Probe-based confocal laser endomicroscopy in COVID-19.

Probe-based confocal laser endomicroscopy (pCLE) is a method that produces microscopic imaging of a lung tissue during bronchoscopy. We report a case ot a patient with negative nasopharyngeal swabs and suspected lung cancer who underwent pCLE. The diagnosis of COVID-19 was confirmed by PCR analyses of lavage fluid and transbrohial biopsy. The pCLE image shows density of alveolar thickened fibres, disorganization of elastin network, and multiple large drops of intraalveolar secretions. As far as we know, this is the first pCLE image discribed in patient with COVID-19 at that moment.

Lobectomy with pathological examination in lung cancer patients who recovered from COVID-19.

We present two cases of lobectomy in lung cancer patients who recovered from COVID-19 before surgical treatment. In both cases, video-assisted thoracoscopic surgery was initiated and hilar fibrosis was detected; as a result, conversion was performed in one case. There were no postoperative complications and mortality. Also, we demonstrate the results of pathological examination in patients who have recovered from COVID-19.

Probe-based confocal laser endomicroscopy in diagnosis of desquamative interstitial pneumonia in nonsmoker.

Desquamative interstitial pneumonia is a rare disease that is predominantly associated with smoking. Surgical biopsy is usually recommended for the diagnosis of this disorder. Probe-based confocal laser endomicroscopy (pCLE) is a new method of minimally invasive in vivo microscopic image of airways and alveoli. We use this method for desquamative interstitial pneumonia in nonsmoker. The pCLE image shows thickened intra-alveolar septae and clusters of autofluorescent cells within the alveoli, which is unusual for non-smoking patients. We think this pattern can be used for differential diagnosis of desquamative interstitial pneumonia in nonsmokers.

Surgical Resection in the Treatment of Pulmonary Tuberculosis.

Surgery for tuberculosis is becoming more relevant today. This article discusses the main indications, contraindications, features of operations, and perioperative period. This information is useful for practicing surgeons and specialists in the treatment of pulmonary tuberculosis.

Image enhancement technology in bronchoscopy: a prospective multicentre study in lung cancer.

INTRODUCTION: Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. METHODS: In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. RESULTS: In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. CONCLUSION: HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases. TRIAL REGISTRATION NUMBER: NCT02285426; Results.

Robot-assisted thoracoscopic right upper bi-lobectomy for pulmonary tuberculosis.

Surgery is one of the current options in cases of pulmonary tuberculosis with failed medication treatment. Lobectomy and bi-lobectomy constitute up to one third of all surgical procedures in such cases. Nevertheless, fibrotic changes near the hilar structures and lymph nodes are limitation factors for spread of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resection. Robotic surgery can reduce some disadvantages of VATS. This is well illustrated by the large pulmonary resections. Current case report showed first robot-assisted thoracoscopic (RATS) bi-lobectomy for pulmonary tuberculosis with good results 1-year follow-up.

Probe-based Confocal Laser Endomicroscopy in Metastatic Pulmonary Calcification.

We report a case of metastatic pulmonary calcification in a patient with chronic renal failure on hemodialysis and secondary hyperparathyroidism. The diagnosis was made by using a probe-based confocal endomicroscopy which showed specific structures in the lung tissue and was proven by a transbronchial lung biopsy. To the best of our knowledge, this is the first reported case of the confocal endomicroscopy findings in a patient with metastatic pulmonary calcification.

Bilateral cavitary multidrug- or extensively drug-resistant tuberculosis: role of surgery.

OBJECTIVES: Cavitary disease and bilateral lesions are among the risk factors for poor outcome of pulmonary tuberculosis (TB). Our aim was to explore the value and limits of surgery in patients with advanced TB. METHODS: A retrospective study of 57 consecutive patients who underwent thoracic surgery for culture-positive bilateral cavitary pulmonary TB was performed. Forty-four (77.2%) patients were men and 13 (22.8%) patients were women; their ages were in the range of 18-61 years. Twenty-two (38.6%) patients had multidrug-resistant (MDR) TB and 35 (61.4%) patients had extensively drug-resistant (XDR) TB confirmed with cultures. On admission, 49 (86.0%) patients had sputum smear microscopy positive for acid-fast bacilli. The main indication for surgery was treatment failure manifested as contagious persisting cavities despite best available therapy. The surgical procedures included combinations of pulmonary resections of different levels, selective thoracoplasties and/or endobronchial valve treatment. The operations were performed consecutively, starting with the most affected side. TB therapy preceded the operation for a minimum of 6 months and was continued after the operation on the basis of the patient's susceptibility to drugs for Mycobacterium tuberculosis. RESULTS: We performed 121 operations: 42 in 22 patients with MDR TB (1.9 operations per patient) and 79 procedures in 35 patients with XDR TB (2.3 operations per patient). No deaths occurred in the 1st year. Two late deaths followed, 1 unrelated to and 1 due to TB progression. Ten major complications (1 complication per patient) developed: main bronchus stump fistula (n = 4), prolonged air leak (n = 3), respiratory failure (n = 2) and wound seroma (n = 1). At the 1-month follow-up visit, sputum smear conversion was observed in 11 (68.8%) patients with MDR and in 15 (45.5%) patients with XDR TB. At the late (20-36 months) follow-up visit, culture negativity was achieved in 21 (95.5%) patients with MDR TB and in 23 (65.7%) patients with XDR TB (P = 0.015). CONCLUSIONS: Thoracic surgery may significantly improve patients' outcomes and even result in a cure in a good portion of patients with bilateral cavitary MDR and XDR TB and should be considered as the essential element of multimodality treatment for MDR and XDR TB, even in patients with bilateral cavitary disease and borderline respiratory reserves.

Robot-assisted surgery in complex treatment of the pulmonary tuberculosis.

Surgery of pulmonary tuberculosis associated with open thoracotomy due to dense pleural and vascular adhesions. These reasons limited the use of video-assisted thoracoscopic surgery (VATS) in these cases. Robotic surgical system aimed to performing successfully minimally invasive operations for pulmonary tuberculosis. This paper showed 3-year experience of one chest center in this area. The results of this work are recommendations that facilitate the implementation of robot-assisted lung resection in complex treatment of pulmonary tuberculosis.

Thymic MIS: state of the art across the world (Russian Federation).

First VATS thymectomy was performed 25 years ago (Landreneau et al., 1992). After that, minimally invasive approaches for surgical procedures have rapidly increased in the world. The aim of this paper was study of current problems and the status of surgery for thymus diseases in Russia. This is first global survey of all thoracic centers, which had experience in thymic surgery.