The objective is to present diagnostic capabilities of virtual bronchoscopy (VB) and fiberoptic bronchoscopy (FB) for determining the localization and shape of stenoses in patients with central lung carcinoma. A systematic study was performed on 220 patients aged 11-83 (54.36±17.24) years with endobronchial disease using the FB and VB methods during the 2013-2017 period. Central carcinoma of the lung was found on VB in 130 patients and on FB in 120 patients. Other nosologic diseases were found in 22 patients. Right localization of central carcinoma prevailed over left localization in both sexes. A significant difference in the localization criterion was found in female patients examined by VB (U-test, p=0.01). VB and FB yielded 86.5% vs. 91.60% precision and 85% vs. 94.5% sensitivity. In conclusion, VB was found to be a successful noninvasive method for determining the localization of lung tumors and shape of stenoses, which are essential in the diagnosis of malignant processes.

Introduction/Objective. Fiberoptic bronchoscopy often is too aggressive, which requires the use of other noninvasive diagnostic methods. The study presents research results on the diagnostic capabilities of virtual bronchoscopy with multidetector computed tomography and fiberoptic bronchoscopy in traumatic abnormalities of trachea and main bronchi. Methods. A total of 21 patients (six males and 15 females) at the ages of 11?82 years (50.65 ? 19.8) were studied by the methods of virtual bronchoscopy with multidetector computed tomography and fiberoptic bronchoscopy. The diagnostic capabilities of virtual bronchoscopy as compared to fiberoptic bronchoscopy were assessed by established criteria. Results. Ruptures of the trachea and/or bronchi were proven by fiberoptic bronchoscopy in 21 patients and by virtual bronchoscopy in 19 patients. The greatest frequency was reported for the post-intubation ruptures (15 patients, 71.42% with virtual bronchoscopy; 16 patients, 76.19% with fiberoptic bronchoscopy), followed by post-traumatic ruptures (three patients, 14.29%); ruptures of trachea and the left lower lobar bronchus as a result of an advanced neoplasm of the esophagus (one patient, 4.76%), diagnosed by both methods; mucosal erosion after instrumental manipulations (4.76%, after fiberoptic bronchoscopy). Conclusion. Achieved diagnostic accuracy in ruptures of trachea and bronchi by virtual bronchoscopy is 90.47% and by fiberoptic bronchoscopy it is 100%. In terms of localization, shape and size, almost complete correspondence of changes with those of fiberoptic bronchoscopy was found. The presence of abundant secretion in virtual bronchoscopy may be interpreted incorrectly and efficiency of virtual bronchoscopy decreases.

Our aim was to analyzed the significance of CD11c and CD123 positive DCs and their relations with some clinical and pathologic parameters of patients with non-small cell lung cancer (NSCLC). The immunohistochemical expression of CD11 c and CD123, was evaluated in 40 patients with NSCLC. After analysis we found that 35.3% of the patients in the T3-4 tumour stage had a high CD11c infiltration in the tumour stroma, while 100% of the patients in the T1-2 tumour stage had low infiltration (p = 0.03). We also found that 71.4% of patients in the M1 stage had a high infiltration with CD123 in the tumour stroma, whereas only 15.6% of patients without metastases had high infiltration, analogous data are also found in comparing the distribution of CD123 in the tumour border (p = 0.002 or p = 0.002). Comparing the density of CD123 in the border of lymph node involvement, we found that only 7.14% of patients without metastases had low infiltration with dendritic cells, whereas in patients with metastatic lymph nodes that percentage was 41.7% (p = 0.008). In conclusion results suggest that CD11c- and CD123-positive DCs play an important role in antitumour immunity and can be predictive factor for tumour development in patients with NSCLC.

Simultaneous occurrence of tuberculosis and lymphoma is a rare combination. A primary malignant disease such as Hodgkin’s disease (HD) can cause inhibition of cell-mediated immunity, which predisposes to concomitant tuberculosis infection. A congenital and acquired immune deficiency, the presence of autoimmune diseases suggests the development of tuberculosis. There is a close link between infectious mononucleosis caused by the Epstein-Barr virus and the development of Hodgkin’s disease. We are describing a patient, aged 52 with simultaneous occurrence of tuberculosis combined with Hodgkin’s lymphoma in a single cervical lymph node material developed with bilateral malignant pleural effusions and ascites, as the Hodgkin’s disease has been determined at IV stage according to the Ann Arbor criteria.

Oesophageal ulcers are a rare pathological finding and usually they are not reason for consideration.The complications they can cause are strictures of the oesophagus as a result of callous chronic ulcer, acute haemorrhage from an oesophageal ulcer or chronic bleeding with development of post-haemorrhagic anaemia, formation of an oesophageal-bronchial fistula, malignant degeneration and perforation with development of mediastinitis and empyema.They occur most frequently in the lower third of the oesophagus, where it is located on the left of the spinal column, just before the card oesophageal junction.Oesophageal ulcers with a higher location to the border between the lower and the middle third of the oesophagus, have also been reported.These ulcers often occur along with a duodenal ulcer and duodenal gastroesophageal reflux.Due to late acceptance of the diagnosis, in most cases after development of mediastinitis and empyema, the treatment is very difficult and with high death rate and incidence rate.The surgical method of treatment with T-tube drainage for release of the oesophageal lumen and the adequate drainage of the mediastinum and the pleural cavity become more and more common in comparison to the conventional methods with removal of the oesophagus and creation of esophagogastrostomy, used widely in the past.

Non-small cell lung cancer (NSCLC) is a leading cause of cancer related mortality. Main factors of development of NSCLC are many immune cells involved in tumor microenvironment. Infiltration with CD68 positive tumor associated macrophages (TAM) in the tumor stroma or in the tumor islets is associated with prognosis and stage of the disease for a long time. Investigating immunohistochemically 40 patients with NSCLC we discovered that 25% of patients with metastasis in lymph nodes had low infiltration with TAM in the tumor border, while 35.7% of the patients without metastasisthe infiltration was high (х2=5.19; р=0.023). We also discovered that all patients in stage I and 66.7% of the patients in stage II had low infiltration with TAM in the tumor border, while 100% of those in stage IV had high infiltration in the border (x2=5.44; p=0.02). In addition, we observed that 52.9% of the patients in T3-4 the infiltration of the tumor border with TAM was high, while only 16.7% of those in T1-2 had high infiltration (x2=2.92; p=0.087). In investigated by our team lung cancers, clear associations were established between CD68 positive cells density in the tumor border and stage of the disease.

MPE management has been changing over the years as this is due both to the technological advancement of mini-invasive surgical methods and to the change in our knowledge about this manifestation of oncology disorder. Advanced cancer disease and poor general condition in most cases do not allow large-volume and duration of surgical procedures. VATS is becoming an increasingly large share of the operating methods of treatment of spontaneous pneumothorax, thoracic trauma, acute pleural empyema, pleural effusion, benign pleural and pulmonary lesions, secondary metastatic and primary malignant lesions - pleural, pulmonary, mediastinal and bilateral location. Diagnostic and therapeutic capabilities of VATS for simultaneous diagnosis and palliative surgical treatment make it the optimal procedure in MPE management. It should be noted that the preliminary assessment of the patient’s condition and local status with an estimate of survival time often undergoes a radical change after the video-assisted surgical procedure. Improvement is reported with an increase of predetermined survival time and improved performance status, which supports the application of more minimally invasive, non-intubated, “awake” single-port VATS.

Objective: Comparative analysis with emphasis on the advantages and disadvantages of single access thoracoscopic surgery compared to conventional three port in the treatment and diagnosis of malignant pleural effusions. Materials and Methods: Prospective results were compared in 136 patients with malignant pleural effusions operated method VATS for the period 01.01.2013 - 31.05.2016 in the Clinic of Thoracic Surgery at the University Hospital "Prof. Dr. St.Kirkovich" JSC. Stara Zagora. 70 patients were operated with single access and 66 with a conventional three port thoracoscopic surgery. Results: She stayed postoperative days average single VATS 5.7 days, conventional 7.4. Satisfaction of patients after inclusion in the management of hospitalization single VATS - 4.3 out of six in conventional 2.9. Level of post-operative pain in the incision: Single access 1st day 1.8, 2nd day 0.9, the third day 0.2 after 3rd day 0.1 Conventional access - 1st day 6.4, second day 5.0, the third day 4.0, after the third day 1.0. Operativе time: Conventional access - 39 minutes, Single access -20 minutes. Conclusion: VATS single access contributes to a greater degree to reduce the negative impacts on and without worsening a performance status of patients.

Introduction: The introduction of a foreign body in the respiratory tract is a serious global problem requiring urgent medical assistance. Purpose: The aim of the study is to assess the applicability of the Virtual bronchoscopy with MDCT for patients (adults and children) with suspected foreign body. Methods: To all 9 patients Virtual bronchoscopy and Fiberoptic bronchoscopy were carried out. The studies were carried out with an optimized protocol. In order to compare the results of FB and VB the sensitivity and precision indicators were determined. Results: When comparing the results of the study of patients with suspected foreign body, both methods established 4 positive results each (44.45%). Conclusions: VB is particularly reliable and suitable for children and adults with poor general condition. The results of VB with MDCT could be used for early diagnosis of suspected foreign bodies.

The relevance of the problem is related to the continued increase in the neoplastic processes, and at the same time also to the development and improvement of the endoscopic and CT equipment, and thus expanding the diagnostic capabilities.Purpose: The presented research examines the results of the study of a rare case of ruptured trachea as a result of cancer of the esophagus.Methods: Fiberoptic esophagoscopy (FOE) and CT of the chest followed by virtual bronchoscopy on a patient with a ruptured trachea, a 63 year-old man, were performed.Result: Performing MDCT with virtual bronchoscopy, according to this study, is crucial as the sole and complex methodology for the described case in connection with the finding of the trachea-oesophageal fistula and evaluation of the mediastinum and the pulmonary parenchyma.Conclusion: The VB is a successful method equally effective compared to the FB, to diagnose of advanced neoplastic processes.

OBJECTIVE: The purpose of this study is to answer the question whether the treatment of these patients leads to control of respiratory failure by relieving and eliminating dyspnea and preserving the patients’ ability to care for themselves, as well as achieving reduction of the number of hospitalizations of patients with unsuccessful pleurodesis and effusion persistence. MATHERIAL AND METHODS: 165 patients with malignant pleural effusions were treated in the Clinic of Thoracic Surgery for the period 01 January 2013 – 31 May 2016. 70 patients underwent surgeries with single-port VATS, 66 patients were operated on with conventional VATS, while 29 patients were treated with thoracocentesis and drainage. RESULTS: Of all 165 alone 5 patients, constituting 3.03% of the total number of patients, had to be admitted to the hospital for a second time due to reaccumulation of pleural effusion within the next 30 days. Satisfactory dyspnea control was established, allowing the patients to take care of themselves. CONCLUSION: The surgical procedures – single-port and conventional VATS surgeries, thoracocentesis, drainage and placement of long-term pleural catheter with, or without, pleurodesis constitute part of the procedures achieving control over dyspnea in patients with MPE.

Virtual bronchoscopy (VB) is 3-dimensional computer-generated technology, creating endobronchial images from spiral CT data. The study aims to present summarized results from researches of different foreign authors about the advantages of VB, the possibilities for its application and the effectiveness of its use in routine practice in the diagnosis of tumors of the trachea and bronchi. The three-dimensional model of the tracheobronchial tree allows assessment of the airways from inside. The majority of the examined studies relate to the diagnosis of new formations of the respiratory tract, preparation for surgery, assessment of the results of surgery, etc. VB is a noninvasive method allowing to examine the smallest bronchi. Relatively few studies in Bulgaria as well as the ensured during recent years new modern equipment for VB and MDCT, provide great opportunities for making VB examinations to study the effectiveness and its wide application in daily X-ray practice.

Purpose : To determine the value of lung perfusion on predicting unresectability of lung carcinoma in patients with exploratory thoracotomy. Materials and methods : We analyzed retrospectively the value of lung perfusion scintigraphy in 25 cases with primary lung carcinoma who had an exploratory thoracotomy (18 right and 7 left thoracotomy), regarding preoperative suggestion of unresectability. In most of these patients other noninvasive diagnostic methods (X-ray and CT) did not indicate inoperability. Results : Only the perfusion lung scintigraphy demonstrated defects near the ipsilateral hilum and/or an enlargement of the mediastinum, displacement of mediastinum, displacement (pulling) of the hilum of the affected lung or a part of it to the mediastinum. At thoracotomy we found an involvement of hilar vessels and the mediastinum by the tumor or by `bulky` nodal metastases. Common peripheral concentric decrease of affected lung perfusion image dimensions, lacking or negligible perfusion of the affected lung also suggest inoperability. Perfusion indices at localization of the tumor in the right lung (15 of the patients) were mean=40,8%, SD=11,02%, SE=2,7%, and at localization in the left lung (6 of the patients) mean=36,27%, SD=10,60%, SE=4,01%. Conclusion : These findings show that in some patients with bronchial carcinoma the perfusion scintigraphy image can suggest a potential unresectability and requires a more extensive staging like mediastinoscopy or thoracoscopy.

The colon cancer is on the first place as etiologic cause for performing pulmonary resection due to pulmonary metastases. The low effectiveness of chemotherapy in case of metastatic progression from colorectal carcinoma is established. Accordingly, the surgical resection is commonly accepted as the only potential therapeutic option. In favour of the good results from surgical treatment is the trend of earlier finding of pulmonary metastases. The metastases diagnostics has important meaning for differentiation from other lung diseases and for the choice of the therapeutic method. The benefits and disadvantages of non-invasive (chest X-ray, CT, lung perfusion scintigraphy, PET and PET/CT, tumor markers) and invasive (bronchoscopy, mediastinoscopy, VATS (video-assisted thoracic surgery, TTNB (trans-thoracic needle biopsy)) methods for diagnosis of intrapulmonary metastases are analyzed.

Purpose: The best treatment for lung cancer is a surgical resection. Patients in advanced stage are subject to chemotherapy and/or radiotherapy. Our aim is to evaluate whether the survival is related to perfusion index, stage and presence of radio and/or chemotherapy. Materials And Methods: We analyzed the follow-up of 125 patients (118 men and 7 women, 30-76 years of age) with lung perfusion scintigraphy made between years 1989 and 1998 until 2013. Fortythree patients have been treated by radio-chemotherapy and 82 by chemotherapy. Patients have been staged by TNM classification from II to IV clinical stage. Survival was calculated by the KaplanMeier method, and groups were compared by the Mantel-Cox Log Rank test. Results: Perfusion changes varied from impaired in different extent perfusion to lack of perfusion in one of the lungs. The Median survival of radio-chemotherapy treated patients with perfusion index of affected lung less than 49% was 10,5 months and with perfusion index greater than 49% was 18,4 months. The overall Median survival of radio-chemotherapy treated patients was 11,2 months. The median survival of chemotherapy treated patients with perfusion index of affected lung less than 49% was 7,9 months and with perfusion index greater than 49% was 4,4 months. The overall Median survival for chemotherapy treated patients was 6,9 months. Conclusion: Perfusion index and stage were not statistically significant factors for the survival of patients with radio-chemotherapy and chemotherapy. Overall radio-chemotherapy treated patients have better median survival than the median survival by stage

PURPOSE : The surgical treatment is the most successful treatment of non-small cell lung cancer (NSCLC) in oncology practice. Lung perfusion scintigraphy as a non-invasive method for evaluation of the perfusion defect related to tumor localization in lung cancer patients is considered the differentiating line of pulmonary tests to predict post-operative lung function. MATERIALS AND METHODS : We analyzed retrospectively the value of lung perfusion scintigraphy in 10 cases with primary lung carcinoma who had a pulmonectomy (9 left and 1 right pulmonectomy). RESULTS : Changes in affected lung perfusion varied from impaired in different rate to perfusion defect in at least 3 lung segments (presented in 3 of the patients), 4 lung segments (present in 2 of the patients), or parts of segments, or defect affecting whole lobe. Impaired perfusion in a zone with polycyclic outlines in homolateral hilum was present in 7 of the patients. Perfusion indices at localization in the left lung (8 of the patients) were mean = 36,79%, SD=19,35%, SE=6,8%. CONCLUSION : Lung perfusion scintigraphy is a valuable method in the complex of pre-operative examinations to define the extent of the impairments in pulmonary perfusion and predicting the post-operative pulmonary function when pulmonectomy is about to be elaborated. The rate of perfusion changes and the percentage of involvement of the affected lung in the common pulmonary function correlate with survival. The low perfusion in the affected lung is not necessarily a contraindication for operative treatment.

Objective: To evaluate the early and long-term results after surgery for primary pulmonary sarcomas (PPS) and to compare them with those of patients with pulmonary carcinosarcomas (PCaSa). Methods: During a 20-year period, 48 patients with PPS and 15 patients with PCaSa underwent surgery. There were 40 males and 23 females with a mean age of 52.1 years (range 13-78). The histologic diagnoses in PPS group were fibrosarcoma (15), fibroleiomyosarcoma (10), leiomyosarcoma (6), rhabdomyosarcoma (6), hemangiopericytoma (3), epitheloid hemangioendothelioma (3), malignant schwannoma (1), liposarcoma (1) and undifferentiated sarcoma (3). The following curative resections were carried out: lobectomy (36), including two sleeve lobectomies (in PPS group), pneumonectomy (15) and polysegmental resections (4). In four PPS cases, these procedures were extended to the thoracic wall, diaphragm or pericardium. An atypical resection was applied in one PPS patient (the tumor was falsely classified as benign on frozen section examination). Exploratory thoracotomy was performed in five of PPS patients (11 %) and in two of those with PCaSa (13%). The majority of PPS patients were with low stages I and II (76%). The PCaSa patients were predominantly with stage IIIA (39%). Results: No postoperative death was registered. Major complications included two localized empyemas (4.2%) in PPS and one reoperation for bronchial stump fistula (6.7%) in PCaSa groups. Local recurrences were operated on in one patient per group (2.1 and 6.7%, respectively). Follow-up was available on 57 patients and ranged from 4 to 148 months. The overall cumulative 5-year survival was 48.81% for PPS and 49.38% for PCaSa patients (P = 0.9035). It was better in low vs. higher stage cases, statistically significant in PPS group (P = 0.0005) and without significant difference in PCaSa cohort (P = 0.11). Conclusions: Complete resection of PPS and PCaSa favors an acceptable survival, especially in low stages. There is no significant difference in the survival rates between PPS and PCaSa patients, despite the greater number of cases with higher stages in PCaSa group. (C) 2003 Elsevier Science B.V. All fights reserved.

The trauma of the trachea and bronchi are extremely rare, in 0.6 to 3 per cent of the patients with chest trauma. Most common are the longitudinal lesions localized in the membranous part. Following are the transversal lesions localized between two cartilaginous rings and in 20 per cent of the cases total circular lesions with dislocation of the two ends are found. A review of the clinical signs, the complications, the diagnosis and the successful operative treatment of a patient with the latter particularly rare traumatic injury of the trachea is presented.

The study includes 1127 injured with thoracic trauma, 23 percent of them with polytrauma. The worse thoracic trauma were these with formed flail chest with pleural and lung complications, accompanied by severe disfunction in circulation and biomechanics of breathing. The application of minimal surgical procedures like pleural punctures and drainage of pleural cavities with aspiration achieved good results. Thoracotomy was performed on clear indications (unstoppable bleeding, large ruptures of lung parenchyma, suppurative lung haematoma, cardiac tamponade, rupture of major airways, rupture of diaphragm, rupture of oesophagus and coagulated haemothorax). The achieved mortality of 5.9 percent is an excellent index suggesting a choice of treatment.