[Comparison of radionuclide studies with pleural morphological changes in patients with tuberculosis pleurisy].

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

[Efficiency of partial pneumonectomies in patients with multidrug-resistant tuberculosis].

The immediate results of partial resections were analyzed in 120 patients with drug-resistant pulmonary tuberculosis, among whom 70 patients had multidrug resistance. A complete clinical effect (abacillation and no decay cavities) was achieved in 117 (97.5%) patients, including in 67 (95.7%) patients with multidrug resistance who showed improvement in 3 (2.5%) cases, fatal outcomes being absent.

[Therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis].

Therapeutic plasmapheresis was performed in 159 patients with pulmonary tuberculosis treated in the clinic in 2000 to 2005. Four hundred and seventy-seven manipulations were made. Among its clinical forms, there was prevalent fibrocavernous tuberculosis (in 136 patients); 9 had infiltrative tuberculosis; caseous pneumonia was present in 5 patients; 4 had tuberculoma; 3 and 2 patients had focal and disseminated tuberculosis, respectively. Out of the 159 patients, 42 (26.4%) underwent therapeutic plasmapheresis at the stages of surgical treatment. Plasmapheresis was made in 61.9% (26/42) before surgery and in 38.1% (n = 16). The study defined indications for and contraindications to therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis, including adolescents and patients at the stages of surgical treatment. A procedure has been developed for discrete and membranous plasmapheresis for this category of patients. In patients with destructive patients, therapeutic plasmapheresis was shown: 1) to level the symptoms of antituberculous chemotherapy intolerance; 2) to correct homeostatic disorders; 3) to enhance the efficiency of basic drug therapy and to promote timely preparation of patients for surgery; 4) to improve the quality of life.

[Effectiveness of the surgical treatment of patients with pulmonary tuberculosis and multidrug resistance of its causative agent]. / Effektivnost' khirurgicheskogo lecheniia bol'nykh tuberkulezom legkikh pri polirezistentnosti vozbuditelia.

In 1996-1998, the Central Institute of Tuberculosis, Russian Academy of Medical Sciences performed more than 600 operations. Of them 90 (15%) patients isolated mycobacteria. The drug resistance of M. tuberculosis was found in 69 (76.7%) patients. In 60.9% of cases, the resistance of M. tuberculosis to isoniazid and rifampicin was concurrently accompanied by that to one (21.4%), two (61.0%), and even 3 (14.8%) tuberculostatics. Removal of the lung or its remnants in the extrapleural layer was most common (67.7%); thoracic cavernomyoplastic operations were made in 17.4% of cases, and partial resections accounted for only 13%. Postoperative complications were more frequently encountered in patients with drug-resistant tuberculosis than in controls (6.7%). Among them, tuberculosis progression and empyema were prevalent (13%). The clinical efficiency and duration of surgical treatment were directly related to the rates of progression and to the magnitude of drug-resistance of Mycobacteria.

[Immunogenetic factors in pulmonary tuberculosis surgery]. / Immunogeneticheskie faktory vo ftiziokhirurgii.

Distribution of HLA antigens, haptoglobin phenotypes (Hp), ABO blood groups and rhesus factor was investigated in 60 patients with fibrocavernous tuberculosis and 50 patients with tuberculomas. All the patients were Russian and had a history of surgery for tuberculosis. Carriers of antigens B27, DR2 of HLA system, HP 2-2 and blood group 0 (I) were encountered more often in the group of tuberculosis patients. Antigens A1, B12, DR3 and A2 occurred among tuberculoma patients more frequently and less frequently, respectively. Among those who developed postoperative complications carriers of blood group A (II) were found significantly less frequently. Antigens HLA and Hp types were unrelated to the incidence of pleuropulmonary and infectious postoperative complications. Tuberculosis reactivation in the postoperative period and postoperative recurrences occurred more often in carriers of HLA antigen DR2.

[Surgical treatment of cavernous pulmonary tuberculosis]. / Khirurgicheskoe lechenie kavernoznogo tuberkuleza legkikh.

Analysis is given of the results of a surgical treatment of 75 patients with cavernous pulmonary tuberculosis that was characterized by the prevalence of pathomorphological features (79%) of the process development. It is shown that signs of chemotherapy inefficiency can be established as early as 4-6 months after the treatment of destructive tuberculosis was begun. The distinguishing features of surgical interventions during this period comprise a small volume of resection, minimal intraoperative blood loss and little time spent on the operation. These interventions have high effectiveness (98.7%) in the absence of fatal outcomes and can be recommended for wide use in the practice of antituberculosis therapeutic institutions.

[Thoracomyoplastic operations in the surgery of tuberculosis of the lungs]. / Torakomioplasticheskie operatsii v khirurgii tuberkuleza legkikh.

Different variants of thoracomyoplasty were performed on 532 patients with fibrous-cavernous tuberculosis and tuberculous empyema of the pleura. Treatment outcomes have shown that the range of applications of thoracomyoplastic procedures is wide enough: (1) as an independent procedure; (2) as prevention of postresection complications; and (3) as one-stage method to eliminate caverns and empyemas in the presence of bronchial, esophageal, thoracic fistulas and defects of the chest wall. Improvement of the operative technique, application of new technical means enable one to increase the efficacy of surgical treatment of patients with common and complicated tuberculosis of the respiratory organs and chronic non-specific diseases of the lungs.

[Pulmonectomy in tuberculosis surgery]. / Pul'monéktomiia vo ftiziokhirurgii.

The results of surgical treatment of 550 patients who were subjected to pulmonectomy for tuberculosis (74.7%) and other respiratory diseases (25.3%) were analysed. Pulmonectomy was either used as an emergency procedure or performed after a short-term intensive preparation depending on the severity of the clinical picture and life-threatening syndrome. New surgical tactics consisting of stage-by-stage and combined surgical interventions has been developed and is used in clinical practice. Pulmonectomy which is performed at the stage of the clinical stabilization of the process is the most effective. Despite high surgical risk, pulmonectomy in progressive and complicated tuberculosis provides clinical effectiveness in 76.9-83.7% of patients.

[Effects of low-frequency ultrasound on Mycobacterium tuberculosis]. / Vliianie nizkochastotnogo ul'trazvuka na mikobakterii tuberkuleza.

The effect of low frequency ultrasound on various strains of tubercle bacilli was studied in 105 experiments. The analysis of the experimental results showed that under the conditions corresponding to those of dissection, sawing and sanation during the surgical operations the ultrasound had a bactericidal action on tubercle bacilli, both sensitive and resistant to antituberculous drugs. In 75 per cent of the objects there was an ultrasound-induced change in the drug resistance of tubercle bacilli in the direction of its lowering. Low frequency ultrasound had not stimulant effect on the growth and multiplication of tubercle bacilli.