[Combined use of low-frequency ultrasound and photodynamic therapy in the prevention of postoperative pleural empyema]. / Sochetannoe primenenie nizkochastotnogo ul'trazvuka i fotodinamicheskoi terapii dlia profilaktiki ostrykh posleoperatsionnykh émpiem plevry.

Results of surgical treatment of 20 patients with malignant lung tumors operated in N.N. Burdenko faculty surgical clinic were analyzed. The authors have developed the method of prophylaxis of acute postoperative pleural empyemas patented in Russian Federation. This method is: after main stage of operation (lob- or pneumonectomy) pleural cavity in filled with antiseptic solutions (furacillin 1:5000, 0.02% chlorgexidin). 5 ml of photosense (sulfured ftalocyanin of aluminium) were injected in pleural cavity, after it pleural cavity is treated by low-frequency ultrasound. After it the antiseptic is removed and pleural cavity is irradiated by red light with use of KAMIN-VIDEO lamp. In all the 20 operated patients who had undergone sanation of pleural cavity by low-frequency ultrasound and it irradiation by KAMIN-VIDEO lamp the postoperative period was uncomplicated.

[Complex use of ultrasound in the diagnosis and treatment of surgical diseases of the lung and pleura]. / Kompleksnoe primenenie ul'trazvuka dlia diagnostiki i lecheniia khirurgicheskikh zabolevanii legkikh i plevry.

Since 1980 the N.N. Burdenko Faculty Surgical clinic, I.M. Sechenov Moscow Medical Academy, has been using a combination of high- and low-frequency ultrasounds for the diagnosis and treatment of surgical diseases of lung and pleura in 156 patients for the diagnosis of pleuritis of various genesis, in 40 patients for transthoracic aspiration biopsy of lung tumors in the preoperative period, in 156 patients for pleural puncture and drainage, in 40 patients for the intraoperative differential diagnosis of peripheral lung tumors and for the inspection of hematogenic and lymphogenic metastatic areas, in 100 patients for intraoperative prophylaxis, and in 20 patients for the treatment of acute postoperative pleural empyema. Ultrasound was demonstrated to be of high informative value in diagnosing different pleuritis. Transthoracic aspiration biopsy was shown to have some advantages over standard methods: use of needle catheters for pleural puncture permits one to avoid serious complications (pneumothorax, bleeding, etc). Ultrasound was used in intraoperative diagnosis of peripheral lung tumors for the first time. The use of low-frequency ultrasound for the intraoperative prevention of acute postoperative pleural empyemas promotes reliable sanitation of the pleural cavity, as confirmed by bacteriologic control data. Timely rethoracotomies with low-frequency ultrasound treatment of the pleura promote more rapid inflammation elimination in the pleural cavity and prevents irreversible complications.

[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.

[Application of ultrasound in differential diagnosis of pleurisy]. / Ul'trazvukovoe issledovanie v differentsial'noi diagnostike plevritov.

According to literature data, pleural exudate is diagnosed approximately in 10% of pulmological patients. The importance of differential diagnosis of pleuriesy is expained by variability of the diseases accompanied by pleural exudate. 146 patients with various diseases accompanied by pleural exudate were examined: 39 from them had pleural empyema, 53--diffuse pleurisy, 42--incapsulated pleurisy, and 12--tumors of the pleura. All the patients underwent ultrasound examination (USE) of the chest together with a routine roentgenography, as well as computed tomography. USE was performed on the. Toshiba and Hitachi egurpment, which work in real time regime with sectorial sensing element (3.5-5.0 mHz). The obtained data show, that USE is most effective diagnostic tool in incapsulated and diffuse liquor accumulations in pleural cavity. In 6 patients the diagnosis of pleuritis was possible only at USE of the pleural cavity. Evaluation of the structure of the liquor and detection of tumor conglomerates on parietal pleura have a substantial diagnostic value. It is noted that echotomographic picture might be insufficiently informative in some situations with a small length of the contact of the lesion with the thoracic wall (less than 3 cm) or thickness of pleural layers up to 4-5 mm, in the presence of artefacts due to pulmonary tissues and osteal structures of the thoracic wall (ribs, scapula, sternum).

[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.

[The role of duplex scanning in determination of indications for shunting procedures in patients with Leriche syndrome]. / Rol' dupleksnogo skanirovaniia v opredelenii pokazanii k shuntiruiushchim operatsiiam u bol'nykh s sindromom Lerisha.

Duplex scanning (DS) is the only available method for visualization of the internal aperture and arteries walls, to evaluate hemodynamic significance of stenosis. DS was used in 41 patients with aorto-femoral occlusions. The vessels diameter parallel with the specific features of the walls lesions and parameters of doppler frequency spectrum have been examined. In all patients the results of DS were compared with the results of paracentetic translumbal or i.v. digital angiography, equally with intraoperative evaluation. The classification of iliac arteries stenosis based on ultrasound examination has been proposed. In cases of stenosis less than 80% the results of DS appeared to be more accurate than results of angiography. In critical stenosis the results of DS coincided with the results of angiography. The use of DS in 11 patients without clinical and angiographical signs of stenosis made it possible to reveal the lesion and take the decision for bifurcation by-pass surgery. In 98% the results of DS coincided with the results of intraoperative evaluation. DS must be used in patients with Leriche syndrome.

[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.

[Diagnosis and treatment of diabetic angiopathy of the lower extremities]. / Diagnostika i lechenie diabeticheskoi angiopatii nizhnikh konechnostei.

Experience in the treatment of 77 patients with diabetic angiopathy of the lower limbs is discussed. Various pyonecrotic complications developed in 44% of cases. Laboratory and instrumental diagnostic methods included general clinical, biochemical, and coagulation tests, angiography, dopplerography, and rheovasography. Rheovasography was elaborated in 1952 at the Facultative Surgical Clinic head by N. Elansky and is still an informative method. The management of patients with diabetic angiopathy included correction of carbohydrate metabolism, angioprotectors, anticoagulants, and anti-aggregation agents. In patients with pyonecrotic complications intraarterial infusion of the medicinal agents is preferred, the method is used in the clinic since 1951. Operations were performed on 74% of patients, the character of the intervention was determined by the affection of the vascular bed. Reconstructive operations were conducted on 16% of patients. In the absence of conditions for reconstruction lumbar sympathectomy was undertaken. According to indications, the operation was combined with necrotomy or "minor" amputations. Adequate non-operative therapy, improvement of circulation in the limb by reconstructive operations of sympathectomy save the limb or limit the volume of the amputation. Amputation through the middle third of the leg was performed in 7, exarticulation at Chopart's joint in 2 and at Lisfranc's joint in one, and exarticulation of the toes in 10 patients. No fatal outcomes occurred. The thigh was amputated in 13 patients with moist gangrene for vital indications, mortality was 45%. Timely recognition of affection of the arteries in diabetes mellitus is recommended for determining the indications for operative interventions aimed at preventing pyonecrotic complications.

[The choice of an optimal variant in the reconstructive stage of gastrectomy]. / Vybor optimal'nogo varianta rekonstruktivnogo étapa gastréktomii.

The authors analyse 40-year experience in gastrectomy and extirpation of the gastric stump in carcinoma of the stomach. Operations were performed on 742 patients. The results show that the mechanical suture has advantages over the manual suture in the formation of the esophago-intestinal anastomosis. The functional results were found to be best when the continuity of the gastrointestinal tract was restored by establishing the esophago-intestinal anastomosis with a loop of the small intestine isolated according to Roux. Comparative appraisal of end-to-end and end-to-side esophago-intestinal anastomoses revealed the advantages of the last-named in relation to the incidence of postoperative complications and total outcomes. The effect of the surgeon's qualification on the frequency of postoperative complications is discussed.

[Use of immunomodulators and low-frequency ultrasonics for prevention of acute postoperative pleural empyema]. / Primenenie immunomoduliatorov i nizkochestotnogo ul'trazvuka dlia profilaktiki ostroi posleoperatsionnoi émpiemy plevry.

Many methods for the prevention of acute postoperative pyothorax have been suggested, but no tendency towards a reduction of its frequency has been noted in the recent years. A group of 100 patients with various diseases of the lungs (malignant tumors, abscesses, bronchiectases) was examined. They were divided into 3 groups according to the degree of the risk of development of acute postoperative pyothorax: with increased, moderate, and high risk. The first group consisted of 20 patients who were given small doses of immunomodulators Dibazole and Dekaris in the pre- and postoperative periods. Control of the immunity indices was conducted in the preoperative period and on days 14 and 21 after the operation. Intraoperative treatment of the pleura with low-frequency ultrasound was applied in the second group of 40 patients. Fourty patients of the third group were treated by a complex of both of the above-mentioned preventive methods. The control group was made up of 347 patients with a similar condition but not treated by the special methods of prevention. All of the 447 patients underwent radical operations. Analysis of the results of the study showed that acute postoperative pyothorax developed in 8.65% of patients in the control group in which immunoprophylaxis and intraoperative treatment of the pleura with low-frequency ultrasound were not applied. Acute postoperative pyothorax developed in 1% of cases in the main group.

[The immunomodulators levamisole and dibazole in the prevention of acute postoperative pleural empyema as one method of preoperative preparation]. / Immunomoduliatory levamizol i diabazol v profilaktike ostrykh posleoperatsionnykh émpiem plevry kak odin i metodov predoperatsionnoi podgotovki.

Numerous methodologies had been suggested to prevent postoperative pyothorax, but the tendency towards reduction in the incidence of this condition couldn't be seen. Forty patients with different lung diseases (malignant tumours, abscesses, bronchiectases) were examined. Twenty patients received low-dose levamisole and dibazole pre- and postoperatively, while to the remaining 20 patients these immunomodulators were not administered. All the 40 patients underwent radical operations. Immunoassay was undertaken in both groups in the preoperative period and at days 7, 14, and 21 postoperatively. As a result it was found that the group of patients devoid of immunoprophylaxis showed development of pyothorax in 5 percent of the cases. The groups of patients exposed to preventive measures including low doses of levamisole and dibazole did not show septic complications in the pleural cavity.

[Prognosis and prevention of postoperative empyema after radical operations on the lungs]. / Prognozirovanie i profilaktika posleoperatsionnykh émpiem plevry pri radikal'nykh operatsiiakh na legkikh.

A system of individual prediction of postoperative pyothorax was elaborated from analysis of the case records of 347 patients with carcinoma and chronic pyogenic diseases of the lungs. The authors identified 10 groups of risk factors which may aggravate the course of the postoperative period. Prognostic coefficients were determined for each one of them and their role in the development of pyothorax was specified. The complex of preventive measures in patients at a high risk of postoperative pyothorax was reinforced by intraoperative treatment of the pleura by ultrasonics, which improved the results of surgical treatment of patients with pulmonary diseases.

[Comparative evaluation of invasive methods of examination of pulmonary coin lesions]. / Sravnitel'naia otsenka invazivnykh metodov issledovaniia pri sharovidnykh obrazovaniiakh legkikh.

The results of examination of 575 solitary spherical structures in the lungs are analysed. Comparative evaluation of various methods of examination showed that transthoracic aspiration biopsy conducted under the control of computered tomography by means of two thin needles has advantages over radiological examination, cytological examination of sputum, and bronchofibroscopic biopsy. The authors developed a diagnostic algorithm used in a patient with a solitary spherical structure in the lung.

[Combined operations in diseases of the stomach and duodenum]. / Sochetannye operatsii pri zabolevaniiakh zheludka i dvenadtsatiperstnoi kishki.

The article generalizes the experience in treating 137 patients with diseases of the stomach and duodenum. The largest group included 82 persons with peptic ulcer; 45 had carcinoma of the stomach; 5 had benign tumors of the stomach, and 5 persons had chronic duodenal obstruction. The most common concurrent disease was cholelithiasis (102 patients), it was diagnosed before the operation in 70% of patients with peptic ulcer and in 85% of those with carcinoma of the stomach. Among the less predominant diseases were abdominal hernias (12 patients), cysts of various localization (7), varicosity (3), chronic appendicitis (3), atherosclerosis obliterans (2), ect. Organ-preserving operations were carried out as the main stage of surgery in most patients with peptic ulcer. The nature of the simultaneous operations corresponded to the concomitant surgical diseases. Most of the operations (125) were performed through a median laparotomy approach; superior median laparotomy was mostly resorted (115 patients). Four (2.9%) patients died after the operation. It is pointed out that patients with gastroduodenal diseases must be thoroughly to reveal concurrent surgical diseases.

[Combined operations in cholelithiasis]. / Sochetannye operatsii pri zhelchnokamennoi bolezni.

Experience in combined operations for cholelithiasis on 162 patients is discussed. In 98 patients, cholecystectomy was performed as a simultaneous stage of surgical treatment, the main stage of the operation was gastrectomy or resection of the stomach for cancer in 26 patients, formation of a small stomach for alimentary-constitutional obesity in 19, various types of vagotomy in 33, hemicolectomy, resection of the colon and sigmoid intestine for malignant tumors in 10, and reconstructive manipulations on the stomach, correction of intestinal obstruction, and other operations in 10 patients. Cholecystectomy was the main stage of the operation in 48 patients with hernias, benign tumors of the uterine appendages, breasts, and soft tissues. The authors insist that cholecystectomy must be carried out when cholelithiasis is a concurrent disease; they showed that increase in the extent of the operative intervention had no essential effect on mortality and frequency of postoperative complications (mortality rate, 1.2%). The authors substantiate the expediency of performing combined operations from economical considerations--the economical effect of the operations conducted by the authors came to some 51,000 roubles.