[Pulmonary alveolar proteinosis associated with persistence of SARS-CoV2 virus]. / Legochnyi al'veolyarnyi proteinoz, assotsiirovannyi s persistentsiei virusa SARS-CoV2.

Alveolar proteinosis is a rare lung disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired surfactant utilization by alveolar macrophages. The frequency is from 2 to 4 cases per 1 million adult population. We present an observation of pulmonary alveolar proteinosis in a patient with a history of coronavirus pneumonia.

[Risk factors of pulmonary cavitation in COVID-19 pneumonia]. / Faktory riska poyavleniya polostnykh obrazovanii legkikh pri COVID-19-pnevmonii.

OBJECTIVE: To identify the risk factors of pulmonary cavitation in COVID-19 pneumonia. MATERIAL AND METHODS: A retrospective study included 8261 patients with COVID-19 between April 2020 and March 2022. Inclusion criteria: age >18 years, COVID-19 confirmed by polymerase chain reaction. Two cohorts of patients were formed: 40 patients with pulmonary cavitation and 40 patients without these lesions. Both groups were comparable in age, lung lesion volume and oxygenation. Sex, age, length of hospital-stay, CT grade of lung lesion, comorbidities, treatment, respiratory support, oxygen saturation and in-hospital outcomes were evaluated. The highest lung lesion volume during hospitalization was assessed. CT was performed upon admission and approximately every 5 days for evaluation of treatment. Statistical analysis was performed using the IBM SPSS Statistics software (IBM Corporation, USA). RESULTS: Patients with pulmonary cavitation significantly differed in age, SpO2, lung lesion volume, more common non-invasive ventilation and prolonged hospital-stay. Cardiovascular diseases were more common in both groups. Univariate logistic regression analysis revealed age, cardiovascular diseases, CT-based severity of lung damage, absence of biological therapy and non-invasive ventilation as risk factors of pulmonary cavitation. According to multivariate logistic regression analysis, these predictors were CT-based severity of lung damage and absence of biological therapy. Univariate logistic regression analysis showed that pulmonary cavitation had no significant effect on mortality (OR=2.613, 95% CI: 0.732-9.322, p=0.139). CONCLUSION: The risk of pulmonary cavitation in COVID-19 is directly related to advanced lung damage and untimely or absent biological therapy with IL-6 inhibitors. Pulmonary cavitation in COVID-19 is not a typical manifestation of disease and can be caused by some factors: fungal infection, secondary bacterial infection, tuberculosis and pulmonary infarction. Further study of this problem is required to develop diagnostic algorithms and treatment tactics.

[Efficacy and safety of surgical treatment of patients with pathological tortuosity of the internal carotid artery]. / Effektivnost' i bezopasnost' khirurgicheskogo lecheniya bol'nykh s patologicheskoi izvitost'yu vnutrennei sonnoi arterii.

No multicenter randomized clinical trial has been conducted worldwide to date on indications, types of surgery and their comparison with conservative treatment in patients with PI BSA. OBJECTIVE: Of the study is to improve the results of surgical treatment in patients with pathological tortuosity of the internal carotid artery. MATERIAL AND METHODS: The study included 119 patients (41 (34%) men and 78 (66%) women) with PI ICA aged 34 to 71 years (average age 53.2±7.5 years) divided into 2 groups. 64 patients (54%) of group I underwent BSA resection with lower mouth and 55 patients (46%) of group II underwent BSA prosthetics. Depending on the degree of neurological disorders, patients were distributed according to the classification of A.V. Pokrovsky. RESULTS: In the early postoperative period, TIA was noted in one patient, and transient lesions of the cranial nerves were observed in 5 patients. During 5 years of follow-up, none of the patients developed TIA, IS or other vascular events. In the early surgical period, there were no significant differences in effectiveness between the groups of patients. In the long-term period (5 years after surgery), a higher frequency of asymptomatic patients was noted in group I. CONCLUSION: Resection and replacement of a pathologically tortuous internal carotid artery (ICA) is a safe and effective surgical treatment. A multicenter randomized trial should be conducted to compare the effectiveness of surgical treatment of PI ICA with a conservative approach to effectively treat patients.

[Post-intubation rupture of thoracic trachea in a patient with iatrogenic esophageal perforation and mediastinitis]. / Postintubatsionnyi razryv grudnogo otdela trakhei u bol'noi s perforatsiei pishchevoda pri fibroendoskopii i mediastinitom.

Iatrogenic injuries of the esophagus and trachea are rare. However, these are life-threatening events due to severe complications. The authors report iatrogenic perforation of cervical esophagus with a long false passage in posterior mediastinum in an 83-year-old patient undergoing endoscopic retrograde cholangiopancreatography for choledocholithiasis. Post-intubation rupture of thoracic trachea was diagnosed early after suturing the defect of esophagus and drainage of mediastinum. Treatment strategy was analyzed and conservative management of tracheal injury was substantiated.

[Endoscopic treatment of bronchial complications after lung transplantation]. / Endoskopicheskoe lechenie bronkhial'nykh oslozhnenii posle transplantatsii legkikh.

OBJECTIVE: To analyze the incidence and structure of bronchial complications following lung transplantation and evaluate an effectiveness of endoscopic treatment of these events. MATERIAL AND METHODS: The study enrolled 50 patients after bilateral lung transplantation (24 men and 26 women). Mean age of patients was 35.4±5 (19; 61) years. Ischemia of bronchial mucous membrane of the transplant was intraoperatively and postoperatively analyzed. We also assessed severity and prevalence of anastomotic and non-anastomotic cicatricial bronchial stenoses. RESULTS: All patients after lung transplantation were diagnosed with bronchial complications, i.e. ischemia of bronchial mucous membrane of the transplant. In 76% of patients, these complications did not require endoscopic treatment. Surgical and endoscopic treatment was required in 24% of cases. Three patients (6%) underwent intraoperative correction of bronchial anastomosis. Bronchial suture failure was diagnosed in 3 patients (6%), cicatricial bronchial stenosis - in 6 (12%) cases. Endoscopic stenting was effective for recovery of bronchial patency with complete epithelialization of mucous membrane. Stenting of lobar bronchus with application of mitomycin C was effective in patients with non-anastomotic stenoses type III after lung transplantation. CONCLUSION: Major bronchial complications occurred in 24% of patients after lung transplantation. Endoscopic treatment of bronchial complications using a self-fixing silicone endoprosthesis after lung transplantation was effective in all patients with anastomotic and non-anastomotic cicatricial strictures. Mitomycin C prevented excessive growth of granulation and scar tissue.

[Surgical treatment of spontaneous esophageal rupture: long-term experience of the Sklifosovsky Research Institute for Emergency Care]. / Khirurgicheskoe lechenie spontannogo razryva pishchevoda: mnogoletnii opyt NII skoroi pomoshchi im. N.V. Sklifosovskogo.

OBJECTIVE: To analyze the treatment outcomes in patients with spontaneous esophageal rupture (SER). MATERIAL AND METHODS: The study included 106 patients with SER admitted to the Sklifosovsky Research Institute for the period from 1992 to 2015. The sample also included 91 patients who were referred from other hospitals. All patients were divided into 4 groups depending on surgical procedure: surgical drainage (Group I, n=19); suturing the esophageal defect without antireflux surgery (Group II, n=12); esophageal wall repair with fundoplication procedure (Group III, n=62); resection of the thoracic esophagus (Group IV, n=13). RESULTS: In the 1st group, complication rate was 100% and significantly exceeded these values in groups II, III, and IV (66.7%, 71%, and 69.2%, respectively; p=0.0318, p=0.0189, and p=0.0413). The length of hospital-stay was the lowest in group IV (mean 42 days) and group I (mean 55 days). Mortality rate in groups I, III and IV was 15-20% lower than in group II. Pneumonia and pleural empyema were significant predictors of poor outcome. Fundoplication improved postoperative outcomes in group III compared to group II. Resection of the thoracic esophagus performed in accordance with strict indications interrupts infectious process and shortens recovery period. Surgical drainage is followed by persistent contamination of mediastinum and pleural cavities that may quickly result a fatal outcome. CONCLUSION: A differentiated approach to SER treatment can reduce the risk of complications and mortality.

[Spontaneous rupture of the esophagus in a patient with chronic obstructive pulmonary disease]. / Spontannyi razryv pishchevoda u patsienta s khronicheskoi obstruktivnoi bolezn'yu legkikh.

A case report of successful surgical treatment of spontaneous rupture of the esophagus in a patient with chronic obstructive pulmonary disease, bronchial asthma and obesity is presented. Rupture of the esophagus occurred during a coughing without vomiting.

[Thoracic and abdominal injuries caused by air weapons]. / Pulevye raneniia grudi i zhivota iz pnevmaticheskogo oruzhiia.

Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.

[Long-term oucomes of tracheal transplantation: success and unsolved problems]. / Otdalennyi rezul'tat transplantatsii trakhei: uspekh i nereshennye problemy.

AIM: To analyze long-term outcomes of tracheal transplantation. MATERIAL AND METHODS: There were 1128 patients with cicatricial tracheal stenosis who have been operated at the Petrovsky Russian Research Center for Surgery and the Sechenov First Moscow State Medical University for the period 1963-2015. RESULTS: Operations have become safer. Postoperative morbidity and mortality reduced from 41.4% (1963-1980) to 5.6% (2001-2015) and from 21.9% (1963-1980) to 0.5% (2001-2015), respectively. Tracheal transplantation was performed in 2 cases and fundamentally different tracheal structures were applied. Donor thyreotracheal complex with restored blood supply through thyroid vessels was used in the first case (2006). Perennial experimental trials preceded clinical application of this technique. In the second case (2010) we applied scientific results of foreign colleagues (cellular technologies and methods of regenerative medicine to create artificial trachea). Patients are still alive after 12 and 8 years, respectively. Restoration of blood supply of donor trachea is possible through thyroid collaterals. This technique is successful in long-term period. Tissue-engineered trachea cannot be considered true trachea due to no all tracheal components. However, such trachea provides air-conducting, evacuation and protective functions. Tracheomalacia requires further researches as one of the main problems of tracheal transplantation.

[Ectopic ACTH-syndrome caused by neuroendocrine tumor of lung]. / AKTG-éktopicheskii sindrom pri neiroéndokrinnoi opukholi legkogo.

Ectopic ACTH-syndrome is a relatively rare neuroendocrine disease. It is characterized by hypercortisolemia-associated severe complications that justifies need for timely diagnosis and radical therapy. Case report of young patient with ACTH-producing lung tumor is presented. There was 1-year diagnostic search on background of endogenous hypercorticism. Treatment resulted severe postoperative adrenal insufficiency that demonstrates current difficulties in management of these patients.

[The features of diagnosis and treatment of traumatic and non-traumatic pulmonary bleeding]. / Osobennosti diagnostiki i lecheniia legochnogo krovotecheniia travmaticheskoi i netravmaticheskoi étiologii.

AIM: To analyze an efficacy of differentiated approach for pulmonary bleeding of different etiology and severity. MATERIAL AND METHODS: The study included 134 cases of pulmonary bleeding for the period 2006-2015 including 53 patients with traumatic and 81 with non-traumatic etiology. Men/women ratio was 2.7:1, mean age was 43 years. Comparative retrospective analysis of X-ray and CT data in diagnosis of bleeding source was performed. Bronchoscopy was used to confirm these data. There were 43 endovascular examinations including 40 cases of bronchial arteriography (BAG). RESULTS AND DISCUSSION: X-ray and CT-signs of bleeding source were detected more often in case of traumatic pulmonary bleeding (62.3% and 93%) compared with non-traumatic (27.2 and 54%; p<0.05). Bronchoscopy revealed ongoing pulmonary bleeding in 40 (30%) patients, completed - in 94 (70%) patients. Indirect angiographic signs were the most frequent for pulmonary bleeding origin: hypervascularization (32.6%), bronchial-pulmonary shunts (23.2%) and bronchial artery dilatation (20.9%). 17 patients with ongoing bleeding underwent bronchial obstruction with adequate hemostasis in all cases. Endovascular interventions included bronchial arteries embolization (EBA) (33), occlusion of intercostal arteries (3) and segmental branches of low-lobar pulmonary artery (1), aortic stenting (1). Early efficacy of EBA was 97% with 2 month recurrence of pulmonary bleeding near 12.5%. Ongoing traumatic pulmonary bleeding was an indication for emergency thoracotomy in 18.9% compared with 12.3% for non-traumatic bleeding when surgery was made after endoscopic and endovascular hemostasis. CONCLUSION: Differentiated approach depending on etiology and severity of pulmonary bleeding improves outcomes and reduces the number of operations for ongoing severe bleeding.

[Enteral tube feeding in adult patients with cystic fibrosis and respiratory failure]. / Énteral'noe zondovoe pitanie u vzroslykh bol'nykh mukovistsidozom s dykhatel'noi nedostatochnost'iu.

AIM: To evaluate the efficiency of nocturnal hyperalimentation in adult patients with cystic fibrosis (CF) and respiratory failure. SUBJECTS AND METHODS: The investigation enrolled 17 patients older than 18 years (mean age, 25.6±4.2 years) diagnosed with very severe CF (forced expiratory volume in one second (FEV1), < 30%; body mass index (BMI), < 18.5 kg/m2); all the patients were on the waiting list for lung transplantation. Nutritional status and pulmonary function parameters, such as body weight, height, BMI, and FEV1, were measured at baseline, before and 6 and 9 months after tube feeding. RESULTS: The study group showed a considerable increase in body weight and BMI after 6 and 9 months. The change in lung function was statistically insignificant. Lung transplantation was successfully conducted in 5 patients; 4 died while on the waiting list; the cause of death was respiratory failure. CONCLUSION: Supplemental PEG tube feeding improves the nutritional status (BMI, body weight) of patients with very severe CF.

[Absence of postoperative pulmonary impermeability in patients with spontaneous pneumothorax]. / Posleoperatsionnaya negermetichnost' legkogo u patsientov so spontannym pnevmotoraksom.

AIM: to improve treatment of patients with spontaneous pneumothorax who had not postoperative pulmonary impermeability. MATERIAL AND METHODS: 87 patients with spontaneous pneumothorax underwent videothoracoscopy (VTS), lung resection supplemented by pleurodesis (parietal pleurectomy or pleural abrasion). Absence of pulmonary impermeability was observed in 5 (5.7%) patients. RESULTS AND DISCUSSION: Re-operation was performed in 2 patients (Vanderschuren 2 and 3) namely re-thoracoscopy and thoracotomy with additional ligation of air origins. Drainage tubes were removed in 4 and 17 days postoperatively in patient without/with emphysema respectively. In patient (Vanderschuren 1) who underwent thoracoscopic resection and parietal pleural abrasion valve bronchoblocation was performed in 9 days after VTS due to persistent pneumothorax. Pleural drainage tube was removed in 13 days (emphysema) after bronchial valve deployment. 2 patients (Vanderschuren 4) had heterogeneous pulmonary emphysema. One of them underwent video-assisted mini-thoracotomy, lung resection with reinforcement of seams with synthetic material. In other observation conversion to thoracotomy followed by atypical resection of bullous emphysema and manual suturing of lung was applied. In both cases bronchoblocation was performed intraoperatively with good results. Drainage tubes were removed in 13 and 17 days respectively. There were no complications. CONCLUSION: Intraoperative endoscopic bronchoblocation is advisable if air leakage is considerable in operating theater and complicates lung smoothing. Such approach reduces hospital-stay and improves outcomes.

[Kaposi's sarcoma in the grafted lung]. / Sarkoma Kaposhi v transplantirovannykh legkikh.

The paper provides a clinical note. A 45-year-old patient suffered from severe primary emphysema and underwent bilateral lung transplantation. A year after surgery, exercise dyspnea again appeared in the patient. Lung computed tomography revealed multiple rounded soft tissue masses; thoracoscopic biopsy and further histological examination proved the development of Kaposi's sarcoma in the patient. The tumor disappeared completely following corrected immunosuppressive therapy. After 22 months of transplantation, the patient died from gastrointestinal bleeding. This case is of interest due to that Kaposi's sarcoma develops extremely rarely in the allogeneic lung after its transplantation.

[TRANSPLANTATION OF TRACHEAL-LUNG COMPLEX IN EXPERIMENT].

The article described the developed and patented method of removal of trancheal-lung complex from dead body and its transplantation to the recipient-corps.

[The effectiveness of the valve bronchial occlusion in case of bronchopleural fistulas].

The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

[Pathomorphological features of pulmonary Langerhans cell histiocytosis].

The paper provides the clinical and X-ray characteristics of pulmonary Langerhans cell histiocytosis (PLCH). It describes pulmonary pathohistological changes in this disease, characterizes the cellular composition of granuloma, and gives methods that can verify the diagnosis of PLCH. A case of PLCH with severe respiratory failure, for which bilateral lung transplantation and histological examination of removed lungs have been made, is described.