesis in these patients]. / Prichiny rezistentnykh plevral'nykh vypotov i effektivnost' khimicheskogo plevrodeza v ikh lechenii.

OBJECTIVE: To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients. MATERIAL AND METHODS: Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage. RESULTS: In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube. CONCLUSION: Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.

[Intraoperative pleurodesis with talc and trichloroacetic acid for exudative pleuritis]. / Intraoperatsionnyi plevrodez tal'kom i trikhloruksusnoi kislotoi pri ekssudativnykh plevritakh.

OBJECTIVE: To compare the efficacy of chemical pleurodesis with talc and trichloroacetic acid during thoracoscopy. MATERIAL AND METHODS: Thoracoscopy with pleural biopsy was performed in 355 (83.5%) out of 424 patients with pleural effusion. Pleurodesis was ensured by intraoperative insufflation of talc powder (n=135) and application of 33% trichloroacetic acid solution to parietal and visceral pleura (n=19) in patients with malignant (125), inflammatory (6), post-traumatic (4), tuberculous (3), pancreatogenic (8) and hepatogenic (8) effusions. Drainage tubes were removed if daily drainage output volume was less than 100 ml or complete lung inflation was observed. RESULTS: Post-pleurodesis drainage took 7.1±5.4 days. Two patients developed bumpy rashes that were initially interpreted as carcinomatosis. However, these rashes were later identified as tuberculosis. Retrospectively, these patients were not good candidates for pleurodesis. Pleurodesis with talc suppressed exudation in 89.6% of cases. Complications developed in 4 cases (3%): pneumonia (1) and pleural empyema (3). These complications were associated with a violation of technical procedure of pleurodesis, i.e. procedure in rigid lung, atelectasis (1) and bronchopleural fistula (2). Mean duration of drainage after trichloroacetic acid-induced pleurodesis was 7.9±6.7 days. This procedure was effective in 84.2% of cases, and there were no complications. There are no previous reports on the use of this pleurodesis technique in the literature. Mean duration of drainage after talc-induced pleurodesis was decreased up to 6.9±5.4 days in patients with malignant pleural effusion (p<0.05), after trichloroacetic acid-induced pleurodesis - up to 7.5±8.1 days (p>0.05) compared to patients without pleurodesis (9.1±11.2 days). CONCLUSION: Pleurodesis with talc or trichloroacetic acid during thoracoscopy is effective for pleural effusions following malignancies, liver, kidney and cardiac diseases with decompensation. Essential requirements are adequate lung inflation, no atelectasis and bronchopleural fistula.

[Analysis of endothelial dysfunction in the context of pleural effusions of various origins using skin thermometry]. / Issledovanie endotelial'noi disfunktsii pri plevral'nykh vypotakh razlichnoi etiologii metodom teplovoi kozhnoi termometrii.

OBJECTIVE: To analyze the mechanisms and severity of endothelial dysfunction in patients with pleural effusion of various origins using skin thermometry. MATERIAL AND METHODS: We studied microcirculation in 135 patients with pleural effusions of various origins. Local skin thermometry and computer wavelet analysis were performed in 3-5 days after thoracoscopy with pleural biopsy using Microtest-100WF device with a temperature measuring resolution of 0.001°C. We estimated endothelial, myogenic and neurogenic indices using spectral analysis of skin temperature fluctuations in a range 0.0095-2 Hz. The control group comprised 40 healthy participants aged 23-36 years. RESULTS: Three groups of patients were distinguished depending on the cause of effusion: malignant pleural effusions (n=65, 48.1%); inflammatory pleural effusions (para-pneumonic, post-traumatic, pancreatogenic, tuberculous) (n=58, 43%); transudates (hepatogenic, cardiogenic, and nephrogenic) (n=12, 8.9%). There were no significant differences in vascular tone in response to local heating of the second finger of the hand up to 40°C. Measurements were carried out within 10 min in all groups. Patients with diabetes mellitus and cardiovascular diseases (n=48, 35.6%) had significant decrease of thermal vasodilation index in endothelial range up to 2.93±1.77, in the control group - up to 4.21±2.40 (p=0.041). CONCLUSION: Endothelial dysfunction is a universal non-specific aspect in pathogenesis of various diseases. This process is essential in pleural effusion. Local thermometry and computer wavelet analysis revealed no significant differences between patients with malignant, inflammatory and transudative pleural effusions. Pleural effusions in the context of cardiovascular pathology and/or diabetes mellitus occur due to impaired vasodilatation mechanisms in endothelial range.

[Diagnosis of malignant pleural effusions using convolutional neural networks by the morphometric image analysis of facies of pleural exudate]. / Diagnostika zlokachestvennykh plevral'nykh vypotov s pomoshch'yu svertochnykh neironnykh setei putem morfometricheskogo analiza izobrazhenii fatsii plevral'nogo ekssudata.

OBJECTIVE: To estimate the possibility of diagnosis of malignant pleural effusion using convolutional neural networks of facies images of pleural exudates obtained by the method of wedge-shaped dehydration. MATERIAL AND METHODS: We studied 163 images of pleural fluid facies obtained by wedge-shaped dehydration in patients with various pleural effusions (10 nosological groups). Recognition and analysis were carried out using convolutional neural network. The images were divided into two groups - malignant effusion (n=65; 40%) and other diseases (n=98; 60%). RESULTS: There were 131 photos selected for further investigation after pre-processing of images by eliminating defective ones, turning them into black and white format, cleaning of 'noise', cutting out the facies. Then the images were standardized. The method of rigid transformations with rotation for every 10 degrees was used. As a result, their number increased up to 4,585. Self-taught neural network analyzed the images of facies independently by separation of the fragments consisting of black and white dots and comparison of them with each other. Self-teaching and training of each neural network were ensured by random sampling of 80% of images from the initial sample. Then the remaining 20% of the images were used as a control sample to assess the possibilities of recognition pleural effusion cause. Four options of convolutional neural networks were used. An accuracy of cancer detection ranged from 82% to 95.6%, benign diseases - from 84% to 94.7%. The neural network with the highest sensitivity was chosen. CONCLUSION: Automated image analysis system of pleural effusion facies using convolutional neural network ensured an accuracy of diagnosis of malignant pleural effusion in 95,6% of cases and other diseases in 90% of cases. The method is simple, efficient, cheap and reagentless.

[Mediastinal pancreatic cysts: review and own clinical observations]. / Mediastinal'nye pankreatogennye kisty.

OBJECTIVE: To present the results of surgical treatment of patients with mediastinalpancreatogeniccysts (MPC). MATERIAL AND METHODS: There were 5 patients with MPC. RESULTS: Laboratory tests revealed increased blood amylase level by 1.5-2 times in 3 cases, urine diastase by 4-5 times - in 2 cases. Pleural effusion with amylase concentration in the fluid from 5680 to 48 640 units was diagnosed in 4 cases. CT data of preudocysts of pancreatic body and tail were obtained in 3 cases, head and body - in 2 patients. These cysts extended to posterior mediastinum through the hiatal orifice for about 3.5-40 cm. Three patients underwent VATS removal of pleural fragments, one - thoracotomy, lung decortication and MPC drainage through pleural cavity. Three patients underwent pancreatic drainage procedures (cystogastrostomy, pancreaticojejunostomy and external drainage of the cyst). A small pseudocyst has been successfully treated by conservative treatment with octreotide. CONCLUSION: MPC is a rare complication of pancreatitis and often associated with pleural effusion. CT and fluid amylase analysis are the main diagnostic measures. Surgical treatment includes VATS, destruction of pleural fragments and pleural drainage, cystogastrostomy, pancreaticojejunostomy or external drainage of pancreatic pseudocyst.