[Changes in the tuberculosis epidemiological situation in the areas of the North-Western Federal District of the Russian Federation in 2001-2006].

In the early 21st century, the prevalence rate of tuberculosis infection in the North-West (North-Western Federal District, NWFD) of Russia remains less than the Russian one. There have been no specific changes in the epidemic situation in the past 6 years. It is early to speak about of stabilization as the epidemiological indices are very unsteady. Their nature is suggestive of the preserving tension of the tuberculosis epidemic situation in the NWFD of the Russian Federation.

[Tuberculosis in the North-Western Federal Okrug (2000-2004)].

Tuberculosis is an urgent problem in the North-Western Federal Okrug of the Russian Federation. In the past 5 years, the tuberculosis epidemic situation in the okrug has remained to be of strain despite the fact that the spread of tuberculous infection in the North-West is less than in whole Russia. The proper financing of tuberculosis-controlling measures, the solution of a staff-associated problem, and the improvement of the logistic base of a tuberculosis service facility are required to stabilize the tuberculosis situation.

[Outcomes of surgical treatment of patients with progressive pulmonary tuberculosis an concomitant diseases].

The pattern of concomitant diseases has been studied in 708 patients operated on for progressive pulmonary tuberculosis. The incidence of concomitant diseases has been found to considerably increase in recent years and it was as high as 77%. Peptic ulcer and chronic viral hepatitis were responsible for 1.5- and 6-fold increases, respectively, in the incidence of concomitant diseases. Virtually all diseases accompanying pulmonary tuberculosis were ascertained to cause an increase in the frequency of postoperative complications. Diabetes mellitus and chronic viral hepatitis concurrent with tuberculosis had the greatest negative impact on the course of a postoperative period. These diseases and peptic ulcer substantially worsened the long-term results of surgical treatment, by increasing the frequency of postoperative recurrences of tuberculosis.

[Surgical treatment of obstructive urinary tract diseases in patients with pulmonary tuberculosis]. / Khirurgicheskoe lechenie obstruktivnykh zabolevanii mochevyvodiashchikh putei u bol'nykh tuberkulezom legkikh.

The paper presents the data of an examination of 92 patients [males (59-64.1%) and females (33-35.9%)] with active pulmonary tuberculosis concurrent with obstructive urinary tract diseases of various etiology. The patients' age ranged from 39 to 90 years (mean 58.2 +/- 2.5 years). Seventy-six (82.0%) patients suffered from infiltrative tuberculosis; 12 (13.0%) and 4 (4.3%) patients had cavernous and fibrocavernous tuberculosis, respectively. A relationship was found between pulmonary tuberculosis and obstructive urinary tract diseases leading to uniform changes in the upper urinary tract. The use of currently available methods for examination and treatment to eliminate infra- and supravesical obstruction permits performance of surgical interventions in patients with active pulmonary tuberculosis.

[Surgical treatment for postoperative recurrent pulmonary tuberculosis]. / Khirurgicheskoe lechenie posleoperatsionnykh retsidivov tuberkuleza legkikh.

The long-term results of 1311 primary resections for pulmonary tuberculosis and 203 repeated interventions for postoperative recurrences were studied. During a 10-year follow-up, the cumulative rate of postoperative recurrences was 18.4%, the minimum (5.7%) being in the operated on for tuberculosis, the maximum in cavernous tuberculosis (27.9%) and caseous pneumonia (40%). 58% of recurrent tuberculosis occur within the first 3 years after surgery, the efficiency of their medical treatment does not exceed 30%, indications for resurgery are established at the same rate. Repeated lung resections, final pneumonectomies were performed in 72.8% of the patients with the immediate efficiency of 87.5-86.2% and mortality rates of 6.2-12.1%. Caverno- and thoracoplasties were made in 27.2% of the patients. The efficiency of these deliberately nonradical operations was 83.3-55.5%.

[Tuberculosis control in the North-West of Russia]. / Sostoianie i perspektivy borby s tuberkulezom na Severo-Zapade Rossii.

The basic epidemiological parameters (prevalence, incidence, mortality due to tuberculosis) and inadequate efficiency of treatment of patients suggest that tuberculosis remains to be a serious problem in the North-West of Russia. There is differentiation in the prevalence of tuberculous infection that reaches the critical values in the Kaliningrad Region. For successful tuberculosis control in the North-Western Region, it is necessary to solve personnel problems, to improve methods for early detection of tuberculosis, to enhance the quality of therapeutic measures by actively introducing the developed technologies for treating drug-resistant pulmonary tuberculosis and for adequately applying surgical treatments for tuberculosis at different sites, to set up a tuberculosis monitoring system with proper financing all implemented antituberculous measures.

[Outcomes of local interventions into the caverns in patients with destructive forms of postoperative recurrences of pulmonary tuberculosis]. / Rezul'taty mestnykh vmeshatel'stv na kaverne u bol'nykh s destruktivnymi formami posleoperatsionnykh retsidivov tuberkuleza legkikh.

The paper presents the outcomes of 48 cavernoplasties for destructive forms of postoperative recurrences, which was 23.5% in the structure of all interventions for postoperative recurrences. One-stage cavernoplasty was performed in 17 patients; 31 patients underwent multistage cavernoplasty (with a period of open sanitation). After one-stage cavernoplasty, at discharge 2 (11.8%) of the patients were found to have formed residual caverns due to detachment of a muscle flap, other complications were not recorded in this group of patients. After multistage cavernoplasty, the above complications developed in 5 (16.1%) cases. There were deaths after these operations. In the late postoperative periods, a steady-state abatement of the process occurred in 12 (33.3%) patients, a relative stable course of tuberculosis with mild exacerbations was noted in 8 (22.2%) patients; further progression was revealed in 44.4% of the cases; late postoperative mortality was 27.8%.

[Immunological changes in patients with pulmonary tuberculosis during glutoxim therapy]. / Dinamika immunologicheskikh pokazatelei u bol'nykh tuberkulezom legkikh pri lechenii glutoksimom.

The paper deals with the effect of glutoxim included into a preoperative preparation regimen on immunological parameters in patients with fibrocavernous pulmonary tuberculosis. On admission, all the patients had inadequate cellular immunity and activated humoral immunity. After termination of a course of glutoxim therapy, there was an increase in the baseline low values of lymphocytic proliferative activity, in the count of mature T lymphocytes, and in the production of IL-2 induced by phytohemagglutinin. At the same time the similar parameters remained unchanged in the control group. The drug exerted the most noticeable stimulating effect on cellular immunity in patients with a limited process. Glutoxim produced no noticeable effect on humoral immunity. The immunomodulating effect of glutoxim was followed by improvement of the clinical and X-ray pictures of the disease. In glutoxim-treated patients with baseline immunological disorders, progression was found to occur 1.5-2 times more infrequently than in the control group. Indications for the use of glutoxim in the treatment of tuberculosis are specified on the basis of the baseline immunological parameters of each patient.

[Long-term results of surgical treatment of pulmonary tuberculosis wtih respect to the extent of bacterial isolation and to drug resistance of Mycobacterium tuberculosis]. / Otdalenny rezul'taty khirurgicheskogo lecehniia tuberkuleza legkikh v zavisimosti ot massivnosti bakteriovydeleniia i lekarstvennoi ustoichivosti vozbuditelia.

The remote postoperative results were followed up for as long as up to 10 years. It was established in case of abacillary patients that the frequency rate of relapses was minimal ranging from 3.6% in the group of patients operated for tuberculosis and caseous-necrotic tuberculosis to 11.5% in fibrous-cavernous tuberculosis. Patients with bacterial discharge, primarily of the extensive nature, had more often relapses (19.4% in operated patients for caseous-necrotic tuberculosis and 31.7% in patients operate for fibrous-cavernous tuberculosis). Drug resistance (DR) of Mycobacterium tuberculosis (MBT) to three and more anti-TB preparations essentially increase a possibility of relapses in all clinical forms of tuberculosis with maximum threat being in patients with fibrous-cavernous lesions (36%). As for the repeatedly operated patients for postoperative relapses involving DR MBT to isoniazid and rifampicin, only slightly above 50% of them survived 5 years after surgery; the index of the 5-year survival was 33% among the patients with DR to 4 and more drugs.

[Results of surgical treatment of locally-disseminated non-small cell lung cancer]. / Rezul'taty khirurgicheskogo lecheniia mestnorasprostranennogo nemelkokletochnogo raka legkogo.

An analysis of results of operative treatment of 390 patients in 1980-1999 has shown growth of incidence of adenocarcinomas, less frequency of exploratory thoracotomies and non-radical resections of the lung, postoperative complications and lethality, more cases of 5-year survival. Reliable factors of prognosis of long-term results of treatment are established.

[Exploratory thoracotomy: causes of inoperability of non-small-cell lung cancer]. / Eksplorativnye torakotomii: prichiny neoperabel'nosti nemelkokletochnogo raka lëgkogo.

The investigation is concerned with evaluation of different procedures of preoperative examination as well as reasons for carrying out explorative thoracotomy for lung cancer. The data on examination and surgical treatment of 81 patients who underwent explorative thoracotomy for primary non-small cell cancer of the lung were analyzed. The procedure was performed in 9.3% of surgical patients. Assessment of preoperative clinical and macro- and microscopic findings as well as resected material was carried out for each patient. The X-ray, bronchological, functional, angiographic and computed tomography evidence identified involvement of the mediastinal systems (pulmonary artery, vena cava superior, myocardium, aorta and trachea) and dissemination of tumor to the pleura as the most common cause of inoperability. Radical surgery was contraindicated in 65% because of the involvement of several organs and tissues. In certain situations, explorative thoracotomy should be resorted to as the last method of diagnosis of primary lung cancer.

[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]. / Postpnevmonéktomicheskii sindrom: nekotorye novye anesteziologicheskie i patofiziologicheskie aspekty problemy.

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.

[Experimental evaluation of different methods of intraoperative aerostasis in surgery of the lungs]. / Eksperimental'naia otsenka razlichnykh metodov intraoperatsionnogo aérostaza v khirurgii legkikh.

The work deals with the results of comparative evaluation of different variants of intraoperative aerostasis by means of glue and bioplastic materials in experiments on 75 animals. The authors give in detail a clinicomorphological characteristics of each method for rendering the lung wound airtight. It is concluded from the obtained data that aerostasis by means of fibrin glue and collagenous film is highly effective.