[Surgery for respiratory tuberculosis at the Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy: history and current trends].

The authors present concise data on the history of surgical treatment for pulmonary tuberculosis at the Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy (1918-2008). They analyze the results of surgical treatment in 1007 patients with different forms of pulmonary tuberculosis in the past 10 years. The most common indications for surgical treatment are tuberculoma (44.2%), fibrocavernous and cirrhotic tuberculosis (37.8%), chronic pleuritis and pleural empyema (7.3%). There are prevalent resection-type operations (77.7%), with fatal cases after pneumonectomy (3.9%), lobectomy (0.6), and minor resections (0%). The proportion of thorocoplastic operations was 4.1% without fatal cases. Mini-invasive surgery using video-assisted technologies have received wide recognition in the diagnosis and surgical treatment of pulmonary tuberculosis. The results of treatment depend on the extent and presence of complications of a tuberculous process, comorbidity, suppressed immunity, and the scope of a surgical intervention. Overall, the efficiency of surgical treatment of patients with pulmonary tuberculosis is 90% or more.

[Video-assisted techniques in phthisiosurgery].

Ten years' experience in applying video-assisted techniques to surgery of pulmonary tuberculosis is generalized. For surgical diagnosis and treatment, a total of 465 patients underwent the following procedures: video-assisted thoracoscopy (n = 133), video-assisted open mini-invasive thoracotomies (n = 117), and mediastinoscopy (n = 215). The main indications for 250 video-assisted thoracoscopic operations were exudative pleuritis or pleural empyema, disseminated lesions to or round masses in the lung of unknown genesis, restrictive forms of pulmonary tuberculosis. After video-assisted thoracoscopic operations, complications were stated in 3.6% of cases; there were no deaths. The accumulated experience has shown that video-assisted thoracoscopy is of relatively limited utility. It is most effective in diagnosing pleuritis and disseminated lung lesions of unknown etiology. Video-assisted mini-invasive operations combine many advantages of open and endosurgical interventions. They may find more extensive use in the surgical treatment of different forms of pulmonary and pleural tuberculosis. In 215 patients, the indication for mediastinoscopy was intrathoracic lymph nodal abnormality of unknown genesis. Specimens for morphological studies were obtained in all cases, which promoted timely diagnosis and definition of treatment policy. Complications were observed in 1.4% of cases; no deaths were seen. Video-assisted mediasthinoscopy has been applied in the past 3 years. This endosurgical technique is technologically new, has a high resolution, and deserves wide use in thoracic surgery.

[Immunophenotyping of epithelioid-cell granulomas in sarcoidosis].

The specimens of biopsy of the lung and lymph nodes from 24 patients with sarcoidosis were immunophenotyped. The monoclonal antibody panel for immunophenotyping the monocyte-macrophage cells included HLA-DR, CD64, CD163; CD7, CD3, CD4, CD8, HLA-DR, and CD20 were used to assess lymphocytic populations. In sarcoidosis, the majority of cell elements of a granuloma are in a state of activation, as evidenced by HLA-DR expression on the epithelioid, giant cells, T lymphocytes (which was observed in more than in 90% of cases), the extent of this expression decreasing as fibrosis develops. There is a statistically significant correlation between the presence of individual lymphocytic subpopulations and monocyte-macrophage cells in the granuloma. No clear relationship of the phenotype of a granuloma to the clinical form (stage) of sarcoidosis suggests that is based on the common self-sustaining process of formation, functioning, and involution of granulomas, which has no direct agreements in the X-ray and laboratory manifestations of the disease.

[External respiratory function in patients before and after saving lung resections]. / Funktsiia vheshnego dykhaniia u bol'nykh do i posle ékonomnykh rezektsii legkikh.

External respiratory function (ERF) was studied in 129 patients with restrictive pulmonary processes (tuberculomas, infiltrative and cavernous tuberculosis) before and after surgery. All the patients underwent saving lung resections. Changes in ERF were examined by conventional and the new method telespirography. This technique detects general and individual pulmonary ventilation disorders, which underlie criteria for assessing whether patients with pulmonary tuberculosis can be operated on. The authors show that the outcomes of surgical treatment are determined by the baseline status of the respiratory apparatus generally and each lung specifically. Distinctive features of complicated and uncomplicated postoperative periods are identified. The benefits of the new method are demonstrated.