[Analysis of lymphatic drainage pathways using infrared fluorescence in patients with lung cancer]. / Izuchenie putei regionarnogo limfoottoka pri rake legkogo s pomoshch'iu infrakrasnoi fluorestsentsii.

OBJECTIVE: To develop a method for analysis of lymphatic drainage pathways from the lobe of the lung affected by non-small cell lung cancer (NSCLC) using infrared fluorescence. MATERIAL AND METHODS: A study enrolled patients with NSCLC who underwent anatomic resection of the lung with systematic lymph node dissection and preliminary intraoperative peritumoral injection of indocyanine green conjugate with human albumin. Registration of fluorescence in regional lymph nodes (LN) was carried out immediately after excision of specimen using the FLUM-808 instrumental system. RESULTS: Infrared fluorescence was observed in 117 hilar and mediastinal lymph nodes from 43 patients (2.7 nodes per a patient). Comparison of localization of fluorescent LN with localization of tumor in various lobes established significant variability of lymphatic drainage pathways. CONCLUSION: The developed method of infrared fluorescent evaluation of lymphatic drainage in patients with NSCLC confirms the necessity of systematic lymph node dissection for adequate staging.

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS.

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas.

[INTRAOPERATIVE DETECTION OF SENTINEL LYMPH NODES USING INFRARED IMAGING SYSTEM IN LOCAL NON-SMALL CELL CARCINOMA OF LUNG].

The article presents the results of the first domestic experience of intraoperative fluorescence mapping of sentinel lymph nodes in lung cancer. The research included 10 patients, who underwent surgery over the period of time from September 2013 to May 2014. After performing thoracotomy, the solution of indocyanine green (ICG) was injected using subpleural position above the tumor in 3-4 points. Fluorescence (ICG) image guided surgery was carried out by using infrared radiation (wave length 808 nm) on lung surface, root of lung, mediastinum in real time. Fluorescence lymph nodes were mapped. In case that metastatic lesions weren't revealed in sentinel lymph nodes, they weren't noted in other nodes. Method specificity consisted of 100%. Biopsy and histological study of sentinel lymph nodes mapped during fluorescence (ICG) image guided surgery could be useful for prevention of lymphodissection in patients with non-small cell carcinoma of lung.

[ULTRASONIC ASSESSMENT OF DIAPHRAGM CONDITION OF THE PATIENTS, WHO PASSED THE SELECTION FOR LUNG VOLUME REDUCTION SURGERY].

The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn't noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn't shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing.

[To the question of reasonability of lung biopsy in primary spontaneous pneumothorax].

A biopsy of lung tissues was a conventional diagnostic method for detection of disseminated processes in the lung, which weren't diagnosed on preoperative stage. It was used during surgical anti-relapse treatment of spontaneous pneumothorax (SP). A retrospective analysis of the results of lung parenchyma biopsy was made in 143 patients, who have been operated for SP. Basic entry criteria of the research were: the age younger than 40 years old, a presence of one episode of spontaneous pneumothorax, an absence of complaints for respiratory organs before the development of the first episode of spontaneous pneumothorax. The biopsy with following pathomorphological investigation allowed a formulation of exact variant of disseminated processes, which gave the reason for the development of spontaneous pneumothorax in 9 (6%) patients out of 143. The presence of disseminated processes in the lung was detected with multispiral CT in all these patients on preoperative stage. The study of biopsy material found out the presence of emphysema of different degree of manifestation or fibrosis sites in the rest of the patients. An analysis of presented materials allowed the conclusion, that a performance of biopsy was indicated in the case of suspicion for lung disseminated processes in patients with SP. The biopsy with the following histological study didn't explain the reason of the development of emphysematous and fibrous changes in lung parenchyma in all other cases. At the same time, it didn't give the option for pathogenetic treatment and it wasn't possible to predict the following pathogenesis.

[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.

[Videothoracoscopic costal pleurectomy by primary and secondary spontaneous pneumothorax].

The aim of the study was to assess the effectiveness of videothoracoscopic (VATS) costal pleurectomy in patients with primary and secondary spontaneous pneumothorax (SP). 136 patients were selected for the retrospective study. Among them 114 were men, the rest 22 - women with a mean age of 29.3 years (range 16 to 37 years). 123 patients had primary SP; 13 patients were diagnosed with interstitial lung disease and secondary SP. The follow-up time after surgery was minimally 3 years. The duration of the postoperative thoracic draining was 2.1 days for patients with primary SP and 3.4 days for those with the secondary SP. The length of the ICU stay was 1.1 and 1.2 days respectively. The overall complication rate was 9% for patients with primary SP and 47% for patients with secondary SP; the recurrence rate was 1 and 23%, respectively. Thus, marked satisfactory immediate and long-term outcomes among patients with primary SP, the VATS pleurectomy can not be considered the method of choice for patients with secondary SP, cause by interstitial lung disease.

[Surgical treatment of respiratory failure in young patients with diffuse lung emphysema].

An analysis of results of examination and treatment of 8 young patients (from 25 to 17 years of age) with generalized emphysema of the lungs, pulmonary failure of the II and III degrees was made. The functional examination of the patients before operation has revealed changed respiration by obstructive type. Symptoms of dysplasia of the connective tissue were found in 4 patients. Surgical reduction of the lung volume was performed in 5 patients for correction of respiratory failure. There were neither serious complications nor lethality. Dyspnea by MMRC scale decreased in all the patients at minimum by 1 point during the first months after operation. Three years later 4 out of the operated patients (80%) had retained positive effect of operation. In patients who had no operative treatment the frequency of infectious complications, level of dyspnea during three years of follow-up remained at the same level, while functional indices continued worsening. The surgical method of treatment of severe respiratory failure allowed tolerance of physical exercise to be increased and quality of life of patients with diffuse lung emphysema to be improved.

[Resection of the left atrium in lung cancer].

An analysis of results of surgical treatment of 28 patients with lung cancer who underwent resection of the left atrium has shown that squamous cell cancer was diagnosed in 18 patients (64%), adenocarcinoma--in 5 (18%), dimorphous cancer--in 2 (7%), mucoepidermoid cancer in 2 (7%), atypical carcinoid--in 1 patient (4%). The degree of regional lymphogenic spread of the tumor NO took place in 11 patients (39%), N1--in 6 patients (22%), N2--in 11(39%). True invasion of the tumor to the left atrium myocardium took place in 20 patients (71%), involvement of the pulmonary vein orifices in the tumor process--in 8 (29%). Resection of the atrium was made using mechanical suturing apparatuses. The right side resections were fulfilled in 16 patients (57%), left side resections in 12 patients (43%). Pneumonectomy was fulfilled in 26 patients (93%), lobectomy--in 2 patients (7%). The operative interventions in five cases (18%) were estimated as microscopically non-radical (R1). The average time in the intensive care unit after operation was 3 days (from 1 till 12), in the surgical thoracal department--18 days (from 13 till 37). In the early postoperative period one patient died (4%), complications were noted in 5 patients (18%). The total one year survival was 69%, three year survival--39%, 5 year survival--17%. The survival median was 23 months. Resection of the left atrium in the selected lung cancer patients was not followed by growing operative lethality and the acceptable long term results were obtained.