[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.

[Photodynamic therapy in treatment of lung cancer].

The effectiveness of photodynamic therapy was studied in 20 patients with different stages of lung cancer. We used the photosensitizer--PHOTOHEM and gold vapor laser (Auran). Photodynamic therapy was combined with high-energy laser photodestruction of tumors in 7 patients. In late (IIIb and IV) cancers the application of photodynamic therapy has significantly reduced the tumor tissue of bronchial obstruction in 9 out of 12 (75%) patients with improvement of the respiratory function, disappearance of atelectases. Photodynamic therapy was less effective in bronchoscopic signs of infiltrative tumor growth, typical for its peribronchial form. In the early stages of cancer the application of photodynamic therapy allowed complete removal of the tumor. However, 2 out of 8 patients showed signs of residual tumor growth within 1-3 months which disappeared due to repeated treatments with photodynamic therapy.

[Composite biodegradable materials based on polyhydroxyalkanoate].

Conditions for the processing and mixing of biodegradable polymers at temperatures less than their thermal destruction (130-150 degrees C) using standard equipment have been identified. The structure of the polyhydroxybutyrate/valerate (PHB/V) copolymer has been revealed and peculiarities of the crystal phase formation at different monomer ratios have been investigated. It was shown that pure PHB with molecular mass 180-270 kDa has elastic module approximately 1.2 GPa, strength approximately 25 MPa, and elongation at break approximately 10%. The most active biodestructors of PHB, PHB/V, and their composites have been selected (Aspergillus caespitosus), and the ability of basidiomycete Panus tigrinus to biodegrade polyalkanoates was demonstrated for the first time. It was shown that A. caespitosus degraded PHB/V and Biopol films along with the PHB with the destruction rate depending on the technology of the film production, on the molecular mass, and on the extend of the polymer crystallinity.

[Transbronchial biopsy of the lungs in diagnosis of respiratory sarcoidosis].

AIM: To specify diagnostic potentialities of transbronchial biopsy of the lungs (TBB) in respiratory sarcoidosis (RS). MATERIAL AND METHODS: TBB of the lungs was performed in bronchofibroscopy under local anesthesia and TV x-ray control with intake of 4-5 biopsy specimens. RESULTS: Biopsy specimens consisted primarily of alveolar tissue in 62.5% patients, of bronchial wall - in 34.8%, were insufficiently informative - in 2.4% patients. Histological examination of the biopsies detected sarcoid granulemas which served the basis for RS diagnosis in 62.5% patients (stage 1 - 51.1%, stage 2 - 70.4%, stage 3 - in 61.6%). Sarcoid granulemas were detected more frequently in alveolar tissue than in bronchial walls (75.3 and 38.5%, respectively, p < 0.05). In RS stage 1 granulemas in the bronchial walls were found less often than in stages 2 and 3 (56.3, 42.9%, respectively, p < 0.01). CONCLUSION: TBB provides morphological RS diagnosis in 2/3 patients and is a safe method. Obtaining biopsies containing alveolar tissue raises efficacy of TBB, especially in the disease stage 1.

[Surgical treatment of laryngotracheal cicatricial stenoses].

An analysis of results of 18 laryngotracheal resections in patients after prolonged artificial pulmonary ventilation with circular, A-shaped or mixed forms of stenosis has shown that one-stage sleeve resection of the larynx below the glottis and upper third of the trachea with the formation of primary anastomosis is possible without placing a stent when they have cicatricial lesion. In patients with laryngotracheal stenosis the sleeve laryngotracheal resection is recommended with primary thyrocricoid tracheal anastomosis as a comparatively safe and effective reconstructive operation giving good immediate and long-term results.

[The potential of surgical and bronchoscopic treatment of idiopathic scarry stenoses of the trachea].

Tracheolaryngeal resection is indicated for treatment of idiopathic scarry stenosis of the trachea with destruction of the cartilaginous tracheal semi-rings and cricoid cartilage. The proximity of anastomosis to the vocal folds does not influence the function of the vocal folds, if all technical peculiarities of the operation are observed. The bronchoscopic elimination of the scarry stenosis using laser dissection of the fibrous tissue, bougieurage and temporary endoprosthesis with a silicon T-shape stent is indicated in case of the saved integrity of the cartilaginous carcass of the trachea and larynx.

[Jet transcatheter artificial ventilation in the surgical treatment of tracheal cicatricial stenosis].

The authors present the results of a study of the baseline condition, the parameters of external respiratory function, gas exchange, and hemodynamics in 42 patients with tracheal cicatricial stenosis (TCS). The impact of transcatheter normofrequency artificial ventilation (AL) on the respiratory and circulatory parameters was studied during surgical TCS removal. The baseline impairments were identified in the external respiratory system and in the hemodynamic provision of breathing processes, which corresponded to first-second grade respiratory failure disorders, despite preoperative tracheal bougienage elimination. Normofrequency and high-frequency AL is the method of choice in treating patients with concomitant respiratory diseases.

[Surgical treatment of the tracheal scarry stenoses]. / Khirurgicheskoe lechenie rubtsovykh stenozov trakhei.

Surgical policy for scarry tracheal stenosis is analyzed. In the years 1998-2003 in the clinic there were 32 circular resections of the trachea. More than 5 cm of the tracheal segment was ablated in 15 of the cases. The initially performed endoscopic treatment including bougieurage and trachea endoprosthesis was carried out in 19 patients. The immediate and long-term results were satisfactory in all cases that allowed the authors to recommend the one-step circular resection of the trachea as a method of choice for the treatment of lengthy scarry stenoses of the trachea.

Aerobic and anaerobic microbial degradation of poly-beta-hydroxybutyrate produced by Azotobacter chroococcum.

Food industry wastewater served as a carbon source for the synthesis of poly-beta-hydroxybutyrate (PHB) by Azotobacter chroococcum. The content of polymer in bacterial cells grown on the raw materials reached 75%. PHB films were degraded under aerobic, microaerobic, and anaerobic conditions in the presence and absence of nitrate by microbial populations of soil, sludges from anaerobic and nitrifying/denitrifying reactors, and sediment from a sludge deposit site. Changes in molecular mass, crystallinity, and mechanical properties of PHB were studied. Anaerobic degradation was accompanied by acetate formation, which was the main intermediate utilized by denitrifying bacteria or methanogenic archaea. On a decrease in temperature from 20 to 5 degrees C in the presence of nitrate, the rate of PHB degradation was 7.3 times lower. Under anaerobic conditions and in the absence of nitrate, no PHB degradation was observed, even at 11 degrees C. The enrichment cultures of denitrifying bacteria obtained from soil and anaerobic sludge degraded PHB films for a short time (3-7 d). The dominant species in the enrichment culture from soil were Pseudomonas fluorescens and Pseudomonas stutzeri. The rate of PHB degradation by the enrichment cultures depended on the polymer molecular weight, which reduced with time during biodegradation.

[The biodegradation of poly-beta-hydroxybutyrate (PHB) by a model soil community: the effect of cultivation conditions on the degradation rate and the physicochemical characteristics of PHB]. / Biodegradatsiia poli-beta-gidroksibutirata v model'nykh usloviiakh pochvennogo soobshchestva: vliianie uslovii sredy na skorost' protsessa i fisiko-mekhanicheskie kharakteristiki polimera.

The biodegradation of films made of poly-beta-hydroxybutyrate (PHB) with a molecular mass of 1500 kDa was studied using a model soil community in the presence and absence of nitrate and at different concentrations of oxygen in the gas phase. The biodegradation of PHB was investigated with respect to changes in its molecular mass, crystallinity, and some mechanical properties.

[The fiber bronchoscopic evaluation of the bronchial inflammatory changes and hyperreactivity in bronchial asthma patients]. / Bronkhofibroskopicheskaia otsenka vospalitel'nykh izmenenii i giperreaktivnosti bronkhov u bol'nykh bronkhial'noi astmoi.

Bronchofibroscopic bronchial examination detected inflammation-induced changes in the bronchi in the form of mucosal thickening (edema), small masses of the sputum and occasional hyperemia in the majority of the examinees with bronchial asthma. In combination with bronchoalveolar lavage, bronchofibroscopy provides diagnosis of bronchial hyperreactivity basing on determination of segmentary bronchial stenosis in response to salt solution instillation. The degree of this stenosis can evidence the degree of hyperreactivity of the bronchi. Bronchofibroscopic signs of bronchial hyperreactivity appear more distinctly in asthma aggravations, in severe run of the disease, in pronounced inflammation.

[Endoscopic laser surgery of the trachea]. / Lazernaia éndokhirurgiia trakhei.

Bronchoscopic laser operative interventions with the use of yttrium- aluminum -garnet laser were carried out in 36 patients with various pathological structures of the trachea. Laser endosurgery was applied as radical and palliative types of therapy. Endoscopic laser interventions make it possible to remove completely benign and carcinoid tumors, correct some types of cicatricial stenoses, restore continuity of the trachea, and remove respiratory insufficiency in inoperable malignant neoplasms with exophytic growth.

Bronchoscopic laser photocoagulation of superficial cancer of the bronchi.

Multifocal squamous cell carcinoma in the bronchus of the anterior segment of the right lung and in the subsegmental bronchus of the posterior subsegment of the left upper lobe was diagnosed in a 61-year-old man. The right-sided upper lobectomy followed by Nd:YAG laser photocoagulation of the superficial cancer in the left side resulted in total eradication of the tumor. Subsequent follow-up examinations for three years have revealed no relapse of tumor growth.

[Assessment of mucociliary clearance using the radioaerosol method in chronic lung diseases]. / Otsenka mukotsiliarnogo klirensa radioaérozol'nym metodom pri khronicheskikh zabolevaniiakh legkikh.

The radioaerosol technique with the use of radioalbumin from the TSK-5 kit and of an ultrasonic inhaler makes it possible to determine primarily the mucociliary clearance of the central parts of the tracheobronchial tree. In patients without any pathology of the respiratory organs, the clearance of the inhaled radiopharmaceutical constitutes 45.5 +/- 9.5 percent for an hour. In patients with pulmonary pathology, the characteristics of the mucociliary clearance vary from dramatically decreased to normal ones depending on the disease pattern, exacerbation phase or remission.