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Since 1980 the N.N. Burdenko Faculty Surgical clinic, I.M. Sechenov Moscow Medical Academy, has been using a combination of high- and low-frequency ultrasounds for the diagnosis and treatment of surgical diseases of lung and pleura in 156 patients for the diagnosis of pleuritis of various genesis, in 40 patients for transthoracic aspiration biopsy of lung tumors in the preoperative period, in 156 patients for pleural puncture and drainage, in 40 patients for the intraoperative differential diagnosis of peripheral lung tumors and for the inspection of hematogenic and lymphogenic metastatic areas, in 100 patients for intraoperative prophylaxis, and in 20 patients for the treatment of acute postoperative pleural empyema. Ultrasound was demonstrated to be of high informative value in diagnosing different pleuritis. Transthoracic aspiration biopsy was shown to have some advantages over standard methods: use of needle catheters for pleural puncture permits one to avoid serious complications (pneumothorax, bleeding, etc). Ultrasound was used in intraoperative diagnosis of peripheral lung tumors for the first time. The use of low-frequency ultrasound for the intraoperative prevention of acute postoperative pleural empyemas promotes reliable sanitation of the pleural cavity, as confirmed by bacteriologic control data. Timely rethoracotomies with low-frequency ultrasound treatment of the pleura promote more rapid inflammation elimination in the pleural cavity and prevents irreversible complications.

The analysis of the results of the examination and treatment of 29 patients with carcinoids of the lungs has been carried out for 1984-1995. Peripheral carcinoids were detected in 59% of cases, of the tumor in the main and lobar bronchi was revealed in 41% of cases. The analysis showed that there are no symptoms, pathognomonic for carcinoids of the lungs; carcinoid syndrome was not detected in any patient. The examination (roentgenography and CT of the lungs, bronchoscopy) has not provided any objective, differential diagnostic criteria for carcinoids, cancer and benign tumors of the lungs. Morphological examination of the removed tumors allowed all the carcinoids to be divided in two types: typical (benign neuroendocrine tumor) and atypical (well differentiated neuroendocrine carcinoma). The final differentiation is possible only after conduction of thorough histological, electron microscopy and immunohistochemical examination. The principal method of carcinoids treatment is surgical one. The optimal surgical procedure is pneumonectomy or lobectomy with lymphadenectomy. Atypical resection of the lung without lymphadenectomy in peripheral location of the tumor is justified only in early stages of the disease and in cases of morphological verification of benign character of neuroendocrine tumor. Late results were followed up in 27 patients. In the group of patients with atypical carcinoids in terms of 6 to 12 months 3 patients died from progressing of the main disease. There were neither lethal outcomes nor signs of relapse of the disease in the group of patients with typical carcinoid. The terms of follow up were from 1 year to 12 years.

67 patients with different kind of lung diseases have been evaluated by intraoperative laser spectroscopy. 49 of them had lung cancer and 18 patients had nonmalignant tumors, tuberculomas and chronic abscess. Helium-neon laser has been used to study spectral parameters of a normal lung tissue and lungs with malignant and benign tumors intraoperatively. It was found that intensity of autofluorescence will increase in cancer tissue. This phenomenon may be used for differential diagnosis of a lung cancer with benign tumors and chronic pulmonary diseases. It was also shown that autofluorescence of metastatic lymph nodes is higher compared to their hyperplasia. That may be used for rapid diagnosis of metastases in mediastinal lymph nodes and intraoperative staging of lung cancer.

The work analyses the results of spectroscopy conducted at the Faculty Surgical Clinic of the Moscow Medical Academy in 105 patients with various pulmonary diseases. Sixty-four patients had carcinoma of the lung, 9 had benign tumors, and the rest had inflammatory diseases and tuberculosis of the lungs. He-Ne laser (wave length 633 nm) was employed. The radiation was recorded with a multichannel spectrum analyzer with the use of a specially designed fiber-optical catheter. The system provided for normalization of the spectra according to the intensity of the laser component scattering. The spectroluminescence characteristics of normal and inflammatory pulmonary tissue and of lung tumors were studied during bronchoscopy, during and after the operation. Analysis of the results showed the high specificity and sensitivity of the spectra of malignant pulmonary tumors. Essential differences between the spectral characteristics of normal pulmonary tissue and those of carcinoma were noted. The dependence of reduced intensity of tissue fluorescence on the distance from the visible tumor border was studied, maximum fluorescence was encountered not on the surface of the tumor or inside it, but at a distance of 1-3 cm from the border of the tumor. Increased tissue fluorescence in suppurative diseases and benign tumors of the lungs was not recorded. Laser fluorescence spectroscopy may be recommended in bronchoscopy for widening its diagnostic possibilities and in intraoperative differential diagnosis of lung carcinoma, benign tumors, tuberculomas, and chronic abscesses during diagnostic thoracotomy.

A system of individual prediction of postoperative pyothorax was elaborated from analysis of the case records of 347 patients with carcinoma and chronic pyogenic diseases of the lungs. The authors identified 10 groups of risk factors which may aggravate the course of the postoperative period. Prognostic coefficients were determined for each one of them and their role in the development of pyothorax was specified. The complex of preventive measures in patients at a high risk of postoperative pyothorax was reinforced by intraoperative treatment of the pleura by ultrasonics, which improved the results of surgical treatment of patients with pulmonary diseases.

A combination of peripheral lung oat-cell carcinoma and early gastric highly differentiated adenocarcinoma in a man of 52 with long-term chronic peptic ulcer existing for 20 years is described. Electron microscopic and histochemical examinations of pulmonary carcinoma revealed neurosecretory granules and keratohyalin in the tumor cells. The gastric tumor on the ultrastructural level had cells differentiating in the direction of the glandular and intestinal epithelium. The presence of two independent malignant tumors in the patient was proven by the use of several morphological methods (cytologic, histologic, histochemical and electron microscopic).