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Metastatic triple-negative breast cancer remains the most unfavourable among all breast cancer subtypes from the prognostic point of view. Despite the active introduction into practice of combinations of cytostatics with immunotherapeutic agents, as well as PARP inhibitors, sequential lines of chemotherapy with the median overall survival which does not exceed 15 months remains the main method of treating patients in this group. This breast cancer subtype is characterized by a rapid development of drug resistance at the early stages of systemic treatment and a predominantly visceral progression, which determines a low life expectancy in patients. The combination of capecitabine and ixabepilone has proved to be effective in the treatment of tumours that are resistant to taxanes and anthracyclines. The use of this combination is characterized by an acceptable and controlled toxicity profile. This article presents a clinical case of therapy with a combination of ixabepilone and capecitabine of a patient with breast cancer progression during the previous therapy of taxanes, a platinum-based doublet chemotherapy and eribulin. This approach, together with symptomatic laparocentesis and pleurodesis, allowed for overall survival exceeding 45 months with the preservation of a satisfactory functional status of the patient.

The objective of the study is еo evaluate the possibilities of videothoracoscopy in the cases of pleurisy of inflammatory nature of specific and non-specific etiology.Material and methods. We carried out the retrospective analysis of medical histories of 135 patients.. Parapneumonic pleurisy was diagnosed in 68 (54.4 %) patients, tuberculous pleurisy – in 57 (45.6 %) patients.Results. Videothoracoscopy was diagnostic procedure in 61.6 % of patients and was performed for the defragmentation of pleurisy in 38.4 % of patients. Videothoracoscopy allows exactly diagnosing the tuberculous pleurisy by means of biopsy in the absence of lesions on the pleura. Resistant parapneumonic pleurisy was diagnosed in 34.9 % of patients. In cases of parapneumonic resistant pleurisy, the pleurodesis reduces the time of the drainage by means of injection through the drainage of mixtures of betadine and concentrated solution of glucose.

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

OBJECTIVE. The authors analyzed the efficacy of bleomycin application as sclerosing agent in patients with transudative pleural effusion in consequence of hepatic failure. MATERIAL AND METHODS. The research included 7 patients with right side hepatic transudative pleural effusion who didn’t respond to conservative medical treatment. Drainage of the right pleural cavity with following injection of bleomycin were performed for all the patients. RESULTS. This procedure was effective in 6 out of 7 patients (86 %). There was a single case of recurrence and lethal outcome (14 %) due to hepatic coma. There weren’t noted any severe side effects during 6 months after induction of bleomycin. CONCLUSIONS. Pleurodesis using bleomycin appeared to be effective and safe method of treatment for patients with hepatic transudative pleural effusions.

Malignant effusion complicates more than 15% of all cancers in delayed stages of progression. The most common causes of metastatic pleuritis are lung cancer, breast cancer, ovarian cancer, lymphoproliferative diseases or dissemination of gastrointestinal tumors. Malignant effusion is associated with negative prognosis for overall survival regardless of etiology of tumor, significantly complicates the course of the underlying disease, impairs life quality and complicates treatment. Despite various methods for pleural cavity obliteration in recurrent metastatic pleuritis, there is still no a uniform approach to choosing the optimal treatment strategy. We analyzed the main methods of conservative and surgical treatment of recurrent metastatic pleuritic regarding efficacy, risk of recurrence and reproducibility.

The article presents a literature review on the VATS treatment of spontaneous pneumothorax as a complication of bullous lung emphysema. The review considers questions of etiology, diagnostics and therapeutic tactics in VATS treatment of spontaneous pneumothorax with bullous emphysema. The main target of surgeons is not only elimination of spontaneous pneumothorax, but quick exposure of lung parenchyma pathology in order to predict possible reoccurrence of spontaneous pneumothorax. Video-assisted thoracoscopy in this case is a mini-invasive, less traumatic and highly efficient method of treatment of spontaneous pneumothorax. Anti-relapsing surgical interventions with pleurodesis are unanimously considered to be necessary. An integrated and differentiated approach to the treatment of spontaneous pneumothorax as a result of bullous emphysema helps to determine diagnostic and therapeutic tactics of VATS treatment and choice of pleurodesis induction leading to improved treatment outcomes in this category of patients.

The article presents the results of thoracoscopic surgeries in case of bullous emphysema of the lung in 88 patients. The patients have been divided into 2 groups according to the method of treatment: 1) destruction of pulmonary bullas and pleurodesis using diathermic electrocoagulation (42 people); 2) destruction of pulmonary bullas and subtotal pleurectomy (47 people). The operative periods weren’t statistically differentiated in patient’s groups. The volume of hemorrhage and exudation period from the pleural cavity were significantly higher in patient’s group, where patients underwent pleurectomy. However, lung spreading terms and ending of air leakage, periods of drains removal from the pleural cavity, hospital stay and rate of pneumothorax recurrence were considerably smaller in the group without application of pleurodesis.

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Objective: To compare the efficacy of chemical pleurodesis with talc and trichloroacetic acid during thoracoscopy., Material and Methods: Thoracoscopy with pleural biopsy was performed in 355 (83.5%) out of 424 patients with pleural effusion. Pleurodesis was ensured by intraoperative insufflation of talc powder ( n =135) and application of 33% trichloroacetic acid solution to parietal and visceral pleura ( n =19) in patients with malignant (125), inflammatory (6), post-traumatic (4), tuberculous (3), pancreatogenic (8) and hepatogenic (8) effusions. Drainage tubes were removed if daily drainage output volume was less than 100 ml or complete lung inflation was observed., Results: Post-pleurodesis drainage took 7.1±5.4 days. Two patients developed bumpy rashes that were initially interpreted as carcinomatosis. However, these rashes were later identified as tuberculosis. Retrospectively, these patients were not good candidates for pleurodesis. Pleurodesis with talc suppressed exudation in 89.6% of cases. Complications developed in 4 cases (3%): pneumonia (1) and pleural empyema (3). These complications were associated with a violation of technical procedure of pleurodesis, i.e. procedure in rigid lung, atelectasis (1) and bronchopleural fistula (2). Mean duration of drainage after trichloroacetic acid-induced pleurodesis was 7.9±6.7 days. This procedure was effective in 84.2% of cases, and there were no complications. There are no previous reports on the use of this pleurodesis technique in the literature. Mean duration of drainage after talc-induced pleurodesis was decreased up to 6.9±5.4 days in patients with malignant pleural effusion ( p <0.05), after trichloroacetic acid-induced pleurodesis - up to 7.5±8.1 days ( p >0.05) compared to patients without pleurodesis (9.1±11.2 days)., Conclusion: Pleurodesis with talc or trichloroacetic acid during thoracoscopy is effective for pleural effusions following malignancies, liver, kidney and cardiac diseases with decompensation. Essential requirements are adequate lung inflation, no atelectasis and bronchopleural fistula.

Objective: To study the causes of resistant pleural effusions and efficiency of chemical pleurodesis with Betadin, Iodopyrone and concentrated glucose solution in these patients., Material and Methods: Resistant pleuritis with daily exudation over 300 ml lasting ≥6 days occurred in 206 (48%) out of 424 cases of pleural effusions. Twenty-seven patients underwent chemical pleurodesis with Betadine, 15 patients - mixture of Iodopyrone with concentrated glucose solution. Solutions were injected via pleural drainage., Results: In multivariate analysis, the risk factors of complicated pleuritis were air leakage, prolonged drainage period, age over 60 years, fluid output volume during thoracoscopy and higher Charlson index. Pleurodesis with a mixture of Betadine 10% 10 ml and glucose 40% 40 ml suppressed exudation in 92.6% of cases. Pleurodesis with a mixture of Iodopyron and glucose solution in the same quantities was effective in 93.4% of cases. If exudation continued, pleurodesis was repeated after 3 days. VAS score of pain syndrome following Iodopyrone injection was 3.0±1.8, in case of Betadine - 3.4±0.3. No significant hemodynamic changes were noted. In case of malignant pleural effusions and low functional parameters after fluid evacuation, favorable effect was obtained after pleurodesis with a mixture of povidone-iodine with glucose through the same catheter and subsequent removal of drainage tube., Conclusion: Resistant pleural effusions with daily exudation over 300 ml for more than 6 days are characterized by advanced risk of infectious and inflammatory complications due to air leakage and duration of drainage. Pleurodesis with mixtures of Betadine or iodopyrone and 40% glucose solution is effective for resistant pleural effusions.

The article presents the authors' experiences with treatment of 292 patients with spontaneous pneumothorax. Results of the suction drainage (188 patients), thoracoscopy and talc pleurodesis (43 patients), videothoracoscopic surgical treatment and pleurodesis (61 patients) are compared. The proposed algorithm allowed to make recurrences 2.8% rarer, the indications for tracheotomy appeared in 1.7% of the patients.

The report presents data on conservative treatment of pleuritis induced by metastases from tumors of different localization by bleomycetin. After the pleural cavity was drained dry in 24 patients, bleomycetin 45 mg was introduced into it. The latter procedure was repeated in 6 cases because profuse exudation continued. The results were evaluated by clinical and roentgenological means. Bleomycetin treatment was painless. Mean drainage duration was 3.8 days, admission time--6.2 days. Stable remission was recorded in 16 patients, partial--7. Pneumonia (2) and chronic empyema (1) were observed as complications. Bleomycetin-induced pleurodesis correlated with exudate pH: a pH value in excess of 7.3 made a patient good candidate for carrying out the procedure. According to Karnofsky index for long-term results, life quality of the patients improved. Eleven patients survived for 1 year after pleurodesis, and 2--more than two years.