[Surgical treatment of patients with chest malignancies in anti-tuberculosis hospital]. / Khirurgicheskoe lechenie bol'nykh zlokachestvennymi novoobrazovaniyami organov grudnoi kletki v protivotuberkuleznom statsionare.

OBJECTIVE: To evaluate the effectiveness of surgical treatment of patients with malignancies of lungs, pleura and chest wall in early and long-term follow-up period in anti-tuberculosis hospital. MATERIAL AND METHODS: There were 2139 patients between 2016 and 2020. Chest tumors were diagnosed in 290 (13.6%) patients and 210 (94.2%) ones underwent surgery. RESULTS: Surgical interventions are rare in patients with lung cancer and active tuberculosis (0.7%, n=15). Lobectomies prevailed (73.3%). All sublobar resections were performed in elderly patients with severe comorbidities and low functional reserves. Postoperative complications occurred in 9% of cases. Overall 3-year survival rate was 84.8%, overall 5-year survival rate - 70.8%. Overall survival of patients with lung cancer and tuberculosis does not depend on activity of specific process. CONCLUSION: The TRA test used in differential diagnostics of tuberculosis and lung cancer has a mediating value. Lung cancer surgery in patients with active tuberculosis has no negative effect on effectiveness of tuberculosis treatment. Surgical treatment of malignancies in anti-tuberculosis hospital can be performed in accordance with standards of specialized medical care in oncology.

[Long-term clinical and functional outcomes of high myopia correction by femtosecond laser-assisted implantation of an intrastromal ring]. / Otdalennye kliniko-funktsional'nye rezul'taty korrektsii miopii vysokoi stepeni metodom intrastromal'noi implantatsii kol'tsa s femtolazernym soprovozhdeniem.

OBJECTIVE: To analyze remote clinical and functional outcomes of correcting high myopia in patients with thin cornea by the method of femtosecond laser-assisted implantation of intracorneal implant MyoRing. MATERIAL AND METHODS: The study included 22 patients (22 eyes; the mean age of study patients was 30.2±5.37 years). Mean spherical equivalent (SE) of refraction was -11.52±1.96 D, cylindrical component (cyl) of refraction was -2.04±1.64 D, minimal pachymetry index in the center was 491.6±20 µm, corneal hysteresis (CH) amounted to 8.6±1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.6±0.23 mm. All patients had a history of mild amblyopia. The follow-up period lasted 2 years. RESULTS: Two years after the surgery uncorrected visual acuity was 0.6±1.22, corrected visual acuity 0.7±0.20. Mean spherical equivalent (SE) of refraction was 0.61±1.43 D, cylindrical component of refraction was -0.13±0.5 D. Predictability of SE within ±0.5 D was recorded in 84% of cases, ±1.0 - also in 84% of cases. Index of safety was 1.16, index of efficacy - 1.0. CH was 9.5±0.03 mm Hg. Mean pachymetry at the center did not change statistically significantly after the surgery in comparison to the initial data (p=1.00). CONCLUSION: MyoRing implantation is an effective and safe method, which ensures correction of the spherical component of refraction, as well as correction of astigmatism, improvement of biomechanical properties of the cornea, and an increase in corneal hysteresis (p=0.01).

[The treatment of tuberculosis under current conditions].

AIM: Study of the current state of problems of treatment of patients with tuberculosis based on literature data and their own experience. MATERIALS AND METHODS: In the Russian Federation, the number and proportion of patients with co-infection with HIV/tuberculosis continues to increase against the background of improvement in the main epidemiological indicants for tuberculosis. In 2017, 20.9% of newly diagnosed tuberculosis patients had HIV infection. The combination of the two infections significantly complicates the further improvement of the situation with tuberculosis, and the appearance of drug-resistant strains of Mycobacterium tuberculosis sometimes completely neutralizes the results of chemotherapy. The article describes the schemes of modern tuberculosis chemotherapy taking into account HIV/tuberculosis co-infection, as well as MDR in combination with surgical treatment methods, as well as analyzes the data of epidemiological monitoring of treatment of 1115 tuberculosis patients newly diagnosed in 2017 in Moscow, 360 tuberculosis patients with MDR MBT (cohort 20132014), the results of treatment with the use of new chemotherapy regimens for tuberculosis (bedaquiline, linezolid, moxifloxacin) in 36 patients, the effectiveness and safety of surgical methods in 192 patients. RESULTS: The application of new individualized anti-TB chemotherapy schedules in patients with HIV co-infection/tuberculosis with MDR-MBT has allowed to improve the treatment efficacy. The surgical intervention combined with modern chemotherapy regimens in patients with HIV/tuberculosis co-infection with MDR MBT has been proved to be effective and safe, contributes to the improving the results of treatment for this category of patients. CONCLUSION: The confluence of two global problems of co-infection HIV/TB and MDR TB, significantly prevents from the end of the tuberculosis epidemic in the world. At the same time, advances in the development and implementation of new anti-TB drugs and surgical treatment methods give hope for significant progress for resolving this situation.

[Tuberculous peritonitis. 'Forgotten' disease]. / Tuberkuleznyi peritonit. 'Zabytaia' bolezn'.

AIM: To analyze diagnosis and treatment of patients with tuberculous peritonitis, to develop the algorithms for instrumental examination and differential diagnosis. MATERIAL AND METHODS: There were 48 patients with tuberculous peritonitis. The examination included radiography, abdominal and thoracic computed tomography, ultrasound, and laparoscopy. All patients underwent histological, cytological, microbiological and molecular-genetic analysis of abdominal exudate and peritoneal biopsy. Exclusion criterion was signs of secondary peritonitis. RESULTS: Clinical picture of tuberculous peritonitis was accompanied by nonspecific symptoms. Previously identified pulmonary tuberculosis and HIV-infection were present in 93.8 and 70.8% of patients. Diagnostic laparoscopy of abdominal cavity as the main method of instrumental diagnosis together with cytological, molecular-genetic and microbiological research of peritoneal exudate and tissue specimens were useful to determine diagnosis in 87.2-95.8% of cases. CONCLUSION: Tuberculous peritonitis may be assumed in patients with previous tuberculosis of lungs or other localizations, HIV-infection. Computed tomography is the most informative method to diagnose tuberculous peritonitis. Diagnostic laparoscopy is indicated for suspected tuberculous peritonitis. This procedure is supplemented by peritoneal biopsy, cytological, molecular-genetic and microbiological examination of peritoneal exudate and tissue specimens.

[Strength properties of rabbit cornea after femtosecond laser keratoplasty with and without different intracorneal implants]. / Prochnostnye kharakteristiki rogovitsy krolika pri femtolazernoi keratoplastike s ispol'zovaniem razlichnykh intrarogovichnykh implantatov.

AIM: to conduct a comparative experimental study of the effect of the use of intracorneal implants during femtosecond laser-assisted intrastromal pocket (IP) and intrastromal tunnel (IT) formation on the strength properties of the cornea. MATERIAL AND METHODS: The experimental study was performed on 24 corneas of 12 rabbit eyes enucleated 1 month after slaughtering. All eyes were divided into 6 groups according to the method of operation. IP and IT were created with IntraLase FS 60 kHz femtolaser. Group 1 (control group) consisted of rabbit eyes with intact corneas. In group 2 corneas, intrastromal tunnels were formed, in group 3 - intrastromal pockets, and in group 4 - intrastromal tunnels with 2 intracorneal segments (ICS). In groups 5 and 6, intrastromal pockets, each supplemented with an intrastromal ring, were created at the depth of 62-72% and 80% of pachymetry readings from the 5.0-mm optical zone, respectively. RESULTS: Higher voltage had to be applied to stretch the samples from group 2 as compared to those from groups 3 and 6. Distribution of the Young's modulus of the test corneas agreed with voltage distribution in the study groups. CONCLUSION: IP was associated with greater reduction in corneal biomechanical stability as compared with IT. Ring implantation into an IP yielded a more pronounced increase in the strength properties of the cornea than ICS implantation into an IT. The result was also more favorable at greater depths of intrastromal ring implantation.

[Comparative analysis of corneal aberrations after intrastromal segments and MyoRing implantation using femtosecond laser in patients with keratoconus]. / Sravnitel'nyi analiz rogovichnykh aberratsii posle femtolazernoi implantatsii intrastromal'nykh segmentov i kolets pri keratokonuse.

AIM: to comparatively analyze corneal aberrations after intrastromal corneal segments (ICS) and MyoRing implantation using femtosecond laser in patients with stage II-III keratoconus (KC) by Pentacam examination. MATERIAL AND METHODS: We have operated on 135 patients (145 eyes) with stage II or III KC. Depending on surgical technique, all patients were divided into two groups. Group I consisted of patients with KC, who received optimized femtosecond laser-assisted MyoRing implantation, group II - of those, who received femtosecond laser-assisted ICS implantation. Depending on the stage of the disease, each group was further divided into two subgroups, for stage II and stage III KC, respectively. Before and after surgery, all patients underwent visometry, biomicroscopy, corneal topography, and corneal aberrations measurement under photopic and mesopic conditions on Pentacam. The follow-up period averaged 30 months (from 6 to 34 months). RESULTS: In both groups corneal aberrations significantly decreased after surgery, which was confirmed by an improvement in parameters of refraction and keratometry readings. CONCLUSION: Implantation of intrastromal MyoRings leads to a greater reduction in the total corneal aberration, higher-order aberrations under photopic and mesopic conditions, and spherical aberration under photopic conditions as compared to ICS in patients with stage III KC; a comparable reduction in the total corneal, higher-order, and spherical aberrations under photopic conditions as compared to ICS in patients with stage II KC; a comparable increase in spherical aberration under mesopic conditions as compared to ICS in patients with stage III KC.

[Comparative evaluation of different corneal cross-linking techniques with respect to biomechanical stability of the cornea].

AIM: To perform a comparative analysis of the following cross-linking techniques: standard cross-linking (SCXL), local transepithelial femto cross-linking (LTF) and transepithelial intrastromal femto cross-linking with MyoRing implantation (TIF+MyoRing) in experimental animals and patients with progressive stage II--III keratoconus (KC), paying particular attention to the changes in biomechanical stability of the cornea. MATERIAL AND METHODS: The experimental series was performed on 20 eyes of 10 rabbits. The animals were divided into 4 groups of 5. Group 1 served as the control, group 2 consisted of animals that underwent SCXL, group 3 -- of those after LTF, and group 4 -- of those after TIF+MyoRing. Femto step was performed using the IntraLase FS 60 kHz femtosecond laser, cross-linking - with the Evolution machine. The follow-up period was 1 month. Clinical study enrolled 48 patients (45 eyes) with stage II-III KC. Depending on the surgical technique all the patients were divided into 3 groups. In group I (14 eyes, 9 patients), TIF+MyoRing was performed, in group II (16 eyes, 20 patients) --SCXL, in group III (15 eyes, 19 patients) -- LTF. The follow-up period was 6 months. RESULTS: The experiment showed a significant increase in rupture resistance of the cornea in all three groups. Six months after surgery, patients from group I demonstrated a 1.0±0.22 mmHg higher corneal resistance factor (CRF) and a 1.0±0.12 mmHg higher corneal hysteresis (CH). In group II, the said parameters increased by 0.8±0.10 mmHg and 0.6±0.16 mmHg, respectively; in group III -- by 0.8±0.25 mmHg and 0.6±0.26 mmHg, respectively. In neither group the density of endothelial cells has reduced significantly over the follow-up period. C-ONCLUSION: All three methods (LTF, TIF and SCXL) equally increase the biomechanical strength of the cornea and are safe. In patients with progressive stage II-III KC, TIF+MyoRing surgery has yielded an even higher improvement of biomechanical parameters in a 6-month follow-up period, which is due to the combination of mechanical and chemical mechanisms of corneal reinforcement.

[Corneal intrastromal Myoring implantation in keratoconus].

The review discusses literature data on the treatment of keratoconus with intrastromal Myoring implantation into a corneal pocket, formed with a Pocket Maker microkeratome and a femtosecond laser alone and in combination with cross-linking of corneal collagen. The method shows high effectiveness as to refractive and functional outcomes and stabilization of keratoconus over the whole follow-up period (more than 3 years).

[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.

[Thiopoeitins in the treatment of tuberculosis].

Drug resistance in Mycobacterium tuberculosis, adverse reactions, caused by antituberculous drugs, as well as suppressed cellular immunity are responsible for lower efficiency of treatment. To improve the results of treatment in patients with tuberculosis in the intensive phase, the authors used glutoxim, a representative of thiopoeitins. Glutoxim treatment was performed in 73 patients with pulmonary tuberculosis (a study group). A control group comprised 45 patients. The course of therapy with glutoxim, 60 mg/day, was 52 days. The study group was characterized by a rapider cessation of intoxication symptoms, the higher rates of bacterial isolation cessation, and decay cavity-closure. At the end of an intensive treatment, there was abacillarity in 64 (86.7%) patients from the study group and in 32 (71.1%) control patients; decay cavity closure was observed in 60 (88.3%) and 29 (70.8%) patients, respectively (p < 0.05).

[Glutoxim in the surgical treatment of patients with pulmonary tuberculosis].

Surgery results in the development of secondary immunodeficiency associated with inhibition of the phagocytic bactericidal systems, leading to postoperative complications. Glutoxim, a representative of thiopoietins, was used to reduce the number of postoperative complications. Twenty-nine patients with pulmonary tuberculosis received glutoxim therapy (a study group). A control group comprised 25 patients. A course of glutoxim therapy was 35 days; the daily dose was 60 mg. Postoperative complications (tuberculous pleural empyema with bronchopleural fistula, progressive tuberculosis, nonspecific pneumonias) developed in 2 (6.9%) study group patients and in 8 (32%) control ones (p < 0.05). The inclusion ofglutoxim into complex preoperative preparation and its postoperative use cause a significant reduction in postoperative complications.

[Glutoxim in the complex treatment of tuberculosis]. / Glutoksim v kompleksnoi terapii tuberkuleza.

Results of Glutoxim investigation are presented. Glutoxim is the the drug of the new class--thiopoietins. It is considered to be immunorehabilitator as it modulates intracellular process of thiols metabolism, initiates cytokins system, activates phagocytosis etc. Results of the glutoxim administration at the 42 patients with tuberculosis using traditional treatment regimes are presented. Results of the randomized study at the patients with severe disseminated drug-sensitive and drug-resistant pulmonary tuberculosis demonstrated high efficacy of the glutoxim and its good tolerability. Glutoxim administration allowed to shorten the period of tuberculosis intoxication signs disappearance, to shorten the period of sputum negativation and shortened the period of pulmonary inflammation reverse process. Glutoxim application was specially favorable at the patients with severe tuberculosis complicated by viral or medicamental hepatitis.