The article showed the results of ultrasonic assessment of topographic and functional diaphragm indices in patients with severe diffuse emphysema. They passed the selection for lung volume reduction surgery. The comparison of diaphragm indices was presented in patients with diffuse emphysema and control group of healthy volunteers. Dynamics of diaphragm condition was studied after surgical treatment. There wasn’t noted any statistical difference of diaphragm topographic indices as compared with the control group. There wasn’t shown a correlation between respiratory function indices and functional diaphragm indices, but it was noted a positive tendency in characteristics during quiet breathing.
The article presents the results of the first domestic experience of intraoperative fluorescence mapping of sentinel lymph nodes in lung cancer. The research included 10 patients, who underwent surgery over the period of time from September 2013 to May 2014. After performing thoracotomy, the solution of indocyanine green (ICG) was injected using subpleural position above the tumor in 3-4 points. Fluorescence (ICG) image guided surgery was carried out by using infrared radiation (wave length 808 nm) on lung surface, root of lung, mediastinum in real time. Fluorescence lymph nodes were mapped. In case that metastatic lesions weren’t revealed in sentinel lymph nodes, they weren’t noted in other nodes. Method specificity consisted of 100%. Biopsy and histological study of sentinel lymph nodes mapped during fluorescence (ICG) image guided surgery could be useful for prevention of lymphodissection in patients with non-small cell carcinoma of lung.
OBJECTIVE. The authors developed methods and assessment of efficacy of infrared fluorescence imaging of pleural carcinomatosis using indocyanine green (ICG). MATERIAL AND METHODS. The prospective study included 14 patients with malignant pleural carcinomatosis. All patients underwent standard thoracoscopy with pleural biopsy, then pleural cavity was examined under fluorescence control using ICG solution. Comparison of accuracy of biopsy materials obtained in white light and fluorescence was made. RESULTS. Signs of malignancy had 21 biopsy specimens out of 28, which were obtained in white light (in 12 patients out of 14). Research of biopsy specimens using fluorescence allowed doctors to make the precise diagnosis in all 14 patients, with 33 out of 34 biopsy materials being informative. CONCLUSIONS. Intraoperative application of infrared ICG fluorescence developed accuracy of biopsy and histological verification of the diagnosis.
Backgrounds: Bronchioloalveolar carcinoma (BAC) is defined as an adenocarcinoma with pure bronchioloalveolar growth pattern and no evidence of stromal, vascular or pleural invasion by 1999 WHO classification. Although BAC has unique clinical and radiological presentations, BAC has been defined inconsistently in various series. We analyzed the clinical features, treatment outcome and prognostic factors of 141 BAC patients in a single institution. Methods: From September 1994 to December 2004, a total of 5,063 patients were diagnosed of non-small lung cancer (NSCLC) at Samsung Medical Center in Korea. Of 5,063 patients, 141 patients (2.8% of NSCLC, 5.2% of adenocarcinoma) were diagnosed of BAC according to the 1999 WHO criteria. The clinical data including radiological features, treatment modalities, relapse and vital status were retrospectively obtained. Results: Among the 141 patients, 100 patients (71%) underwent surgical resection with curative intent. The male to female ratio was 0.85:1 and the median age was 62 years (range, 29 -83). Only 29% of the patients were current or ex-smokers. Most patients (61%) had clinicopatholgic stage I, 5% stage II, 8% stage III, and 26% of the patients presented with stage IV disease. The most common initial radiological presentation was solitary nodule (63%) followed by multiple nodules in both lungs (18%), infiltrating or pneumonic mass (9%), multiple nodules in the same lung (6%), and a cavitary mass (4%). The most frequent location of the tumor was the right upper lobe (28%) followed by the right lower lobe (17%), the left lower lobe (16%), the left upper lobe (9%), and the right middle lobe (6%). The estimated 5-year overall survival rate of the 100 patients who underwent surgical resection was 71.4 %, and the median survival has not been reached yet. Among the resected patients, 24 patients developed relapse mostly in the lung (19 patients, 78%). The median survival was 6.9 months for the 39 patients without surgical resection. At the multivariate analysis, initial radiological presentation with solitary nodule and curative resection were favorable prognostic factors for survival. Conclusion: Pure BAC is uncommon lung adenocarcinoma in Korea. Patients with localized, resectable disease and initial radiological finding of solitary nodule have a significantly better survival.
OBJECTIVE. The research evaluated efficacy of combined treatment of initially nonresectable and inoperable cases of non-small cell lung cancer. The treatment consisted of preoperative endobronchial and intraoperave photodynamic therapies. MATERIAL AND METHODS. The prospective investigation included patients with central non-small cell lung cancer. These cases were initially considered as nonresectable (the trachea was involved in tumor) or inoperable (functional intolerance of pneumoectomy/ bilobectomy). Neoadjuvant chemotherapy (2-6 courses) and endobronchial photodynamic therapy (PDT) were conducted for these patients in preoperative period. PDT of resection edge was carried out during the operation and it was straight away after specimen removal and ipsilateral lymphodissection. RESULTS. The research was made on 38 patients. Lung resections underwent 30 (79 %) patients. Surgeries included 20 pneumoectomies and 10 lobectomies. Bronchial resection was performed by crossing an initially affected zone. It was noted that 5-year survival consisted of 68 %. CONCLUSIONS. Photodynamic therapy was important in combination with chemotherapy and surgical treatment of central non-small cell lung cancer. These measures allowed doctors to decrease the resection volume in part of inoperable patients or patients with initially nonresectable tumors.
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