[Efficiency of endobronchial ultrasonography in the diagnosis of peripheral lung masses].

OBJECTIVE: To evaluate the efficiency of endobronchial ultrasonography (EBUS) in the diagnosis of peripheral lung masses. MATERIAL AND METHODS: The investigation enrolled 38 patients, including 34 males; their mean age was 63.8+/-15.8 years. Bronchoscopy was carried out under local anesthesia in all the patients in their sitting position, by using a flexible endoscope, along with transbronchial lung biopsy (TBLB). During the study, a 20 mHz radial scanning ultrasonic miniprobe was successively introduced into the working channel of a bronchoscope through the ostium into the preselected bronchi. If the peripheral mass could be located by EBUS, after withdrawing the probe, TBLB was performed using biopsy forceps. RESULTS: EBUS could locate a pathological mass and perform TBLB in 34 (89.5%) of the 38 cases. The cumulative efficiency of TBLB was seen in 63.2% (24/38) patients: there was adenocarcinoma in 16 (42.1%) cases, squamous cell carcinoma in 6 (15.8%), hamarthoma in 1 (2.6%), and tuberculoma in 1 (2.6%). The predictors of biopsy efficiency were tumor sizes above 20 mm; bronchial drainage as shown by computed tomography; the central position of a miniprobe about the mass, the proximal position of a mass about the bronchial ostium; a less than one-and-a-half-minute study; smoking index. CONCLUSION: Endobronchial ultrasonography is an effective and safe method for controlling endoscopic lung biopsy in peripheral lung masses.

[Diagnostics and treatment of postcholecystectomy biliary complications].

The study concerns early postoperative bile leak and obstructive jaundice syndrome after cholecystectomy. 4865 patients were included in the study. The initial cholecystectomy was performed through the traditional laparotomy (n=2122), minilaparotomic access (n=1024) and laparoscopic access (n=1710). Early biliary complications were registered in 135 (2,8%) patients, of whom 47 had bile leak and 88 develop obstructive jaundice. The external drainage bile leak was registered in 0,68%; bile leak trough the trained common bile duct had 0,17% and bile leak into the abdominal cavity had 0,12% of these patients. In 17 cases the bile leak was caused by the cystic duct stump insufficiency, 12 cases were caused by bile leak from the gall bladder bed. 73,5% of bile leak were caused by misdiagnosed choledocholithiasis and papilla Vateri stenosis. Obstructive jaundice in early postoperative period was determined by underdiagnosed bile ductal pathology in the majority of patients (84 patients of 88). The main diagnostic method of biliary complications was the retrograde cholangiopancreaticography with the efficacy of 99,2%. Endoscopic transpapillary operations were curative in 97% of cases. Complications after endoscopic manipulations developed in 3,3%, all of them were successfully conservatively treated.