Invasive sonography of lung tissue and chest (original) (raw)
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PULMONOLOGIYA, 2020
This publication is devoted to the ultrasound method of lung examination, which has gained particular relevance during the pandemic of the new coronavirus infection 2019. The lecture discusses the general provisions of lung ultrasound, ultrasonic signs of lung damage, features of ultrasound semiotics in the viral nature of lung lesions, differences from the bacterial nature of lung damage, presents aspects of the use of lung ultrasound during the pandemic of the coronavirus infection 2019. The lecture is based on the experience of domestic and foreign researchers, as well as on the authors’ own experience, which demonstrates the value of this method both in intensive care units and in a therapeutic clinic.
Video-Assisted Thoracoscopic Anatomic Lung Resections
Chest, 1996
В работе представляется один из самых крупных материалов выполнения видеоторакоскопических анатомических резекций в России. Материал и методы. Ретроспективный анализ результатов лечения 246 пациентов, перенесших видеоторакоскопические анатомические резекции легкого с 2010 по 2014 г. в Центре торакальной хирургии КБ №122 С.-Петербурга. Одной хирургической командой оперированы 125 мужчин и 121 женщина в возрасте от 20 до 85 лет (58,8±13,4 года). Среди операций: 216 лобэктомий (87,8%), 4 билобэктомии (1,6%), 9 пневмонэктомий (3,7%), 10 сегментэктомий (4,1%) и 7 трисегментэктомий (2,8%). В группе лобэктомий наиболее частые-верхние справа 87 (40,3%). Наибольшая часть операций выполнялась через 2 порта (119 пациентов). Средняя величина наибольшего разреза оперативного доступа составила 4,3±0,93 см (от 2 до 6 см). Все пациенты обследованы по единому плану. У 26% пациентов ОФВ1 был менее 70%; в 24% случаев индекс коморбидности составил 5 баллов и более; 23,2% пациентов были старше 70 лет. Результаты. Немелкоклеточный рак легких (НМРЛ) выявлен у 168 (68,3%) пациентов, туберкулез легких-у 27 (11%), хронические нагноительные заболевания легких-у 27 (11%). Кроме того, диагностированы 9 случаев метастатического поражения легких, 11 случаев карциноидов, 1-MALT-лимфомы, 1-лейомиомы, 2-мелкоклеточного рака легких, а так же один случай IgG ассоциированной псевдоопухоли. Среди 168 случаев НМРЛ операция выполнена в 87 случаях (51,8%) по поводу I стадии рака, у 46 (27,3%) пациентов со II стадией, у 27 пациентов с III стадией (16 случаев IIIA стадии и 11 случаев IIIB стадии). Кроме того, прооперированы 8 (4,7%) пациентов с IV стадией рака легкого, при радикально оперированном солитарном метастазе. Средняя продолжительность операции составила 202,1±58,2 мин (от 100 до 380 мин). При лимфодиссекции у онкологических больных в среднем удалено 12,8±5,6 медиастинальных лимфоузлов (от 9 до 32), среднее количество групп лимфоузлов-4,1±1,1. У 11 (4,5%) пациентов произведена конверсия в открытую операцию: интраоперационное кровотечение (3 случая), технические сложности (8 случаев). Средняя продолжительность послеоперационного дренирования плевральной полости составила 5,1±4,3 дня (медиана 3 дня), пребывания пациентов в стационаре 7,9±4,7 дня (медиана 6 дней). У 66 (26,8%) пациентов наблюдались осложнения разной степени, не приведшие к периоперационным летальным исходам. Наиболее частым осложнением явился продленный сброс воздуха. Выводы. Торакоскопические анатомические резекции легких безопасны и эффективны при большинстве хирургических заболеваний легких. Небольшая доля осложнений в сочетании с быстрой реабилитацией позволяет рекомендовать их к более широкому внедрению в торакальных отделениях России. Самой частой причиной конверсий в открытый доступ является кровотечение или его риск, связанный с фиброзными изменениями в корне легкого. Ключевые слова: видеоторакоскопические резекции легких, хирургическое лечение. Aim. To present one of the largest materials of video-assisted thoracoscopic (VATS) anatomic lung resections in Russia. Material and methods. It is a retrospective analysis of treatment of 246 patients who underwent VATS anatomic lung resection for the period from 2010 to 2014 at the Center for Thoracic Surgery of St. Petersburg Clinical Hospital №122. One surgical team has operated 125 men and 121 women aged from 20 to 85 years (58.8±13.4 years). There were 216 (87.8%) lobectomies, 4 (1.6%) bilobectomies, 9 (3.7%) pneumonectomies, 10 (4.1%) segmentectomies and 7 (2.8%) trisegmentectomies. Upper right-side lobectomy was the most frequent in this group (87 (40.3%)). Most of operations was performed via 2 approaches (119 patients). Average length of the longest incision was 4.3±0.93 cm (range 2-6 cm). All patients were examined according to a single plan. FEV1 less than 70% was observed in 26% of patients; comorbidity index was 5 scores or more in 24% of cases; 23.2% of patients were older than 70 years. Results. Non-small cell lung cancer (NSCLC) was diagnosed in 168 patients (68.3%), pulmonary tuberculosis-in 27 (11%), chronic suppurative lung disease-in 27 (11%) cases. Furthermore there were 9 cases of pulmonary metastases, 11 cases of carcinoid, 1-MALT-lymphoma, 1-leiomyoma, 2-small cell lung cancer, as well as one case of IgG-associated pseudotumor. Among 168 cases of NSCLC operations were performed in 87 (51.8%) cases for cancer stage I, in 46 (27.3%) patients for stage II, in 27 patients for stage III (including 16 cases of stage IIIA and 11 cases of stage IIIB). 8 patients (4.7%) with lung cancer stage IV have been operated in radical surgery for solitary metastasis. Mean duration of surgery was 202.1±58.2 minutes (range 100-380). On the average 12.8±5.6 (range 9-32) mediastinal lymph nodes were excised during lymph node dissection in cancer patients. Mean number of nodes groups was 4.1±1.1. In 11 (4.5%) patients conversion to open surgery was made due to intraoperative bleeding (3 cases) and technical difficulties (8 cases). Mean duration of postoperative pleural drainage and hospital-stay were 5.1±4.3 (median-3 days) and 7.9±4.7 days (median-6 days) respectively. Complications which were not associated with perioperative deaths were observed in 66 patients (26.8%). Prolonged air vent was the most common complication. Conclusion. VATS anatomical lung resections are safe and effective in most of pulmonary surgical diseases. Such interventions may be recommended for wider introduction at the Thoracic Departments of Russia because of small number of complications and rapid rehabilitation. Bleeding or its risk associated with fibrotic changes in pulmonary root are the most frequent causes of conversion to open access.
Lung Ultrasound: new Opportunities for a Cardiologist
Kardiologiia, 2020
This review focused on ultrasound examination of lungs, a useful complement to transthoracic echocardiography (EchoCG), which is superior to chest X-ray in the diagnostic value. The lung acoustic window always remains open and allows obtaining high-quality images in most cases. For a cardiologist, the major points of the method application are determination of pleural effusion and lung congestion. This method has a number of advantages: it is time-saving; cost-effective; portable and accessible; can be used in a real-time mode; not associated with radiation; reproducible; and highly informative. The ultrasound finding of wet lungs would indicate threatening, acute cardiac decompensation long before appearance of clinical, auscultative, and radiological signs of lung congestion. Modern EchoCG should include examination of the heart and lungs as a part of a single, integrative ultrasound examination.
Medical Visualization
Puropose of the study. Basing on the previously obtained results on the proven high efficiency of magnetic resonance imaging (MRI) of the chest organs in the visualization of major lung diseases, in the current period of mass incidence of viral pneumonia (VP) caused by COVID-19, we tried to study the possibility of using MRI OGK to image lung damage in this pathology both in primary detection and for follow-up reconvalescence control.Material and methods. MRI of the chest in T1 -, T2-weighted modes (T1-w, T2-w), also with fat suppression, diffusion-weighted, STIR-modes, in the axial and frontal planes, with breath holding, or with automatic synchronization of acquisition with breathing was carried-out in 47 patients with VP of various severity, 32 of them were confirmed by PCR as COVID-19, all did have a clinic of pneumonia. The control group comprised 15 volunteers, of them 8 non-smokers, and 7 smokers. In 18 patients, an CT study of the chest was also performed, with a step of 0.5...
Endoscopic ultrasound examination in the detection of metastatic lung lesion
Onkologiya. Zhurnal imeni P.A.Gertsena, 2018
Objective-to show the efficiency of endobronchial ultrasound (EBUS) examination in patients with suspected pulmonary metastasis. Subject and methods. In 2010 to 2016, a total of 65 patients with suspected pulmonary metastasis underwent bronchoscopy using ultrasound miniprobes at a scanning frequency of 20 MHz to search and verify peripheral lung neoplasms. Results. The sensitivity of the technique in the group was 63.1%. At the same time, the specificity for 5 patients who underwent surgical treatment after endoscopic verification of lung metastases was 100%. Conclusion. Ultrasonic bronchoscopy is an effective, relatively simple and easy-to-use tool for diagnosing metastatic lung lesion.
General Reanimatology, 2018
The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ve...
VESTNIK KHIRURGII IMENI I.I.GREKOVA
В в е д е н и е. Заболеваемость раком лёгкого (РЛ) в мире достигает 1 300 000 случаев [3, 6, 8, 12, 16]. В Российской Федерации РЛ находится на 2-м месте в общей структуре онкологических заболеваний (11,6 %) и на 1-м (20,4 %) среди злокачественных опухолей у мужчин. Число заболевших им ежегодно превышает 50 000 человек, причём умирают от него 90-96 % заболевших, а свыше 50 % из нихуже в год постановки диагноза. Несмотря на бурное развитие диагностических и лечебных технологий, 5-летняя выживаемость при РЛ во всех странах за последние полвека не меняется, не превышая 15-20 %. При этом известно, что эффективность лечения находится в прямой зависимости от распространённости опухоли на момент начала реализации клинических мероприятий. Так, если для I стадии 5-летняя выживаемость может достигать 70-80 %, то для IV-не превышает 5 %. Ранняя диагностика РЛ до настоящего времени остаётся нерешённой проблемой, и более 2 / 3 заболевших начинают специализированное лечение, имея местно-распространённые либо генерализованные формы опухоли [1, 6, 7, 13].
Detection of lung nodules on digital medical images
Bionics of Intelligence, 2018
This paper presents a study that addresses the issues of digital processing and analysis of medical images. As the medical images considered human lung images that are obtained by computer tomography. Procedure for detecting lung nodules considered. This helps to conduct the diagnosis of lung cancer disease. The efficiency and effectiveness of the proposed procedure is shown.
Medical Visualization
Purpose of the study. To evaluate the practical significance of MRI in the primary diagnosis of inflammatory lung diseases, as well as in follow-up control of treatment, also in comparison with the results of CT of the chest.Material and Methods. In 25 patients with acute pneumonia, six of them with acute myocardial infarction developed as complication of it, the MRI of the chest organs was performed in T1 - and T2-weighted (-w.) modes, also with fat signal suppression, with slice thickness of 2.5 to 5 mm, in a matrix of 256 × 256 or 256 ×392 pixels, with a scanning field of view as large as 40 x 40 cm. In T1-w. mode TR = 390–650 ms, TE = 10–15 ms. When T2-w. scanning, respectively, TR = 2900 -4000 ms, TE = 20–25 ms. Paramagnetic contrast enhancement was also carried out in 16 of 24 patients, at a dosage of 0.1 mmol/kg of body weight. Post-contrast images were acquired 12-17 minutes after the introduction of paramagnetic agent. In 17 out of 25 of our patients, chest CT was also perf...
Meditsinskiy sovet = Medical Council
Introduction. COVID-19 is a highly contagious infectious disease caused by the novel coronavirus SARS-CoV-2. After the acute phase and discharge from the hospital, convalescent people continue to have respiratory symptoms, changes in pulmonary function (PF) and indicators of chest computed tomography (CT).Aim. To evaluate changes in PF and quantitative CT data in patients after severe coronavirus pneumonia.Materials and methods. A cross-sectional observational study was conducted: 55 patients (including 28 men, aged 32–78 years) with a diagnosis of “lung interstitial process due to a coronavirus infection” were examined. All patients underwent a study of PF (spirometry, body plethysmography, measurement of the diffusion lung capacity: DLCO) in the interval of 24–305 days after discharge from the hospital. CT scan of the chest was performed simultaneously with the functional examination (±30 days), the parameters were calculated: ground glass areas, functional lung tissue volume (...