[Multidrug-resistance: the modern problem of surgical treatment of pulmonary tuberculosis]. / Dauginis atsparumas vaistams - siuolaikine plauciu tuberkuliozes chirurginio gydymo problema.

The problem of multidrug-resistance is urgent because the part of these patients undergoes treatment failure after chemotherapy. In such cases the operations are performed. In 1998-2002 in the Department of Thoracic Surgery of Republic Santariskes Tuberculosis and Lung Disease Hospital 739 thoracic operations were performed for the patients with pulmonary tuberculosis. Because of multidrug-resistant pulmonary tuberculosis 355 patients (48%) were operated on, radical operations were performed to 190 patients (53.5%) and for 165 (46.5%) - palliative. Positive outcome was documented for 324 patients (91.3%); 31 patients (8.7%) died. Various postoperative complications were confirmed in 76 cases (21.4%) when multidrug-resistance was determined. CONCLUSIONS. When multidrug-resistance is developed, clinic or radiological dynamics of tuberculosis process is not positive, after 3-4 months is it necessary to discuss the question of the operation. In case of monolateral process the radical operations with the type of resection are performed, but in case of widespread process and various complications palliative operations are performed. The treatment with antituberculotic drugs when patient is operated on because multidrug-resistance is continued for 22-24 months.

[Surgical approach to lung tuberculosis]. / Plauciu tuberkuliozes chirurginio gydymo principai.

The article describes treatment results of 1228 patients operated on because of different forms of pulmonary tuberculosis. According to spreading of tuberculosis and developed complications in spite of the medicamental treatment the patients were divided in to two clinical groups. The first group included 417 patients with direct indications for surgery. The second group included 811 patients with complications of pulmonary tuberculosis (with spontaneous pneumothorax - 237, spontaneous pyopneumothorax - 170, tuberculous pleural empyema - 271, pulmonary hemorrhage - 105, with pulmonary reoperations - 28). The results of radical and paliative operations were as follows: 1176 (95.8%) patients recovered, and 52 patients (4.2%) died. CONCLUSION. When therapical treatment of pulmonary tuberculosis is ineffective, especially in drug resistant cases, the surgical treatment is indicated.

[Surgical approach in treatment of associated lung pathology - lung cancer at tuberculosis]. / Plauciu patologijos - vezio ir tuberkuliozes darinio chirurginio gydymo ypatybes.

We analyzed 21 cases of coexistent pulmonary tuberculosis and lung cancer in the article. All these patients were operated on: pneumonectomy - 9 (42.8%), lobectomy - 8 (38.1%), and explorative thoracotomy - 4 (19%). The mortality was 9.5%. The development of cancer on the site of previous active tuberculosis and residence metatuberculosis changes was evident. This shows the importance of the control strategy of patients on going tuberculosis. CONCLUSIONS. Post tuberculosis pulmonary dysplasia is influenced not only by active pulmonary tuberculosis; in addition it can be influenced by post tubercular findings and sclerotic changes.

[Surgical treatment of lung carcinoma in tuberculosis patients]. / Plauciu vezio ir tuberkuliozes derinio chirurginio gydymo galimybes.

UNLABELLED: Objective of our study was to analyze the cases of coexistent pulmonary tuberculosis and lung cancer. MATERIAL AND METHODS: During 1990-2002, 2218 patients with lung cancer were operated in Republic Santariskiu Tuberculosis and Lung Diseases Hospital and the Department of Thoracic Surgery and Oncology at the Institute of Oncology of Vilnius University. RESULTS: Forty-six (2.1%) patients were diagnosed lung cancer and tuberculosis-associated pathology. By stages patients were divided into: I(st)stage - 12 patients (26.1%), II(nd)stage - 11 patients (23%), IIIA stage - 23 patients (50%). In 37 cases (80.4%) central tumor type was found, and in 9 cases (19.6%) - peripheric type. According to morphology, in 24 (52.2%) patients squamous cell was found, in 10 (21.2%) patients - adenocarcinoma and in 12 (26.1%) patients - mixed adenosquamous tumors. All these 46 patients were operated on: pneumectomy was performed for 18 (39.2%) patients, lobectomy - for 10 (21.7%) patients, bilobectomy - for 10 (21.7%) patients, and segmentectomy - for 8 (17.4%) patients. Six (21.4%) patients deceased. The development of cancer on site of previous active tuberculosis and residence metatuberculosis changes was evident. This shows the importance of the control strategy of patients with tuberculosis. CONCLUSIONS: Coexistence of lung cancer and tuberculosis is very rare. Out of 2218 patients, operated on due to lung cancer, this pathology was diagnosed to 46 (2.1%). Squamous cell cancer was found in 52% and stage IIIA was observed in 50% of cases. Postoperative complications occurred in 28 (80%) patients, and 6 (28%) patients died. Crucial treatment method of lung cancer in tuberculosis patients is surgery. Average survival of these patients was 28+/-2 months.

[The surgical treatment of lung tuberculosis]. / Plauciu tuberkuliozes chirurginis gydymas.

UNLABELLED: The article informs about the treatment results of 1036 patients operated on because of different forms of pulmonary tuberculosis. According to spreading of tuberculosis and developed complications in spite of the medicamentical treatment the patients were divided into two clinical groups. The first group included 387 patients with direct and relative indications for surgery. The second group included 649 patients with complications of pulmonary tuberculosis, and 167 new diagnosed cases were documented among them (with spontaneous pneumothorax - 180, spontaneous pyopneumothorax - 117, tuberculous pleural empyema - 225, pulmonary hemorrhage - 101, with pulmonary reoperations - 26). The results of radical and paliative operations were as follows: 991 (95.6%) patients recovered, 45 patients (4.4%) died. CONCLUSION: When the therapeutical treatment of pulmonary tuberculosis is ineffective, especially in drug-resistant cases, the surgical treatment is indicated.