[Bronchial fistulae after pneumonectomy for lung cancer].

Fistula of bronchial stump developed in 246 (9.4%) cases of 2614 patients who were underwent pneumonectomy for lung cancer in 1964-2013. Mortality rate in case of bronchial fistulae was 17.9%. It was analyzed causes of this complication, an important role of infection for its development was emphasized. So prevention of wound infection is main prophylactic action. Postoperative pneumonia and bleeding are considerable risk factors. Clinico-anatomical type of tumor, stage and technique of bronchial stump treating don't affect incidence of fistulae. Bronchial stump covering is important intraoperative preventive measure. Treatment of this complication includes early drainage and pleural cavity sanitation and isolation of fistula from pleural cavity. Endoscopic procedures (impact with silver nitrate, trichloroacetic acid, laser) are preferred to solve the last problem. It allowed to achieve fistulae healing in 58.1% of cases.

[Artificial pneumothorax in the treatment of destructive pulmonary tuberculosis complicated by its drug-resistant pathogen].

A hundred and nine patients with complicated destructive pulmonary tuberculosis who had received chemotherapy with reserve drugs, artificial pneumothorax (AP), pneumoperitoneum (PN), physiotherapy, and resection surgery were followed up. The application of video thoracoscopy made it possible to eliminate any types of pleural adhesions. Individualization of therapeutic measures considerably increases the efficiency of treatment. AP is the method of choice in therapy of newly detected patients who have undergone ineffective routine treatment regimens.

[Chronic fibrous mediastinitis with a superior vena cava compression syndrome]. / Khronicheskii fibroznyi mediastinit s sindromom sdavleniia verkhnei poloi veny.

An observation of chronic fibrous mediastinitis in a woman of 32 with the previous history of puerperal sepsis with bilateral pneumonia is described. The disease manifested clinically by a syndrome of v. cava superior compression. Chronic inflammatory process in the mediastinal adipose tissue with the development of a rough fibrosis was found morphologically.

[Surgical treatment of lung cancer in elderly patients]. / Khirurgicheskoe lechenie raka legkogo u bol'nykh pozhilogo vozrasta.

The study was concerned with ann analysis of the immediate and long-term results of surgical treatment of 263 lung cancer patients aged 60 years and older. Postoperative lethality rates were as follows: lung resection-5.4%, pneumonectomy-8.9 and extensive and combined pneumonectomy-27.2%. 35.1% survived 5 years and longer. Extensive and combined pneumonectomy gave poor immediate and long-term results in the above group. X-ray, broncho- and mediastinoscopy offer means for evaluation of mediastinal involvement to avoid the said procedures.

[Method of extensive mediastinoscopy in lung cancer]. / Metodika rasshirennoi mediastinoskopii pri rake legkogo.

The technic of extensive mediastinoscopy is described, which enables visualization of anatomical structures of the mediastinum and lung hilus inaccessible for an examination while using mediastinoscopy after the Carlens technic. An experience with the extensive mediastinoscopy performed in 116 lung cancer patients is reported. This kind of investigation does not increase the incidence of complications as compared with the Carlens mediastinoscopy. The mediastinoscopy was performed immediately before thoracotomy.

[Parasternal mediastinopleuroscopy in the diagnosis of malignant neoplasms of the anterior mediastinum]. / Parasternal'naia mediastinoplevroskopiia v diagnostike zlokachestvennykh novoobrazovanii perednego sredosteniia.

The authors suggest a clinical procedure of parasternal mediastinopleuroscopy which assures intercostal examination, instrumental palpation and biopsy of neoplasms of the anterior mediastinum without causing considerable trauma. The procedure makes it possible to assess operability and to determine optimal access for surgical removal of tumor. The procedure was used in clinic in 35 cases; in 23 of them, intervention was limited to biopsy, while 12 cases underwent radical surgery.

[Mechanisms of impairment of gas exchange and hemodynamics following pneumonectomy in patients with lung cancer]. / Mekhanizmy rasstroistv gazoobmena i gemodinamiki posle pnevmonéktomiu bol'nykh rakom legkogo.

A correlation analysis of basic indexes of gas exchange and hemodynamics observed on day 4 postpneumonectomy was carried out in 56 patients. Factors accounting for relevant dysfunction were studied. Patterns of postoperative changes in basic parameters were established. Respiratory insufficiency was due to ventilation-perfusion balance derangement caused by obstruction and lung hypertension, and compromised pulmonary blood flow in a single lung because of decreased cardiac output.

[How to improve the diagnosis of diseases of the respiratory organs? (the experience in organizing diagnostic services at the Sverdlovsk Pulmonology Center)]. / Kak uluchshit' diagnostiku boleznei organov dykhaniia? (opyt organizatsii diagnosticheskikh sluzhb v Sverdlovskom pul'monologicheskom tsentre).

The authors have summed up their 12-year experience in forming a system of organizational measures for the diagnosis of pulmonary diseases in an industrial area with the adult population of 3,616 mln. The major stages of diagnosis were studied, measures for its improvement defined, the main causes of diagnostic errors brought to light. The authors are of opinion that separate examination of patients with pulmonary pathology in different institutions is inappropriate.

[Means of improving the organization of surgical care of lung cancer patients]. / Puti uluchsheniia organizatsii khirurgicheskoi pomoshchi bol'nym rakom legkogo.

The paper discusses improvement in diagnosis and surgical treatment of lung cancer starting from detection of alterations in the lungs to establishing indications for surgery. A complex of diagnostic and therapeutic measures aimed at improving the results of surgical treatment of the disease is suggested.

[Use of laser impulses in the treatment of melanoblastoma of the skin]. / Lechenie impul'snym lazernym izlucheniem melanoblastom kozhi.

Favourable results of the treatment of skin melanoblastoma by means of pulse laser radiation are reported in 34 patients and of melanoblastoma skin metastasis in 13 patients. The follow-up lasted up to 5 years. There were no cases of local relapse. Metastasis in the regional lymph nodes were found in 5 patients (17%). Before the start of the treatment the latters had not shown any metastasis.

[Parasternal mediastino-pleuroscopy in the diagnosis of diffuse lesions of the lungs]. / Parasternal'naia mediastinoplevroskopiia v diagnostike diffuznykh porazhenii legkikh.

A procedure for parasternal mediastinopleuroscopy (PMS) has been proposed for biopsy of pulmonary tissue and intrasternal lymph nodes. A surgical technique of intervention is described in the paper. PMS was performed in 81 patients with diffuse lesions of the lungs and the disease was morphologically verified. The clinical and X-ray diagnosis was found to be incoincident with their final morphological diagnosis after PMS had been performed in 48 out of 81 patients. To obtain an informative biopsy specimen needed for a morphological diagnosis, biopsies of the lung and lymph nodes should be taken in all cases. Complications occurred in 2 patients. These included bleedings from the intercostal arteries, which required vascular ligation.

[Feasibility and limitations of the preoperative diagnosis of meningocele]. / Vozmozhnosti i predely dooperatsionnoi diagnostiki meningotsele.

The paper is concerned with clinical and x-ray analysis, performed in 10 patients (9 women and 1 man) aged 40 to 50, with meningocele, a congenital abnormality. The final diagnosis of this disease was made possible only by means of transthoracic needle biopsy of cerebrospinal fluid, which was effectively performed in 5 patients.

[Bronchitis after pneumonectomy in patients with lung cancer]. / Bronkhit posle pnevmonéktomii u bol'nykh rakom legkogo.

Postoperative bronchitis developed in 99 (8.3%) of 1,189 patients who underwent pneumonectomy for lung carcinoma. The sequelae of postoperative bronchitis were the cause of death in more than one third of patients who died from pneumonectomy. The high incidence of bronchopleural complications in this group of patients is emphasized. Data are presented which provide evidence that the functions of external respiration and blood circulation are disturbed in patients with postoperative bronchitis. A complex of measures for the prevention and treatment of this complication are suggested, which made it possible to reduce the frequency and mortality rate of postoperative bronchitis in the last years.

[Surgical policy in tuberculous pleurisy]. / Khirurgicheskaia taktika pri tuberkuleznom plevrite.

Two hundred and eighty seven cases of tuberculous pleurisy are analyzed. According to the pleural contents, four phases of development of this disease are identified. These include: 1) free pleurisy; 2) partially encysted pleurisy; 3) encysted pleurisy, and 4) adhesive pleurisy. An algorithm of use of draining procedures and surgical interventions depending on the phase of pleurisy is proposed. Among other things, indications for thoracoscopy that was performed in 66 patients with tuberculous pleurisy for its therapy were stated. Thoracoscopy is ineffective in adhesive pleurisy, in the presence of a rigid residual cavity in particular, and thus preference should be given to thoracotomy with pleurectomy and decortication of the lung. This operation was made in 39 cases. Timely use of draining procedures and surgical interventions make it possible to achieve recovery from tuberculous pleurisy over shorter periods of time and with minimal residual changes.

[Diagnosis and surgical treatment of a mediastinal form of lymphogranulomatosis]. / Diagnostika i khirurgicheskoe lechenie mediastinal'noi formy limfogranulematoza.

The article deals with material on 161 patients with the mediastinal form of lymphogranulomatosis. Variants of the X-ray picture and clinical manifestations of the disease are described. The authors list the indications for the use of bioptic methods of examination--prescalene biopsy, transthoracic needle biopsy, transtracheobronchial puncture, and mediastinoscopy. Comparative characteristics of the diagnostic value of these methods is given. Ten patients were treated by radical removal of the affected mediastinal lymph nodes, a satisfactory late--term result was produced in 8 of them.