[First time revealed small formations of lungs (under 2 cm in diameter). Dynamic follow-up or surgery?] / Vpervye vyyavlennye ochagovye obrazovaniya legkikh malogo razmera (do 2 sm v diametre). Dinamicheskoe nablyudenie ili operatsiya?

AIM: To develop the treatment algorithm in patients with first time revealed lung lesions smaller than 2 cm. MATERIAL AND METHODS: The study included 110 patients with pathological lung lesions with small dimensions who have been treated in the Burdenko Clinic of Faculty Surgery for the period 1997-2013. All patients underwent surgical removal of lung tissue using different surgical approaches: 44 cases of videothoracoscopic resections, 43 video-assisted minithoracotomies, 23 minithoracotomies. RESULTS: There were 25 patients with lung cancer, 38 cases of benign tumours (hamartoma and tuberculoma) and 10 patients with disseminated tuberculosis thar required special treatment. CONCLUSION: Small pulmonary formations (from 0.5 to 2 cm) can be removed without morphological verification prior to surgery. Optimal surgical approach should be selected depending on the amount and size of formations. Management of solitary lung formation smaller than 0.5 cm that was newly diagnosed by computed tomography should include dynamic follow-up and performance of computed tomography in 3-6-12 months.

[Surgical access for small-sized lung lesions].

Experience of diagnostics and surgical treatment of of 100 patients with small-sized lung lesions was analyzed. Thus, authors pose, that patients with lung focal lesion less than 10mm in diameter, should have a lung resection, performed from minithoracotomy. Videthotacoscopic lung biopsy is appropriate by multiple focal lesions. Patients with solitary peripheral lung lesion more than 1sm in diameter, should get a lung resection, performed from minithoracotomy with videoassistance. Patients with solitary lesion less than 5 mm in diameter requier radiological dynamic follow-up (CT-scan each 6 months).

[Intraoperative ultrasound investigation and laser spectroscopy for diagnosis of cancer in patients with lung tumors].

The experience in more than 2000 surgeries on the lungs is analyzed. Recently intraoperative ultrasonic and laser autofluorescent spectroscopic revision of tumors of the lungs and mediastinal organs is successfully used. Intrasurgical ultrasonic examination of the lungs permits to detect the structure and diffusion of primary lung tumor (invasion of vessels) that influences policy of treatment. Optical spectroscopy permits one to carry out intraoperative rapid diagnosis of benign and malignant lung tumors.

[Ultrasonic technologies in diagnosis and treatment of patients with surgical diseases of lungs and pleura]. / Ul'trazvukovye tekhnologii v diagnostike i lechenii bol'nykh s khirurgicheskimi zabolevaniiami legkikh i plevry.

The results of complex examination and treatment of 376 patients with different diseases of the lungs and pleura were analyzed. High-frequency ultrasound was used in 256 patients for diagnosis of lungs and pleura surgical diseases, 412 ultrasonic examinations were performed. Intraoperative treatment of pleura with low-frequency ultrasound was carried out 134 times for prophylaxis and treatment of acute postoperative pleura empyema in 120 patients operated on for malignant tumors and chronic purulent diseases of the lungs. High efficacy of high-frequency ultrasound for diagnosis of pleura empyema, diffuse and encapsulated pleurisy is demonstrated. Ultrasound-assisted pleural punctures an transthoracic aspiration biopsies permit to avoid complications. Ultrasonic examination of the lungs during surgery in patient suspected of lung cancer permits to study tumor structure. Treatment of pleura with low-frequency ultrasound and combination of this method with photodynamic therapy promote reliable sanation of pleural cavity. Limited rethoracotomy and treatment of pleura with low-frequency ultrasound is the method of choice in the treatment of acute postoperative empyema when there is no effect of conservative treatment.

[Endobronchial laser therapy in complex preoperative preparation of patients with lung diseases]. / Endobronkhial'naia lazernaia terapiia v predoperatsionnoi podgotovke bol'nykh s zabolevaniiami legkikh.

The method of endobronchial laser therapy with the use of photosensitiser-photosense (phthalocyanine aluminum)--was used since 1998 for the first time in faculty surgical clinic, as preoperative preparation in 36 patients with surgical diseases of the lungs (malignant and benign tumors and chronic inflammatory diseases). The method aimed at elimination of postoperative pyogenous complications and improvement of the respiratory system functional. The method consists in introduction into the organism by various ways the photosensitizing preparation photosence, followed by irradiation of the right and left parts of bronchial tree by low intensity laser light, (wave length 675 mm) through dispersing light guide, introduced through the flexible bronchoscope to the areas of the ostia of the lobar bronchi. 3 ways of introduction of the photosensitizer were used: endobronchial (9 patients); aerosol (22 patients); combination of the endobronchial lavage and intravenous injection (5 patients). The duration of the procedure of irradiation made up 5 min. at each side of the bronchial tree, the power density being 85 mV/cm2. The procedure was repeated twice for 2 days. The following results were obtained: antibacterial effect; reduction of endoscopic and morphological features of inflammation of the bronchial mucosa; stimulation of local immunity; decrease of the tumor aggression (according to histological examination); the appearance of the tumor destruction areas; lavering of Ki-67 and bcl-2, increase of c-bax; the improvement of the respiratory system functional; positive dynamics of clinical status (a decrease of cough, dispnea, quantity of mucus discharge and haemoptysis). The perspectiveness of the method is stressed as a preoperative preparation in patients with surgical diseases of the lungs.

[Carcinoids of lungs]. / Kartsinoidy legkikh.

The analysis of the results of the examination and treatment of 29 patients with carcinoids of the lungs has been carried out for 1984-1995. Peripheral carcinoids were detected in 59% of cases, of the tumor in the main and lobar bronchi was revealed in 41% of cases. The analysis showed that there are no symptoms, pathognomonic for carcinoids of the lungs; carcinoid syndrome was not detected in any patient. The examination (roentgenography and CT of the lungs, bronchoscopy) has not provided any objective, differential diagnostic criteria for carcinoids, cancer and benign tumors of the lungs. Morphological examination of the removed tumors allowed all the carcinoids to be divided in two types: typical (benign neuroendocrine tumor) and atypical (well differentiated neuroendocrine carcinoma). The final differentiation is possible only after conduction of thorough histological, electron microscopy and immunohistochemical examination. The principal method of carcinoids treatment is surgical one. The optimal surgical procedure is pneumonectomy or lobectomy with lymphadenectomy. Atypical resection of the lung without lymphadenectomy in peripheral location of the tumor is justified only in early stages of the disease and in cases of morphological verification of benign character of neuroendocrine tumor. Late results were followed up in 27 patients. In the group of patients with atypical carcinoids in terms of 6 to 12 months 3 patients died from progressing of the main disease. There were neither lethal outcomes nor signs of relapse of the disease in the group of patients with typical carcinoid. The terms of follow up were from 1 year to 12 years.

[Laser fluorescence spectroscopy in intraoperative diagnosis and staging of lung cancer]. / Lazernaia fluorestsentnaia spektroskopiia v intraoperatsionnoi diagnostike i otsenke rasprostranennosti raka lëgkogo.

67 patients with different kind of lung diseases have been evaluated by intraoperative laser spectroscopy. 49 of them had lung cancer and 18 patients had nonmalignant tumors, tuberculomas and chronic abscess. Helium-neon laser has been used to study spectral parameters of a normal lung tissue and lungs with malignant and benign tumors intraoperatively. It was found that intensity of autofluorescence will increase in cancer tissue. This phenomenon may be used for differential diagnosis of a lung cancer with benign tumors and chronic pulmonary diseases. It was also shown that autofluorescence of metastatic lymph nodes is higher compared to their hyperplasia. That may be used for rapid diagnosis of metastases in mediastinal lymph nodes and intraoperative staging of lung cancer.

[Significance of spectral-fluorescence analysis in the diagnosis of surgical lung diseases]. / Znachenie spektralno-fliuorestsentnogo analiza v diagnostike khirurgicheskikh zabolevanii lëgkikh.

The work analyses the results of spectroscopy conducted at the Faculty Surgical Clinic of the Moscow Medical Academy in 105 patients with various pulmonary diseases. Sixty-four patients had carcinoma of the lung, 9 had benign tumors, and the rest had inflammatory diseases and tuberculosis of the lungs. He-Ne laser (wave length 633 nm) was employed. The radiation was recorded with a multichannel spectrum analyzer with the use of a specially designed fiber-optical catheter. The system provided for normalization of the spectra according to the intensity of the laser component scattering. The spectroluminescence characteristics of normal and inflammatory pulmonary tissue and of lung tumors were studied during bronchoscopy, during and after the operation. Analysis of the results showed the high specificity and sensitivity of the spectra of malignant pulmonary tumors. Essential differences between the spectral characteristics of normal pulmonary tissue and those of carcinoma were noted. The dependence of reduced intensity of tissue fluorescence on the distance from the visible tumor border was studied, maximum fluorescence was encountered not on the surface of the tumor or inside it, but at a distance of 1-3 cm from the border of the tumor. Increased tissue fluorescence in suppurative diseases and benign tumors of the lungs was not recorded. Laser fluorescence spectroscopy may be recommended in bronchoscopy for widening its diagnostic possibilities and in intraoperative differential diagnosis of lung carcinoma, benign tumors, tuberculomas, and chronic abscesses during diagnostic thoracotomy.

[Comparison of amino acid sequences of sturgeon triprotamines using protamines from Acipenser stellatus gonads as an example]. / Sravnenie aminokislotnykh posledovatel'nostei triprotaminov osetrovykh na primere protaminov iz gonad Acipenser stellatus.

The amino acid sequence of the triprotamine stelline C from mature sperm nuclei of Acipenser stellatus has been established by automated sequence analysis of the protein and from data provided by thermolysine peptides. The complete amino acid sequence of stelline C is: R-R-R-R-R-H-A-S-T-K-L-K-R-R-R-R-R-R-R-H-G-K-K-S-H-K. The comparison of the primary structure of stelline C with that of other triprotamines from Acipenser stellatus shows that they are similar except for the absence of N-terminal alanine in the stelline A molecule. The main structure difference between stelline C and other fish protamines is that the stelline C molecule begins with five arginine residues.

[A comparative study of the antiheparin activity and acute toxicity of stellins]. / Sravnitel'noe issledovanie antigeparinovoi aktivnosti i ostroi toksichnosti stellinov.

The comparative study of the antiheparin activity and acute toxicity of the commercial preparation stellin and its homogeneous fractions was carried out. The summary preparation stellin along with a low antiheparin activity possessed a high toxicity explained by the content of ballast proteins of the nonprotamin nature. One of the homogeneous fractions--stellin B had the best antiheparin properties (heparin neutralizing ratio of 8:1 w:w) and a low toxicity due to a high content of arginine residues and a rigid macromolecular structure facilitating the interpolymer interaction with heparin.

[Principles of creating biotransducers based on nucleic acid liquid crystals]. / Printsipy sozdaniia biodatchikov na osnove zhidkikh kristallov nucleinovykh kislot.

A brief concept of biosensors is presented. Structural peculiarities and properties of single- and double-stranded nucleic acids that are to be taken into account when creating sensing units for biosensors using different principles of molecular recognition are considered. General schemes of sensing units based on liquid-crystalline dispersions formed from low-molecular mass DNA, its complexes with "cross-linking" agents and from circular superhelical DNA molecules are described.

[Circular dichroism spectra of DNA complexes with stellins A and B--protamines from Acipenser stellatus]. / Krugovoi dikhroizm kompleksov DNK so stellinami A i B--protaminami iz Acipenser stellatus.

The circular dichroism (CD) spectra of DNA complexes with stellins A and B, protamines from Acipenser stellatus, in 2,5 x 10(-4) M EDTA were studied. The CD spectrum of the stellin B--DNA complex practically coincides with that of original DNA. In the CD spectrum of the stellin A--DNA complex the positive band amplitude increases at 275 nm, while the negative band amplitude decreases at 245 nm at increasing of protein/DNA ratio. The resulting A-like CD spectrum is apparently coupled with the changes in the parameters of DNA double helix. The changes in the CD spectra in the stellin A--DNA complex are correlated with a higher capacity of stellin A for helix formation in ethanol. The data obtained suggest that individual components of stellin play a specific role in the structural organization of nucleoprotamine.

[Thermal denaturation and nuclease degradation of complexes of stellins A and B with DNA]. / Termicheskaia denaturatsiia i nukleaznoe rasshcheplenie kompleksov stellinov A i D DNK.

The soluble complexes of stellins A and B-protamines from Acipenser stellatus-with DNA were obtained by direct mixing in 2,5.10(-4) M EDTA, pH 8,0. The differential curves of melting of the complexes reveal two transitions at Tmelt.1=49+/-1 degree and Tmelt.2=90+/-1 degree, corresponding to melting of DNA regions of free and protamine-bound DNA regions. The number of amino acid residues per one nucleotide in the protein-binding sites of DNA is 1,30 and 1,22 for the stellin A- and stellin B-DNA complexes, respectively. It was demonstrated that under denaturation the DNA filaments do not break apart completely. Data from the analysis of products of the complexes hydrolysis by DNAse I allowed to postulate a selective binding of the protamines to the AT-pairs of DNA. This assumption was confirmed by changes in the melting curves under different protein/DNA ratios.