Development and Characterization of a Porcine Mitral Valve Scaffold for Tissue Engineering.

Decellularized scaffolds represent a promising alternative for mitral valve (MV) replacement. This work developed and characterized a protocol for the decellularization of whole MVs. Porcine MVs were decellularized with 0.5% (w/v) SDS and 0.5% (w/v) SD and sterilized with 0.1% (v/v) PAA. Decellularized samples were seeded with human foreskin fibroblasts and human adipose-derived stem cells to investigate cellular repopulation and infiltration, and with human colony-forming endothelial cells to investigate collagen IV formation. Histology revealed an acellular scaffold with a generally conserved histoarchitecture, but collagen IV loss. Following decellularization, no significant changes were observed in the hydroxyproline content, but there was a significant reduction in the glycosaminoglycan content. SEM/TEM analysis confirmed cellular removal and loss of some extracellular matrix components. Collagen and elastin were generally preserved. The endothelial cells produced newly formed collagen IV on the non-cytotoxic scaffold. The protocol produced acellular scaffolds with generally preserved histoarchitecture, biochemistry, and biomechanics.

[Thoracic endometriosis--the rare pathology in thoracic surgery].

Thoracic hematogenic endometriosis is a rare pathology. A clinical course hasn't pathognomic symptoms, because of it, the diagnosis is established due to histological study. The article presented two cases of female patients, who were suffering from thoracic endometriosis. They were hospitalized to the department of thoracic surgery of Municipal multifield hospital No 2 in Saint-Petersburg. The first patient had a posterior mediastinum tumor with asymptomatic disease course. The second patient was with recurrent catamenial pneumothorax.

[Spontaneous pneumothorax -an analysis of 1489 cases].

A retrospective analysis of medical history of 1489 patients with spontaneous pneumothorax was made. The patients were hospitalized to the department of thoracic surgery in municipal hospital No 2. According to the data, the incidence rate of primary spontaneous pneumothorax was noted in men during last decade in Saint-Petersburg. The number of patients with secondary spontaneous pneumothorax didn't considerably increase in spite of the growth of incidence of chronic obstructive lung disease. The secondary spontaneous pneumothorax took place in female population two times more, than in male.

[Comparative efficacy of clinical use of reamberin, remaxol and ademethionine in patients with tuberculosis of the respiratory organs and liver drug-injury].

The efficacy ofreamberin, remaxol, S-adenosyl-L-methionine (ademethionine) and 5% glucose solution was estimated in the treatment of patients with tuberculosis of the respiratory organs and drug hepatotoxicity signs confirmed by higher activity of liver indicative enzymes and nitrogen oxide levels. Remaxol showed a pronounced positive effect on the cytolytic syndrome signs, evident from lower activity of alanine aminotransferase and aspartate aminotransferase. At the same time ademethionine was superior to remaxol in the effect on the cholestatic signs and inferior in the effect on the cytolytic signs. By the effect on the activity of alanine aminotransferase and aspartate aminotransferase, reamberin was inferior to remaxol and superior to ademe-thionine, its effect on the cholestasis markers level vs. the other drugs being superior only to that of 5% glucose solution. As compared to reamberin, ademethionine and 5% glucose solution, remaxol promoted higher integral indices of the host antioxidant protection (total antioxidant capacity and total antioxidant status), that partially explained the drug pronounced hepatoprotective effect.

[Hepatotropic therapy in treatment of liver injury].

At present, the conception of the use, efficacy and safety of hepatotropic agents in treatment of drug-induced liver injury, in particular due to antituberculosis drugs is not yet final, which is conditioned by extremely rare clinical trials on the subject adequate to the up-to-date principles of the conclusive medicine. The review presents data on the hepatotoxic effect of antituberculosis drugs, analysis and systematization of the data on the use of hepatotropic agents in liver injury induced by antituberculosis drugs, the principles and characteristics of their clinical use. The mechanism of action of remaxol, a new original hepatotropic agent and the indications of its use are discussed. The experimental findings on the remaxol ability to decrease the antituberculosis drug-induced liver injury through lowering the carbohydrate, albuminous and fatty degeneration and activating the organ reduction are presented. The clinical trials are evident of the most efficient action of remaxol on the signs of toxemia, as well as cytolysis and cholestasis, which along with its antiasthenic and antidepressant action allows to use remaxol as an universal hepatotropic agent in the treatment of diverse drug-induced liver injuries in both the therapeutic and prophylactic schemes.

[Options for remodeling of the right ventricular function during pneumonectomy].

UNLABELLED: The aim of the study---a comprehensive assessment of haemodynamic alterations during pneumonectomy using pulmonary arterial volumeter (PAV) opportunities. MATERIALS AND METHODS: 72 patients were included in the study, (the average age - 51 +/- 3,8 years, body weight - 68 +/- 7 kg), who underwent pneumonectomy about lung tumors under general anesthesia with separate ventilation (on indications - jet high-frequency ventilaton).

[Prevention of tuberculosis: current approaches to development of vaccines].

This review is focused on recent advances in development of new vaccines for the prevention of tuberculosis. The main reasons for lack of BCG vaccine efficacy in different populations and geographic regions are presented. Design of new vaccines based on live modified strains of Mycobacterium bovis BCG, attenuated strains of Mycobacterium tuberculosis, recombinant proteins and viral vectors is considered in the specific examples. The usage of the heterologous "prime-boost" vaccination strategy against tuberculosis is discussed.

[Possibilities of palliative operations in patients with intrapulmonary metastases of renal cancer].

Results of treatment of 51 patients with intrapulmonary metastases of renal cancer were analyzed. Surgical interventions in volume of complete cytoreduction were made in 31 of them. All the patients were followed-up after operations at the period from 3 through 68 months. A multi-factor analysis has shown that surgical metastasectomy gives reliably better results of treatment of patients with disseminated renal cancer. Regressive analysis in the group of operated patients has shown that involvement of the lymph nodes of the bronchopulmonary group and mediastinum gave reliably worse results of treatment of this group of patients.

[Cytoreductive operations in complex treatment of patients with intrapulmonary metastases of colorectal carcinoma].

An analysis of results of treatment of 112 patients with metastases of intrapulmonary colorectal carcinoma (CRC) for the period from 1990 to 2006 has shown that cytoreductive opera tions for excision of the metastases are an effective method of treatment of this category of patients which allows a two times increased survival median as compared with analogous index in the group of patients exposed to palliative chemotherapy. Palliative chemotherapy fails to have statistically significant influence to survival of patients who have ablated intrapulmonary CRC metastases in the volume of complete cytoreduction.

[Technique of endarterectomy from pulmonary artery in chronic thromboembolic pulmonary hypertension].

The article gives detailed description of a technique of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. The method is based on the experience of the world leader in surgical treatment of this disease--the clinic of California, San Diego headed by Stuart Jamieson, cardiothoracal clinic Papworth Hospital in the only center in Great Britain, where PE is performed and on the experience obtained by the collective of the Department of hospital surgery of the medical department of the St. Petersburg state University and the City multi-field hospital.

[Specific medical strategy for spontaneous pneumothorax in patients with chronic obstructive pulmonary disease].

Results of examination and treatment of 62 patients with spontaneous pneumothorax which appeared against the background of chronic obstructive pulmonary disease during the period from 1998 to 2009 were analyzed retrospectively. Emergent drainage of the pleural cavity was made to all the patients at admission to hospital. Surgical intervention was fulfilled in 28 (45%) patients. Complications at the postoperative period were noted in 54% of the patients. An assessment of occurrence of complications did not reveal their regular increasing along with the degree of bronchial obstruction. Differential approach and selection of high risk patients is considered to be necessary.

[Changed functional ability of the lungs after lobectomy in patients with concomitant chronic obstructive disease of the lungs].

Lobectomy is the operation of choice for many diseases of pulmonary pathology, lung cancer being the most frequent indication to it. Smoking, as a common etiological factor, leads to a frequent combination of chronic obstructive disease of the lungs (CODL) and lung cancer. The expected disturbance of lung function after operation in such patients can make it not necessary. However, the functional results of lobectomy in CODL patients still remain not studied. The aim of this prospective investigation was to study effects of lobectomy in patients with diseases of the lung parenchyma without hypoventilation or partial atelectasis. 76 patients were divided into 2 groups: 35 patients with CODL and 41 patients without CODL. In patients with CODL after lobectomy the external ventilation function was less affected than in patients without it. The generally accepted formula for the calculation of the postoperative VFE 1 reliably increased the prognosed reduction of this index. Reduction of the indices of the external ventilation function after lobectomy was less pronounced in patients with the medium and severe degree of CODL.

[Special medical strategy in patients with decompensated stenosis of the trachea of malignant genesis].

The article presents a generalized experience with treatment of 49 patients with malignant stenosis of the trachea complicated by respiratory insufficiency. Different methods of endoscopic recanalization of the stenosed portion of the trachea are analyzed. Factors are shown influencing the outcome of urgent restoration of patency of the respiratory pathways. Exact indications are proposed on carrying out self-locking stents in patients with malignant damage of the trachea, and the sequence of actions in patients with decompensated stenosis of the trachea of malignant nature.

[The possibility and prognostic value of secondary lymphatic cancer spread in intrapulmonic metastases of solid tumors].

In the period from 1996 to 2007 operations were fulfilled in 120 patients with isolated pulmonary metastases of solid tumors (68 men and 52 women aged from 22 through 77 years): 46 patients with metastases of colorectal cancer, 28 - with cancer of the kidney, 23 - with non-small cell carcinoma of lung, 7 - with breast cancer, 9 - with endometrium cancer, 7 - with melanoma. Altogether there were 128 operations. The operations have revealed lesion of intrathoracic lymph nodes in 29 patients (24%). In most cases (21 patients) they were lesions of lymph nodes of the lung root and intrapulmonary lymph nodes. In 93% of cases (27 patients) localization of the lesion coincided with anatomical pathways of lymph outflow from the affected part of the lung. The survival rate median of the operated patients who had alterations in the lymph nodes was 21 months, in cases with intact lymphatic system it was 37 months. A conclusion is made of possible secondary lymphatic cancer spread from intrapulmonary metastases of solid tumors and its negative influence on results of treatment that allows recommendation of revision of the lymphatic system of the lungs and mediastinum in all cases of surgical treatment of intrapulmonary metastases, and in a number of cases recommendation of anatomical resections of the lung tissue as operation of choice.

[Role of cytoreductive surgery in complex treatment for lung metastases from solid tumors].

The report evaluates prognostic factors derived from the data on survival of 123 patients with isolated lung metastases from solid tumors after performing full-scale cytoreductive surgery. Colorectal carcinoma was diagnosed in 43 patients (35%), renal carcinoma--26 (21%), non small cell lung cancer--25 (20%), melanoma--11 (9%), endometrial carcinoma--9 (7.5%) and breast cancer--9 (7.5 a%). All patients were followed up for 3--150 months (median--16 months). Fifty-eight patients (48%) had died by the time the study started. Median of survival for colorectal carcinoma was 29 mos, renal carcinoma--23 mos, non small cell lung cancer--18 mos, melanoma--13 mos, endometrial carcinoma--70 mos and breast cancer--38 mos. According to the findings on regression results, of prognostic value for such patients are both intraoperative and histologically confirmed evidence of secondary metastases to the lymph nodes as well as relapse-free survival. Median of survival for secondary metastases to the lymph nodes was 21 mos and 67 mos without them (p = 0.04). Three cohorts were identified relating to relapse-free survival: 0-12, 12-24 and more than 24 mos. Median of survival for those groups was 19, 23 and 38 mos, respectively (p = 0.03). Such parameters as tumor site, gender, age or postoperative antitumor pharmaceutical therapy appeared irrelevant as far as survival was concerned.