Probe-based confocal laser endomicroscopy in diagnosis of desquamative interstitial pneumonia in nonsmoker.

Desquamative interstitial pneumonia is a rare disease that is predominantly associated with smoking. Surgical biopsy is usually recommended for the diagnosis of this disorder. Probe-based confocal laser endomicroscopy (pCLE) is a new method of minimally invasive in vivo microscopic image of airways and alveoli. We use this method for desquamative interstitial pneumonia in nonsmoker. The pCLE image shows thickened intra-alveolar septae and clusters of autofluorescent cells within the alveoli, which is unusual for non-smoking patients. We think this pattern can be used for differential diagnosis of desquamative interstitial pneumonia in nonsmokers.

Surgical Resection in the Treatment of Pulmonary Tuberculosis.

Surgery for tuberculosis is becoming more relevant today. This article discusses the main indications, contraindications, features of operations, and perioperative period. This information is useful for practicing surgeons and specialists in the treatment of pulmonary tuberculosis.

Bilateral cavitary multidrug- or extensively drug-resistant tuberculosis: role of surgery.

OBJECTIVES: Cavitary disease and bilateral lesions are among the risk factors for poor outcome of pulmonary tuberculosis (TB). Our aim was to explore the value and limits of surgery in patients with advanced TB. METHODS: A retrospective study of 57 consecutive patients who underwent thoracic surgery for culture-positive bilateral cavitary pulmonary TB was performed. Forty-four (77.2%) patients were men and 13 (22.8%) patients were women; their ages were in the range of 18-61 years. Twenty-two (38.6%) patients had multidrug-resistant (MDR) TB and 35 (61.4%) patients had extensively drug-resistant (XDR) TB confirmed with cultures. On admission, 49 (86.0%) patients had sputum smear microscopy positive for acid-fast bacilli. The main indication for surgery was treatment failure manifested as contagious persisting cavities despite best available therapy. The surgical procedures included combinations of pulmonary resections of different levels, selective thoracoplasties and/or endobronchial valve treatment. The operations were performed consecutively, starting with the most affected side. TB therapy preceded the operation for a minimum of 6 months and was continued after the operation on the basis of the patient's susceptibility to drugs for Mycobacterium tuberculosis. RESULTS: We performed 121 operations: 42 in 22 patients with MDR TB (1.9 operations per patient) and 79 procedures in 35 patients with XDR TB (2.3 operations per patient). No deaths occurred in the 1st year. Two late deaths followed, 1 unrelated to and 1 due to TB progression. Ten major complications (1 complication per patient) developed: main bronchus stump fistula (n = 4), prolonged air leak (n = 3), respiratory failure (n = 2) and wound seroma (n = 1). At the 1-month follow-up visit, sputum smear conversion was observed in 11 (68.8%) patients with MDR and in 15 (45.5%) patients with XDR TB. At the late (20-36 months) follow-up visit, culture negativity was achieved in 21 (95.5%) patients with MDR TB and in 23 (65.7%) patients with XDR TB (P = 0.015). CONCLUSIONS: Thoracic surgery may significantly improve patients' outcomes and even result in a cure in a good portion of patients with bilateral cavitary MDR and XDR TB and should be considered as the essential element of multimodality treatment for MDR and XDR TB, even in patients with bilateral cavitary disease and borderline respiratory reserves.