[Surgical treatment for pulmonary tuberculosis with Mycobacterium resistance to drugs].

The results of surgical treatment were analyzed in 481 patients who had been preoperatively found to have drug resistance. Patients with fibrocavernous, cirrhotic tuberculosis, chronic pleural empyema, and cavernous pneumonia constituted the vast majority (83.2%). Chemotherapy was performed by individual schemes, by taking into account MBT susceptibility. Glutoxim and pentaglobin were used as pathogenetic therapy for immunity correction. Resection-type operations [n = 368 (68.9%)], thorocoplastic interventions [n = 78 (14.6%)], thoracostomy or cavernostomy [n = 35 (6.5%)], pleurectomy [n = 26 (4.9%)], operation on the stump of the main bronchus [n = 15 (2.8%)], and mediastinal lymphadenectomy [n = 12 (2.2%)] were predominant. Postoperative complications occurred in 15.5% of cases; mortality was 1.7%. The mycobacterium resistance to drugs verified by laboratory studies exerted no evident impact on the number and pattern of postoperative complications. The results of treatment depended on the extent and presence of complications of a tuberculous process, comorbidity, suppressed immunity, and the scope of a surgical intervention.

[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.

[Functional studies in the prediction of postoperative complications in the presence of lung diseases]. / Funktsional'nye issledovaniia v prognoze posleoperatsionnykh oslozhnenii pri zabolevaniiakh legkikh.

Data on the functional status of the cardiorespiratory system are required to identify patients at risk for postoperative complication in the presence of lung diseases. Very many factors influence the course of an operation and the postoperative period so there is no golden standard or the only parameter for predicting how the postoperative period runs. Patients with normal spirographic values (FEV1, more than 80%??) and without cardiovascular comorbidity are at a slight risk for postoperative complications. These patients do not need to be additionally examined. A less than one-month history of myocardial infarction, instable angina pectoris, decompensated heart failure, severe valvular disease are contraindications to planned surgery. The risk of cardiovascular events is high when the signs of myocardial ischemia occur with low exercise (less than 4 MET). Stress echocardiography, loading tests, and radioisotopic study are used as auxiliary techniques, FEV1, under 60%; ppo-FEV1, and ppo-DC, under 40%; VO2max, under 15 ml/kg/min are the values of a high risk for respiratory complications.

[Videothoracoscopy in diagnosing and treating exudative pleuritis]. / Videotorakoskopiia v diagnostike i lechenii ékssudativnykh plevritov.

Telethoracoscopy (TT) was performed in 76 patients with exudative pleurisy of unclear etiology. A correct diagnosis was made in all (100%) cases. Tuberculosis was detected in 41 (54%) patients. In this group of patients, the results were analyzed by taking into account the duration of disease, the nature of an operation, and morphological findings. In tuberculous pleurisy, TT may be conducted at any time; however, it is most effective when an acute period subsides and an exudate begins forming. At this time (2-3 months after the onset of the disease), surgery is not diagnostic, but also remedial as sanitation of the pleural cavity with partial pleurectomy.

[Bilateral lung resections]. / Dvustoronnie rezektsii legkikh.

Bilateral operations on the lungs were carried out in 90 patients with hydatid disease, intrapulmonary metastases, carcinoma, and bronchiectasis. Various types of stepwise resections of the lung are the operation of choice. One-stage interventions are allowable in rare cases of circumscribed affection with a hydatid cyst or metastases. Sternotomy is the standard approach in such cases. The total postoperative mortality was 4.4%. Economical operations less than lobectomy in volume are safest and most effective. Neither complications nor fatal outcomes were encountered subsequently. More extensive operations are marked by increased risk of complications, particularly if the volume of the resection exceeds lobectomy on both sides. Such an approach is justified in carcinoma because other methods of treatment leave no hope. Bilateral resections are indicated in purulent diseases mainly in children and young persons with circumscribed atelectatic forms of bronchiectasis.

[Results of the surgical treatment of pleural empyema after lung resection and pneumonectomy]. / Rezul'taty operativnogo lecheniia émpiemy plevry posle rezektsii legkogo i pnevmonéktomii.

Pneumothorax was treated by operation in 189 patients, after pneumonectomy in 111 of them and after various types of lung resection in 78. The treatment was complex in character but surgery was the principal method. The choice of the operation was guided by various factors, but the determinants were the phase of the empyema, the presence of a bronchial fistula, and the volume of the first lung resection. Postoperative complications occurred in 32.8% of cases, lethality was 11.5%. Complications developed most frequently after extensive and traumatic operations for removal of remaining parts of the lung after the type of pleuropneumonectomy. On the whole, operative methods allowed recovery or improvement to be achieved in 76.2% of patients in whom nonoperative methods failed to cure of produce a stable remission.

[Removal of the retained sections of the lung according to the type of pneumonectomy]. / Udalenie ostavshikhsia otdelov legkogo po tipu pnevmonéktomii.

The article analyses the results of 90 operations for removal of remaining parts of a lung after the type of pneumonectomy. Three groups of patients are set apart for whom the operation is indicated: with various postoperative complications (14), recurrent tumors in the resected lung (41), and recurrent chronic suppurative process in the lungs (35). Despite the successes of thoracic surgery, such operations are still difficult technically, traumatic, and associated with a high risk of serious complications (53.3%) and mortality (26.7%). However, the second operation produces satisfactory results if it is undertaken in time and according to indications. Among oncological patients a 3-year survival was 28.8% and a 5-year survival 17.3%. In chronic suppurative processes the results were good and satisfactory in 96.3% of followed-up patients.

[The clinical picture, diagnosis and surgery of cancer of the lung in young subjects]. / Klinika, diagnostika i khirurgiia raka legkogo u molodykh.

The article discusses the experience in the diagnosis and surgical treatment of lung carcinoma in 195 patients under 40 years of age. The specific features of the clinical course of lung carcinoma in the young, the principles of establishing the diagnosis, and the indications for surgery are determined. Various complications occurred in 16.2% of patients. Postoperative mortality was 2.2%. Five-year survival was 48.4% in stage I-II and 18.2% in stage III.

[Reoperations in adenomas of the bronchus]. / Povtornye operatsii pri adenomakh bronkha.

The authors discuss their experience in the treatment of 18 patients who were operated on for a second time due to the development of a recurrent tumor. A true and false recurrence was distinguished. The causes of their development were: diagnostic errors in 6, malignancy of the adenoma in 4, and technical faults during the operation in 8 patients. Various types of repeated interventions were conducted in in all 18 patients, preference was given to reconstructive-plastic operations. There were no fatal outcomes. Fourteen patients have a survival period of 5 months to 17 years, four patients with malignant carcinoid died from metastases.

[Late results of the combined treatment of small-cell lung cancer]. / Otdalennye rezul'taty kombinirovannogo lecheniia melkokletochnogo raka legkogo.

The paper discusses an experience with combined treatment of 104 cases of small-cell lung cancer which included surgery. Small size of tumor matched by absence of regional and distant metastases was the major indication for surgery. All patients received chemoradiation treatment; 82 of them were followed up. Mean survival of operated patients was 35.5 months, and three-, five- and ten-year survival rates--36, 27 and 19%, respectively. Surgery appears to play a role in treatment of small-cell lung cancer, alongside with chemotherapy and radiation.

[Repeat surgery of intrapulmonary metastases]. / Povtornye operatsii pri vnutrilegochnykh metastazakh.

The results of repeat surgery for pulmonary metastases in 17 cases are discussed. The study was based on the data of 38 repeated interventions for metastases following lung resection for cancer, bilateral metastases and recurrent pulmonary metastases. All surgery was carried out as a component of combined treatment including chemotherapy and radiation. It was intended to increase the effect of chemotherapy by cutting down the size of tumor. Surgery was not performed unless lesions were limited in number (solitary metastases) and when there were local recurrences of primary tumor or distant metastases to other organs. The extent of resection should be as limited as possible to preserve lung tissue. It is increased of necessity in cases of repeat removal of metastases from the same lung; lobectomy or pulmonectomy is indicated in such cases. Both short- and long-term results show good tolerance of surgery by patients, low incidence of complications and longer survival when patients are supported by chemo- or chemoradiation treatment.