[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 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%.

[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%.

[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.

[Significance of mycobacterial drug resistance in pulmonary tuberculosis surgery]. / Znachenie lekarstvennoi ustoichivosti mikobakterii v khirurgii tuberkuleza legkikh.

The outcomes of surgical treatment of 546 patients with pulmonary tuberculosis were analyzed in relation to the bacteriological characteristics. Seeding detected sputum bacterial isolation in 52.4% of cases. Mycobacterial drug resistance was detected in 83.6% of the tested cultures. It has been concluded that the resistance is a first-order infectious agent whose action is shown in lowering the efficiency of preoperative courses of chemotherapy by 2.5 times, in increasing the incidence and severity of postoperative pleural and pulmonary complications by 6-7 times, in deteriorating the immediate outcomes of surgical treatment to 82.4% with a 7.4% mortality rate. Intensive bacterial isolation unarrested by surgery is a second-order infectious agent which more clearly shows a relationship of the efficiency of surgical treatment to a reduction in the cure rate to 74.2% with a total mortality of 15.2%. There is evidence for that it is advisable to apply an active surgical policy in a group of patients having an infectious risk factor.

[Surgical risk factors of complex polysegmental resections of lung for tuberculosis at multiple sites]. / Khirurgicheskie faktory riska slozhnykh polisegmentarnykh rezektsii legkikh po povodu tuberkuleza s mnozhestvennoi lokalizatsiei.

The results of 240 complex polysegmental resections of the lung for tuberculosis at multiple sites are analyzed. Surgical risk factors associated with additional surgical elements, such as expansion of an interventional area in the lung outside anatomic resection, traumatic elements of correction of volumetric ratios, and special procedures for isolating the lung from adhesions. Complex polysegmental resections as an anatomic variant without additional elements provide a high direct surgical effectiveness (95-100%) without deaths. The efficiency of complex polysegmental resections as a combined variant using additional elements reduces the effectiveness of treatment to 88% with 4.5-7.4% death rates in relation to the type of an operation. There is a high risk of postoperative complications in optional polysegmental and lobe + segment resections.

[Late results of multistage polysegmental lung resection for tuberculosis at many sites]. / Otdalennye rezul'taty slozhnykh polisegmentarnykh rezektsii legkikh po povodu tuberkuleza s mnozhestvennymi lokalizatsiiami.

The late outcomes of surgical treatment of 124 patients operated on for pulmonary tuberculosis at many sites were analyzed. Surgery was made in the anatomic variant of typical polysegmental resections involving 3 to 7 bronchopulmonary segments in combination with a number of additional elements. The stable cure rates were 77.7, 71.2, and 64.3% at 3-, 5- and 10-year follow-ups, respectively. The maximum relapse rates at 2- and 3-year follow-up were 9.5 and 9.2%, respectively with variations in some subgroups according to the type of resection, the clinical forms of tuberculosis, the bacteriological activity of the process by surgery and the drug resistance of Mycobacteria. The cumulative adjusted survival rates in the same periods were 92.1, 85.1, and 70%, respectively, with the maximum mortality rate (6.8%) at 3-year follow-up, they being ranged under the influence of the above risk factors. No systematic controlled preventive chemotherapy regimens are a cause of relapses and death in the late periods of follow-ups.

[Significance of immunologic testing of patients in surgery of pulmonary tuberculosis]. / Znachenie immunologicheskogo testirovaniia bol'nykh v khirurgii tuberkuleza legkikh.

Immunological testing of surgical patients with specific pulmonary tuberculosis revealed specific immunodeficiency in 68% of cases which appeared at higher risk of postoperative complications. A scheme of a simple immunological testing by 2 reactions is provided.

[The importance of short-term test therapy in the differential diagnosis and surgical treatment procedure in lung diseases]. / Znachenie kratkovremennoi test-terapii v differentsial'noi diagnostike i taktike khirurgicheskogo lecheniia zabolevanii legkikh.

Methods of differential diagnostics of diseases of the lungs based on using short-term antiinflammatory therapy during 2-3 weeks are substantiated. An analysis of results of the methods in question in 225 patients has shown that additional diagnostical information can be obtained in 78% of the patients operated upon and among patients of the differential diagnostic department-in 41% of the patients. These methods must be always used in cases of uncertain results of clinical diagnostics which will prevent diagnostic errors and their negative consequences.

[Results of surgical treatment of postoperative recurrences of pulmonary tuberculosis]. / Rezultaty khirurgicheskogo lecheniia posleoperatsionnykh retsidivov tuberkulëza lëgkikh.

The paper provides the experience in surgically treating 125 patients with recurrent pulmonary tuberculosis after lung resections. The results were analyzed in accordance with the author's classification. Differential surgical policy and preventive and therapeutical measures for postoperative complications are described. The therapeutical results depend on the type of relapses and the presence of pleuropulmonary complications and concurrent abnormalities. They include favourable immediate results in 66.4% of the uncomplicated course of the postoperative period, liquidation of most complications and at the 7.2% hospital mortality in most cases with systemic complications.

[BCG vaccine immunotherapy after radical operations for lung cancer]. / Immunoterapiia vaktsinoi BTsZh posle radikal'nykh operatsii po povodu raka legkikh.

An investigation of immune reactivity to BCG vaccination was performed in 48 patients with lung cancer according to the Mantoux test. It was found that high immune reaction was noted in the group with 5-year survival and course without recurrences, the reaction growing after revaccinations. In patients with 2-year survival the reaction to vaccination was negative or weakly pronounced. A conclusion is made that the immune therapy facilitates improvement of long-term results of surgical treatment of patients with lung cancer.

[Stage-by-stage pneumonectomy in pleural empyema]. / Etapnaia pnevmonéktomiia v usloviiakh émpiemy plevry.

Staged pneumonectomy tactics in complication of the main lung affection by pleural empyema was described. Surgery was based on an open treatment of empyema cavity before and after the principal surgical stage--pneumonectomy, which was completed by closed treatment using the method of early pleural cavity filling with curative solutions. Use of staged surgical treatment tactics makes it possible to prevent serious postoperative complications such as empyema recurrence and bronchial fistulas. Full clinical effect was achieved in 11 of the 56 operations of staged pneumonectomy in the presence of empyema.

[Methods for the control of pulmonary hemorrhage]. / O metodike ostanovki legochnykh krovotechenii.

The paper reviews literature data on the incidence of pulmonary hemorrhage (PH) in various diseases (tuberculosis, chronic nonspecific lesions of the lungs, cancer); presents new evidence on PH pathogenesis, an underlying role of pulmonary hypertension and aneurysmic vascular rearrangement of the affected site. The system to control PH is staged and implies measures to achieve temporary and final arrest of bleeding. These are to promote enhancement of coagulation, inhibition of fibrinolysis, include endobronchial and endovascular hemostasis, radical surgery. A detailed description covers a technique of artificial controlled hypotonia under drug ganglionic blockade.

[Repeated pneumonectomy in recurrence of pulmonary tuberculosis]. / Povtornye rezektsii--pnevmonèktomii pri retsidivakh tuberkuleza legkikh.

The analysis of the outcomes of a surgical treatment of recurrent tuberculosis in the operated lung is presented. With disseminated forms of the pulmonary lesions complicated by empyema, surgical removal of the portion remained after the primary resection is indicated. A complex of measures improving the treatment efficacy, decreasing a surgical risk and providing a favourable outcome in 90% of the operated patients is given. The indications for such repeated operations, such as final pneumonectomy, are substantiated.