[Videothoracosopy in diagnosis and surgical treatment of tuberculosis]. / Videotorakoskopiia v diagnostike i khirurgicheskom lechenii tuberkuleza.

From 1993 to May 2001, 795 psychiatric patients were treated including 563 with pleural effusion, 98 with multiple or solitary tuberculoma, 69 with tuberculous empyema, 14 with fibrotic-cavitary tuberculosis, 51 with disseminated tuberculosis. Mean age of the patients was 32 years. Survey of pleural cavity with pleural or lung biopsy was performed in 691 patients. In tuberculoma 14 lobectomies were performed, 23 patients underwent atypical lung resection without stapler (including with precise technique). Bilateral on-stage interventions were made in 32 patients. In empyema necrectomy and lung decortication were performed. 14 patients underwent videocavernoscopy with sequestrectomy and cavity drainage. In disseminated tuberculosis lung biopsy without staplers was usually performed. Aerohemostasis was achieved with plasma stream. One patient with empyema and one patient with pleural effusion died (lethality was 0.25%). Rate of postoperative complications was 7.5% in tuberculoma and 1.5% in disseminated tuberculosis. Conversion to thoracotomy was necessary in 3 (3%) patients with tuberculoma and 12 (17%) patients with empyema. Mean hospital stay was 4 days after diagnostic surgery and 7 days after lung resection. In pleural effusion diagnosis was verified in 98% cases, in disseminated tuberculosis--in 100%. Videothoracoscopy is the best diagnostic method for pleural effusion and disseminated forms of lung tuberculosis and operation of choice in tuberculoma and empyema. Videothoracoscopy in tuberculosis is highly effective and associates with low rate of postoperative complications and lethality.

[Surgical treatment of stage IIIA non-small-cell lung cancer]. / Khirurgicheskoe lechenie patsientov s IIIA stadiei nemelkokletochnogo raka lëgkogo.

Data on five-year survival were evaluated for 258 patients with non-small cell lung cancer (stage IIIA) (N2). In 155 patients (60%), N2 tumor was detected during surgery. Total resection was carried out in 179 (69.4%), subtotal--79 (30.6%). Total lymph node dissection was not employed in the latter group. Lateral thoracotomy was used in 213 cases. Transsternal procedure was performed in 45 cases of bulky tumor and extensive invasion of mediastinal fat. A comparison of five-year survival data failed to establish any relationship between survival and postoperative radiochemotherapy in radically-operated patients. It was found that surgery for non-small lung N2 tumors with mediastinal involvement is indicated and may be effective if total lymph node dissection is performed.