[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.

[Prognosis of outcome of radical surgery in patients with lung cancer associated with severe complications and concurrent diseases]. / Prognozirovanie iskhodov radikal'nykh operatsii u bol'nykh rakom lëgkogo s tiazhëlymi sochetannymi i konkuriruiushchimi zabolevaniiami.

From 1981 to 2001 (20 years) 1307 patients with lung cancer underwent surgery. Postoperative lethality was 1.7% (after 635 pneumonectomies it was 2.4%, after 672 lob- and bilobectomies--1.2%). Medical histories of 171 operated patients with severe concomitant diseases was studied to analyze surgical outcomes depending on such important factors as age, concomitant diseases, surgical trauma. It is demonstrated that age of patients is not a factor of postoperative prognosis, but concomitant diseases and surgical trauma (i.e. pneumonectomy) are important factors of it. Results of surgery in the group of patients with four and more concomitant diseases after pneumonectomy were most unfavorable (lethality was 22.9%). In less severe surgical trauma (lobectomy) results of surgery were more favorable. It is concluded that surgery in patients with a lot of concomitant diseases must be less radical to obtain lower lethality. Radicality of treatment in these patients is ensured due to complex chemo- and radiation therapy after surgery.

[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.

[Long-term results of balloon dilatation in the treatment of esophageal achalasia]. / Otdalennye rezul'taty ballonnoi dilatatsii pri lechenii akhalazii pishchevoda.

25 patients (aged from 32 to 58 years) with achalasia of the esophagus during 1985-1997 years underwent balloon dilatation of the esophagus. 18 patients had stage IV, 5--stage III and 2--stage II of the disease. Mean diameter of the stricture's area in the esophagus made up. 7.2 +/- 2.0 mm. Balloon dilatation was performed in 4 patients by 2-4 balloons d = 10 mm in one stage, and in the test patients by balloon "Rigiflex" d = 40 mm. 2-3 procedures were carried out with the interval 7-10 days. In all cases balloon dilatation was successful. Mean diameter of the esophageal lumen after dilatation has increased to 16.0 +/- 2.5 mm. In 2 patients with IV stage of the disease relapse was detected within 6-8 months. 5 year follow-up results were satisfactory in 4 patients, from 5 to 10 years--in 14 patients, and over 10 years--in 5 patients. Prolonged clinical follow-up (for 7.5 years) demonstrated complete absence of dysphagia and normal regime of nutrition. Balloon dilatation is safe, available and effective method of nonoperative treatment for achalasia of the esophagus.

[Surgical treatment of postgastrectomy syndromes]. / Khirurgicheskoe lechenie postgastrorezektsionnykh sindromov.

The article deals with 33-year experience in surgical treatment of 200 patients. Among the indications for surgery were severe degrees of the dumping syndrome, the afferent loop syndrome, moderately severe progressive forms of these syndromes, and a stable pain syndrome and bilious vomiting in reflux gastritis. Three types of reconstructive operations were performed: gastroejunoduodenoplasty in 152 patients, gastroduodenoanastomosis in 20 patients, and formation of gastrojejunal Y-shaped EEA after Roux in 28 patients. The operations was complemented by vagotomy in 96 patients. One patient died after operation performed in the clinic. In the late-term periods after reconstructive gastroejunoplasty positive results were recorded in 91% of patients examined.

[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.