[Airway stenting in patients with complex benign tracheobronchial stenosis]. / Odnomomentnoe endoprotezirovanie trakhei i glavnykh bronkhov pri rubtsovom stenoze.

Tracheal and bronchial stenting is actively used for cancer and benign airway stenosis. This procedure is common in patients with advanced cancer. Stenting ensures breathing and availability of early chemo- and radiotherapy without the need for tracheostomy. This procedure is less common in patients with benign tracheal stenosis. In this case, isolated tracheal or bronchial stenting is performed. Complex tracheobronchial stenosis is extremely rare and creates significant difficulties. We present 3 cases of tracheobronchial stenting for cicatricial stenosis. In each case, stenosis was dilated with a rigid bronchoscope or balloon dilatation. Then, a silicone stent was installed. Resection with an appropriate anastomosis was contraindicated due to advanced pathological process. Thus stenting was regarded as a palliative operation. The follow-up periods were 9 months, 3 and 10 years. Each patient underwent inhalation therapy, endoscopy and repeated stenting if necessary.

[Surgery of primary tracheal tumors]. / Khirurgiya pervichnykh opukholei trakhei.

OBJECTIVE: To determine the main forms of primary tracheal cancer (PTC), to specify the indications for various surgeries in these patients depending on extent and localization of lesion. MATERIAL AND METHODS: There were 263 PTC patients. Benign tumors were diagnosed in 68 (25.9%) patients, malignancies - in 195 (74.1%) cases. Tracheal cancer includes 3 basic morphological variants - adenocystic cancer (49.7%), carcinoid (18.7%) and squamous cell carcinoma (19.0%). Other forms of malignancies were much less common. We applied endoscopic intraluminal and open surgeries. In malignant PTC, open surgeries were performed in 165 (84.6%) out of 195 patients. Baseline palliative endoscopic treatment was performed in 30 patients. They underwent airway recanalization (with subsequent tracheal stenting in 19 patients). Endoscopic resection was preferred for benign tumors. RESULTS: Twenty (12.1%) patients died after open surgery, and 1 (3.3%) patient died after endoscopic procedure. Most lethal outcomes occurred in early years of development of tracheal surgery. The causes of mortality were tracheal anastomotic failure in 12 patients, pneumonia in 6 patients, and arterial bleeding in 2 patients. Severe postoperative period was observed in all 3 patients after tracheal replacement with a silicone prosthesis. Long-term treatment outcomes depended on morphological structure of PTC. Favorable results were observed in patients with neuroendocrine tumor (carcinoid), worse outcomes in adenocystic cancer and unfavorable results in squamous cell carcinoma (p<0.0013). Five-year survival rates were 75%, 65.6%, and 13.3%; 10-year survival rates were 75%, 56.2%, and 13.3%, respectively. These outcomes after combined treatment of primary tracheal cancer were significantly better compared to lung cancer (p<0.05 when compared to global data). CONCLUSION: Treatment of primary tracheal cancer should be based on classical principles of modern oncology (combined therapy, tumor resection with lymphadenectomy). Open and endoscopic interventions are justified. PTC is characterized by more favorable outcomes compared to lung cancer. It is difficult to analyze long-term results in tracheal cancer depending on various features of tumor process due to small number of observations. Accurate conclusions require multiple-center studies, preferably with international participation, which can convincingly prove certain concept.

[Airway complications after lung transplantation]. / Bronkhial'nye oslozhneniya posle transplantatsii legkikh.

Lung transplantations have been regularly performed in the Russian Federation since 2010. Therefore, the number of lung transplant recipients, as well as the number of patients with airway complications following lung transplantation has been increasing. Treatment of these patients takes place not only in transplantation centers, but also in other hospitals. This review is devoted to risk factors, clinical manifestations, treatment and prevention of airway complications after lung transplantation. We analyzed literature data over the last 15 years. It was confirmed that bronchoscopy is a «gold standard¼ for diagnosis of airway complications while bronchoscopic interventions are preferred for treatment. Balloon and rigid bronchodilation and endoscopic airway stenting are the most effective interventions. Silicone stents are the most optimal. Antimicrobial prophylaxis and timely use of antiproliferative immunosuppressive drugs are important factors in prevention and treatment of airway complications after lung transplantation.

Sublingual administration of 5-aminolevulinic acid for laser-induced photodiagnostics and photodynamic therapy of oral cavity and larynx cancers.

BACKGROUND: The study aimed to develop a method for sublingual administration of 5-aminolevulinic acid to patients and evaluate its effectiveness in fluorescence diagnostics and photodynamic therapy of neoplasms of the oral cavity and larynx. METHODS: The boundaries of the neoplasms were established by the video-fluorescence diagnostics and clarified using spectral-fluorescent diagnosis before and after photodynamic therapy. RESULTS: The fluorescence diagnostics demonstrated a high accumulation of protoporphyrin IX, induced by sublingual administration of 5-aminolevulinic acid to patients before the photodynamic therapy and photobleaching of protoporphyrin IX in pathologically altered tissues after the photodynamic therapy. Glucose contained in the sublingual dose supports active transport of 5-ALA into the cells. It increases the PpIX accumulation in the cells, therefore improving the PD and PDT efficacy. CONCLUSION: The study and the initially obtained results demonstrated the possibility and effectiveness of laser-induced photodiagnostics and photodynamic therapy with sublingual administration of 5-ALA to patients with premalignant lesions of the oral cavity and larynx. It can eliminate the threat of the transformation of these diseases into malignant tumors and prevent the need for surgical treatment.

[Assessment of tracheal elasticity and tracheal anastomosis tension in cicatricial stenosis]. / Otsenka elastichnosti trakhei i natyazheniya trakheal'nogo anastomoza pri rubtsovom stenoze.

OBJECTIVE: To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection. MATERIAL AND METHODS: At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively. RESULTS: Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient. CONCLUSION: Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.

[The application vitamins of patients with atopy: a risk or the realized necessity?]. / Primenenie vitaminov u bol'nykh atopiei: risk ili opravdannaia neobkhodimost'?

The research showed that allergic reactions mostly not develop not to vitamins themselves but to dyes and flavorings. Prescription of vitamins with hypoallergic formula (e.g. Vitrum Junior) is not only realized but also necessary as an important containing part of complex treatment of allergic diseases. Risk of development of allergic manifestations during the period of taking of vitamins is decreased and provocative paros tests have been processed before.

[Risk factors and etiological structure of children's cross-allergic reactions to food products]. / Faktory riska i étiologicheskaia struktura perekrestnykh allergicheskikh reaktsii na pishchevye produkty u detei.

Authors of article have recently analyzed the frequency of prevalence and risk factors of cross-reactivity to foodstuffs among 239 children of Abakan in the age of from 6 months till 15 years with skin, respiratory and combined manifestation of atopy. It was proved that risk factors of development of cross-reactivity to food among children of the first years of life are hereditary predisposition to allergic diseases (77.8%) and early introductions of supplemental feeding (44%). Among children older then 7 years pollen sensitization (62%) which preceded the development of cross allergic reactions between separate foodstuffs reaches up to 73.7%, between pollen and foodstuff up to 79% and between epidermal and food up to 10.1%.