A Comparison of Clinical and Radiographic Signs of Nontuberculous Mycobacterial Pulmonary Disease, Destructive Drug-Resistant Pulmonary Tuberculosis and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis.

A misdiagnosis of isolated pulmonary tuberculosis (pTB) is highly likely when a patient has nontuberculous mycobacterial pulmonary disease (NTMPD) or a combination of nontuberculous mycobacterium pulmonary disease and pulmonary tuberculosis. Frequently, bacterial excretion is absent or only Mycobacteria tuberculosis (MBT) is found. This often results in an incorrect diagnosis and subsequent misinformed treatment regimes. In order to determine possible clinical and radiographic differences between patients with NTMPD (Group 1), destructive drug-resistant pulmonary tuberculosis (Group 3) and a combination of NTMPD and pTB (Group 2) we compare clinical and radiographic signs for these three patient groups. When comparing with Group 3 (2.5%), Groups 1 (25%) and 2 (17.4%) have a substantially higher incidence of pulmonary haemorrhages. Thus, upon clinically observing the combination of pTB and NTMPD, there are no pathognomonic clinical and radiographic detected symptoms. However, the presence of an indolent course, hemoptysis and bronchiectasis in the presence of acid-fast bacteria (or identified MBT) in the sputum makes it possible to suspect not simple pTB, but a combination of pTB and NTMPD. To clarify this necessitated in-depth bacteriological examination.

Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children.

INTRODUCTION: Treatment of cavernous and fibrous cavernous tuberculosis in children, especially in the presence of multiple drug resistance-tuberculosis or extremely drug resistance-tuberculosis, presents a major challenge. MATERIALS AND METHODS: We analyzed results of treatment of 65 patients (mean age 14.8 + 2.9 years) with cavernous TB (group I) and 116 patients (mean age 15.6 + 1.9 years) with fibrous-cavernous TB (group II). Evaluation of treatment efficiency was performed directly at discharge and 1 year after treatment according to Lazerson's criteria. RESULTS: In group I, after 80 operations, two (2.5%) cases showed delayed expansion of the lung after combined resections, in group II, postoperative complications after 160 operations occurred in eight (5.0%) cases (the difference is reliable p ≤0,05). There was no hospital fatality. The effectiveness at the time of discharge from surgery (cessation of bacterization and elimination of decay cavities in the lung) was 100% in groups I and II, respectively. A year later, according to Lazerson's criteria, the efficiency in group I was 100%, in group II was 97.4%. CONCLUSION: Operations in patients with cavernous tuberculosis performed after 10 to 12 months of conservative treatment present a lower risk of postoperative complications and relapses of cavernous tuberculosis than operations in patients with fibrous cavernous tuberculosis performed after 22 months or more of treatment.

Surgical Treatment of Nontuberculous Mycobacterial Pulmonary Disease and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis.

OBJECTIVES: Nontuberculous mycobacterial pulmonary disease (NTMPD) is an important health system problem worldwide. Surgical treatment experience is limited, and the safety of such operations is still unclarified. Therefore, improving our knowledge of NTMPD is important. DESIGN: In this retrospective observational study, we analyzed the medical records of 2,432 patients operated on from January 2011 through December 2017 in our hospital. There were 20 patients with NTMPD in group 1 and 23 patients with combined NTMPD and pulmonary tuberculosis in group 2. Patients received antibiotic treatment before and after surgery as per Russian Federal clinical guidelines and individual drug susceptibility. RESULTS: Postoperative complications occurred in 2 (10%) cases in group 1 and 4 (17.4%) in group 2, and intraoperative complications occurred in 2 (8.7%) cases in group 2. There was no 30-day mortality in both groups. After 1 year, all 40 traced patients had neither bacterial excretion nor cavities in the lungs. After 3 years and 5 years, the efficacy among 32 and 13 traced patients was 100%, respectively. CONCLUSIONS: Modern surgery for small NTMPD forms is safe - helping improve outcomes for ineffective antibiotic treatment. Combined surgery and antibiotic treatment are acceptable in both the short and long term.

Surgical treatment of giant bullae on the background of cystic lesion and vascular malformation. Case report.

Bullae formation on a cystic background is still not described thoroughly. This clinical case aims to improve this situation and describes the combination of multiple cysts with vascular malformation, giant bullae (2/3 of the left hemithorax and 1/2 of the right hemithorax) with suppuration in a 50-year-old smoker. Before surgery, treatment for chronic obstructive lung disease (COPD) was administered without a positive outcome. Bullectomy was subsequently conducted and histopathological data revealed vascular malformation causing microinfarctions in pulmonary parenchyma, cystic degeneration and tuberculosis. Although it became possible to establish a final diagnosis due to histology, the need for surgical treatment was clear from clinical and x-ray evidence. Such instances as the one presented in this case report should assist with improving our knowledge about bullae in combination with cysts in the lungs because they provide additional context in a clinical setting.

Thoracoplasty-Current View on Indication and Technique.

Thoracoplasty was invented for removing cavities between thoracic wall and remnant lung or mediastinum. It was initially used in cases of tuberculosis or unspecific infections, while currently it is used mainly for space problems after lobectomy/pneumonectomy.This article presents an overview of the historical and current techniques of this surgical procedure.Nowadays, thoracoplasty is rarely performed due to the low incidence of diseases for which this method is necessary. Therefore, this method has even been discredited. Furthermore, certain technical aspects of the thoracoplasty are not very well known because of the infrequent application of this procedure.Unfortunately, a look into the literature of thoracoplasty is not always usefull due to the biased views of advocates of different techniques such as Schede's thoracoplasty, Heller's Jalousie-Plastik, Alexander's extramusculoperiosteal thoracoplasty, Bjork's osteoplastic thoracoplasty, etc.Not to forget, there has always been a lack of research on the relevance and on the several techniques of thoracoplasty.The point is precise indication and correct execution of thoracoplasty as a final therapeutic option, which allows a safe and definitive solution of the space problem even in complex cases, without creating serious functional and cosmetic impairment for the patient.The main types of thoracoplasty are described in this article. Although the core principle of this operation remains unchanged, modern techniques are often cosmetically more considerable and less destructive, compared with techniques that were used in the past.