[Argon-laser ablation is a new method of airways recanalization for tumoral stenosis]. / Novyi metod rekanalizatsii dykhatel'nykh putei pri opukholevykh stenozakh: argonolazernaya ablyatsiya.

AIM: To develop the new method of laser recanalization of airways for tumoral stenosis. MATERIAL AND METHODS: It is proposed to conduct laser effect in the gas environment that does not support combustion (argon). Also the device for these AIM: is suggested. The method is called argon-laser ablation (ALA). A comparison of ALA and conventional high-energy laser exposure (LPD) was performed. RESULTS: ALA and LPD were used in 46 patients and 17 patients with non-small cell lung cancer. The duration of endobronchial operations and incidence of complications were significantly higher in group 2. The incidence of complete remission was significantly higher in group 1. CONCLUSION: Endobronchial argon-laser ablation of tracheal and bronchial tumors removes exophytic tumoral component in more favorable conditions compared with conventional high-energy laser exposure. Also it significantly increases an efficiency and reduces the frequency of complications.

ENDOBRONCHIAL PHOTODYNAMIC THERAPY UNDER FLUORESCENCE CONTROL: PHOTODYNAMIC THERANOSTICS.

One of the disadvantages of photodynamic therapy is impossibility to specify the method according to biological features of malignant tumor such as a degree of blood supply, accumulation of photosensibilizator in tumorous tissue, proliferative activity and etc. The authors aimed to develop a mode of individualization of endobronchial photodynamic therapy of central non-small cell carcinoma of lung and assessment of method efficacy. The suggested method is based on fluorescent diagnostics of degree of accumulation of photosensibilizator in timorous tissue and the rate of its expenditure in process of performing of photodynamic therapy. There was made a comparison of parameters of methods and results of photodynamic therapy in 2 randomized groups. Each group consisted of 45 patients. The research method was applied in the main group and the standard method was used in the comparison group. It was found that the research method allowed significant reduction of duration of irradiation compared with conventional method (at the average from 690±65sec to 470±45sec, p=0,02), though the treatment results were the same. The suggested method allowed separation of group of patients with absence of fluorescence of timorous tissue. Performance of photodynamic therapy is unreasonable for these patients.

[Transthoracal puncture biopsy under ultrasonic induction in tumors of the anterior mediastinum].

Differential diagnostics of tumors of anterior mediastinum is one of the most difficult problems of thoracic surgery and oncology. The authors conducted a retrospective analysis of the results of transthoracal puncture biopsy under ultrasonic induction in 44 patients with the tumors of the anterior mediastinum. Transthoracal biopsy was carried out using the device for biopsy (Multiple Biopsy Device-MBD-23) and ultrasonic scanner (Voluson 730 Expert), the patients being under intravenous (38 patients) and under local (6 patients) anesthetization. The diagnosis was made as a result of morphological research in all 100% of patients, the biopsy being performed the second time in one patient. The general information value of puncture biopsy under ultrasonic induction was 98%. A complication (localized pneumothorax, cupping off by itself) took place only in one of the follow-up study (2%). The analysis of presented material let the authors make a conclusion that transthoracal puncture biopsy under ultrasonic induction is a safe and highly informative method of diagnostics of tumors of the anterior mediastinum in selected patients.

[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.

[Application of photodynamic therapy to reduce the amount of resection for non-small cell lung cancer].

A prospective analysis of results of combined treatment of 22 patients with central stage II-III non-small cell lung cancer (NSCLC) was performed (the defeat of the main bronchi or lower parts of the trachea), which initially had been regarded as unresectable or inoperable (12 patients for functional reasons could not pass pneumonectomy, and in 10 patients a contraindication to primary surgery was the involvement of the distal trachea in tumor), but underwent surgery after preoperative treatment.Combination therapy included preoperative endobronchial photodynamic therapy (PDT) and chemotherapy followed by surgery and intraoperative PDT resection margins. PDT was carried out with the use of chlorine E6 (Radachlorin) and light wavelength of 662 nm. Overall response rate after neoadjuvant treatment was 82 %, endoscopic remission was observed in 21 of 22 patients (95%). 10 patients underwent pneumonectomy, 12--lobectomy. 19 surgical interventions were regarded as radical (R0--86%), 3--as microscopically non-radical (R1--14%). Degree of lymphatic metastasis spreading pN0 was detected in 6 patients (27 %), pN1--in 14 (64%) and pN2--in 2 patients (9%). Surgical lethality was 5%. In the late time of the whole observation period none of the patients developed local recurrence. One-year survival was 95%, 3-year--91%. PDT can play an important role in combination with surgical treatment for NSCLC and reduces the amount of resection in part of initially unresectable or inoperable patients.

[The role of endoscopic methods in treatment of tracheal cicatricial stenoses].

Treatment of tracheal cicatricial stenosis is one of the most difficult problems of modem medicine. There are two main therapeutic approaches--endoscopic (bronchoscopic) and surgical (open). The paper describes the methods of endoscopic treatment of stenoses allowing achieving complete recovery of tracheal lumen in some cases. The scheme of treatment for tracheal cicatricial stenosis is also described.

[Combined treatment of cancer of the middle third of the esophagus]. / Kombinirovannoe lechenie raka srednei treti pishchevoda.

The results of combined treatment of carcinoma of the mid-third of the esophagus are discussed. Optimal radiation dose appeared to be 30-40 Gy. Surgery should be performed not later than three weeks after termination of radiation treatment. Preoperative irradiation may be followed by pulmonary complications. Due to application of combined treatment of esophageal cancer, percentage of operable cases is increased. However, no effect on 5-year survival was registered.

[Vagotomy in stomach and duodenal ulcer]. / Vagotomiia pri iazve zheludka i dvenadtsatiperstnoi kishki.

The article is devoted to the analysis of results of vagotomy in the treatment of peptic ulcer. The material shows vagotomy to be an antiphysiological operation, not always efficient but always resulting in grave disturbances of the function of digestive organs as well as the vital activity of the whole organism. It should not be recommended for a wide introduction to the surgical treatment of the ulcer.

[Use of novosept in surgical operations]. / Ispol'zovanie novosepta pri khirurgicheskikh operatsiiakh.

For 15 years now the participants of surgical operations have been using novasept for the treatment of hand and operation fields. Novasept contains synthetic cationactive substances and superficially active substances which moisten the skin and penetrate the pores. The drug possesses high bactericidal action and does not irritate the skin.

[Cancer development in the cicatricially altered esophagus]. / O razvitii raka v rubtsovoizmenennom pishchevode.

The development of cancer in the cicatricially changed esophagus was observed by the authors in 6 patients. Only one patient proved to be operable. The authors make an objection to prophylactic exclusion of the jugular portion of the esophagus or its transection in the region concerned. The follow-up and careful examination of these patients is believed to be necessary in increased pain sensations, the use of esophagoscopy and aimed biopsy being mandatory.

[Surgical treatment of cardial and gastroesophageal neoplasms]. / O khirurgicheskom lechenii kardio- i gastroézofageal'nogo raka.

The experience in surgical treatment of cancer of the proximal portion of the stomach in 1003 patients is described. The transpleural access was used in 452 operations. The authors believe that long-term results of the surgery are mostly dependent on the spread of tumour and the type of tumour growth.

[Autologous blood transfusion in surgical treatment of peptic ulcer]. / Autogemotransfuzii v khirurgii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

From 1975 the authors used autohemotransfusion in stomach resection for ulcer complications. The procedure was carried out upon 68 patients aged from 28 to 57. 200-350 ml of the blood were taken from these patients 4 to 7 days before operation. The routine method of donor blood conservation was used. The transfusion was performed during the operation. The patients did not develop any complications due to the blood exfusion and transfusion.