Morphological Variations of the Lungs: A Cadaveric Study

The lungs are the organs of respiration which are situated on either side of the heart and other mediastinal contents in its pleural cavity. A fresh lung is spongy, can float in water and crepitates when handled. Lungs are important with respect to its blood circulation. The lungs are divided by fissures into lobes which facilitate movements of lobes in relation to one another. The hilum of each lung is its gateway. In the present study, we aim to assess the morphological variations of human cadaveric lungs at Chitwan Medical College (CMC). An observational study was conducted at dissection hall of anatomy department at Chitwan Medical College from September 2019 to October 2020 after taking ethical approval form Institutional Review Committee of CMC. All the intact 70 lungs present in the department were studied. Photographs of the intact lungs were taken from different surface. The lungs were porus, highly elastic and spongy in texture. On keeping lungs to water tank it got floated. We found 34(80.96%) of the studied specimen of right side had horizontal fissure present in it. The remaining 8 (19.04%) specimens did not have horizontal fissures, while 3 (5.88%) specimens had incomplete fissures. The oblique fissure was not present in 2 (2.38%) of the study specimens. The left side of the study specimen has a variance of 1(4.16%). When the hilum right lung was examined, 40 (95.23%) of the structure had the usual organization pattern. In the left lung, the usual pattern of organization was 21(75%). The differences are thought to be present in the lung’s fissure and hilum. The current study’s findings are therapeutically important. The findings could prove beneficial to cardiovascular and thoracic surgeons.

Pleuroskopi Sebagai Tindakan Diagnostik pada Paru

Pleuroscopy, also known as medical thoracoscopy, is a minimally invasive procedure that is used to examine and biopsy the pleural cavity as well as to perform therapeutic interventions. This procedure has a near-perfect diagnostic accuracy in malignant pleural effusions and tuberculosis. With a mortality rate of 0.1%, the complication rate is low (2% - 5%) and usually mild (subcutaneous emphysema, bleeding, infection). Objective : Increase knowledge of pleuroscopy as a diagnostic and therapeutic tool in lung disease. Method : This paper is based on a review of the literature on pleuroscopy. Conclusion : Pleuroscopy is a minimally invasive procedure that can be used to examine and biopsy the pleural cavity, as well as for therapeutic intervention. Complications are uncommon and usually minor. Sugestion : Other articles are required to increase knowledge about pleuroscopy in order to obtain more knowledge.

ДЕКОМПЕНСОВАНИЙ ВИПАДОК ГІПОТИРЕОЗА З УРАЖЕННЯМ СЕРЦЕВО-СУДИННОЇ СИСТЕМИ

We present a clinical case that demonstrates a lack of compliance in a patient with hypothyroidism, which led to severe complications of the cardiovascular system. The clinical feature of this case is the development of severe complications of hypothyroidism due to the patient’s low adherence to therapy and untimely treatment. The patient had all characteristic signs of severe hypothyroidism with heart and skin lesions (total alopecia, edema, dryness and peeling of the skin). Fully available diagnostic criteria were as follows: critical disorders of thyroid hormone levels in the blood, hyperenzymemia, hypothyroidism, fluid in the pleural cavity, increased heart shadow, fluid in the pericardial cavity, left ventricular dilatation, decreased ejection fraction, arrhythmia. The predominant lesion of the cardiovascular system is characteristic of such cases and prevailed in the clinical presentation of the disease and was the direct reason for seeking medical help. Under the influence of treatment, the patient's sinus rhythm was restored, myocardial contractility improved, there was no fluid in the pericardial cavity and pleural cavity, edema decreased, mental activity and emotional state improved. However, the patient flatly refused further observation and treatment. As a result, hypothyroidism is underdiagnosed. Initiation of treatment in the early stages of the disease and prevention of complications relies on early diagnosis through systematic screening according to the recommendations. Heart disease, associated with hypothyroidism is a condition that can be prevented if it is detected and treated by family doctors in a timely manner in an outpatient setting. Timely detection of the disease and hospitalization will allow avoiding serious complications of hypothyroidism, timely diagnosing this pathology and prescribing adequate therapy according to the stage of the disease.

CT Guided Placement of the End of the Microcoil in the Pleural Cavity: A More Helpful Method for Video-Assisted Thoracic Surgery (VATS) Resection of Ground Glass Opacity (GGO)

Objective To investigate and summarize the effectiveness and safety of CT guided microcoil localization before video-assisted thoracic surgery (VATS) for the removal of ground glass opacity (GGO).Method 147 patients with GGO who were treated in our hospital from January 2019 to February 2021 were retrospectively analyzed. They were divided into two groups according to the final position of the end of the microcoil, intracavity group (n=78) and extracavity group (n=69). Comparison of the two groups of patients with puncture complications, and the influence of the end position of the coil for VATS.Results The proportion of supine and prone position in the intracavity group was significantly higher than that in the extracavity group (82.1% vs. 66.7%, P<0.05). The incidence of intrapulmonary hemorrhage, chest pain and coil displacement in the intracavitary group was significantly lower than that in the extracavitary group (28.2% vs. 46.4%; 19.2% vs. 39.1%;1.3% vs. 11.6%, P<0.05), and the incidence of pneumothorax had no significant difference(P>0.05). The time of VATS and the rate of conversion to thoracotomy in the intracavity group were significantly lower than those in the extracavity group (103.4±21.0min vs. 112.2±17.3min, 0% vs. 5.8%, P<0.05).Conclusion CT-guided placement of the microcoil was a very practical, simple and convenient localization method before VATS with high success rate and few complications, further more, it was a better method to place the end of the coil in the pleural cavity because of the lower complication rate, shorter VATS time and lower rate of thoracotomy conversion.

Diagnosis and surgical treatment of liver echinococcosis

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

Surgical treatment of patients with descending purulent mediastinitis

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

Genotype and Th2 cells control monocyte to tissue resident macrophage differentiation during nematode infection of the pleural cavity

The recent revolution in tissue-resident macrophage biology has resulted largely from murine studies performed in the C57BL/6 strain. Here, we provide a comprehensive analysis of immune cells in the pleural cavity using both C57BL/6 and BALB/c mice. Unlike C57BL/6 mice, naive tissue-resident Large Cavity Macrophages (LCM) of BALB/c mice failed to fully implement the tissue residency program. Following infection with a pleural-dwelling nematode these pre-existing differences were accentuated with LCM expansion occurring in C57BL/6 but not BALB/c mice. While infection drove monocyte recruitment in both strains, only in C57BL/6 mice were monocytes able to efficiently integrate into the resident pool. Monocyte to macrophage conversion required both T cells and IL-4Rα signalling. Host genetics are therefore a key influence on tissue resident macrophage biology, and during nematode infection Th2 cells control the differentiation pathway of tissue resident macrophages.

TREATMENT OF BRONCHIAL FISTULA ASSOCIATED WITH NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: Review

The treatment of non-specific chronic pleural empyema with bronchial fistulae remains one of the most relevant issues in thoracic surgery. The question about the treatment phasing of bronchial fistulae associated with chronic pleural empyema is yet to be answered. Is it reasonable to seal a bronchial fistula before or after the sanitation and obliteration of the residual pleural cavity? The choice of bronchial fistula sealing technique is also a relevant issue because, in spite of the multitude of techniques, there is still no single doctrine. The terms of traditional and minimally invasive techniques aimed at bronchial fistula sealing and pleural cavity obliteration are not defined, either. This article summarises the opinions of leading authors presented in the literature concerning the solution of this complex, life-threatening problem.

THE PROBLEM OF THE SURGICAL TREATMENT OF NON-SPECIFIC CHRONIC PLEURAL EMPYEMA: LITERATURE REVIEW

Despite the rapid development of thoracic surgery, the problem of the surgical treatment of non-specific chronic pleural empyema remains relevant. The variability of the proposed treatment methods: puncture and drainage interventions aimed at pleural cavity sanitation, minimally invasive videothoracoscopic surgeries and traditional lung decortication, dictates the need for case-by-case surgical tactics and determining the stages and duration of the above methods. Treatment outcomes are significantly worsened by the presence of bronchial fistulas, which either cause the development of chronic pleural empyema or develop as a result of its presence and late treatment. Some answers to these key questions are provided in this paper, which aims to identify them in the Ukrainian and foreign literature.