Modern Collapse Therapy for Pulmonary Tuberculosis.

Multidrug-resistant tuberculosis (TB), extensively drug-resistant TB, and TB-human immunodeficiency virus (HIV) coinfection require a special approach in anti-TB treatment. Most patients cannot be successfully cured by conventional chemotherapy alone. They need a modern approach using minimally invasive therapeutic and surgical techniques. The novel approaches of collapse therapy techniques and minimally invasive osteoplastic thoracoplasty increase the effectiveness of complex anti-TB therapy. Achieving the required selective collapse of lung tissue in destructive pulmonary TB, especially in cases of drug resistance and/or HIV coinfection, leads to bacteriologic conversion, cavity closure, and successful cure.

Lobar Collapse Therapy Using Endobronchial Valves as a New Complementary Approach to Treat Cavities in Multidrug-Resistant Tuberculosis and Difficult-to-Treat Tuberculosis: A Case Series.

BACKGROUND: The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches. OBJECTIVES: We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment. This report describes the feasibility, effectiveness and safety of the procedure. METHODS: Patients with severe lung destruction, one or more cavities or those who were ineligible for surgical resection and showed an unsatisfactory response to standard drug treatments were enrolled. During bronchoscopy, endobronchial valves were implanted in the lobar or segmental bronchi in order to induce atelectasis and reduce the cavity size. RESULTS: Four TB patients and 1 patient with atypical mycobacteriosis were treated. The mean patient age was 52.6 years. Complete cavity collapses were observed on CT scans in 4 of the 5 cases. All patients showed improvements in their clinical status, and sputum smears became negative within 3-5 months. There were no severe short- or long-term complications. The valves were removed in 3 of the 5 patients after 8 months on average; there was no relapse after 15 months of follow-up. CONCLUSION: These data suggest that endobronchial valves are likely to be useful adjuncts to the treatment of therapeutically difficult patients. More data are required to confirm our findings.

Oleotórax bilateral / Bilateral Oleothorax

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Plombage thoracoplasty with balls performed for tuberculosis--still working after 46 years.

Plombage thoracoplasty using different synthetic materials was a popular procedure in the management of tuberculosis (TB) in the 1940-50's, being then abandoned. We report an 81-year-old patient who underwent a plombage thoracoplasty with balls at the age of 35; at the moment of examination in our unit, the patient had no chest complaints and no complications related to the surgical procedure was noted. CT scan showed the presence of the plombage material (balls) surrounded by fibrosis and calcifications but without other significant lesions. In our knowledge, this is the first modern detailed imaging description of a plombage thoracoplasty with uncomplicated outcome 46 years after surgery.

[Treatment of the newly diagnosed destructive lung tuberculosis with elimination of bacilli].

The study aimed to increase the efficacy of the newly diagnosed destructive lung tuberculosis with elimination of bacilli, using the collapsotherapeutic and surgical methods combined with intensive chemotherapy. 334 patients were diagnosed with lung tuberculosis in 2009 in Pensa region. Different methods of collapsotherapeutic and/or surgery were used in 255 (76.4%) patients. The comparative analysis of treatment results with patients, diagnosed with tuberculosis in 2006 and 2007 years, before the introduction of the new treatment modality, showed almost two-fold increase of the efficacy and 3-fold decrease of mortality rate.

Late extrusion of pulmonary plombage outside the thoracic cavity.

Plombage, a variant of collapse therapy for patients with pulmonary tuberculosis that uses a variety of foreign materials, was undertaken until the 1950s before the invention of effective antimicrobial therapy. Complications related to previous plombage procedures are not uncommon. Management of these complications can be challenging. We report a patient presenting with extrusion of plombage 59 years later and managed successfully with removal of the plomb and pectoral muscle flap transposition.

New modality of collapse therapy for pulmonary tuberculosis sequels: tissue expander.

Classical collapse therapy with extrapleural Lucite balls placement used for tuberculosis sequelae is associated with long term complications, such as migration of the foreign body. We report a new modality of collapse therapy for tuberculosis cavitation which may avoid this complication and which uses percutaneous tissue expanders. Postoperative course was uneventful and mid term follow-up confirmed the functional improvement without recurrence of the infection. This new modality of post-tuberculosis collapse therapy may allow treatment with fewer physical and physiologic sequelae of the residual cavities, and should reduce long term complications such as migration.

La colapsoterapia como tratamiento de la tuberculosis pulmorar / Collapse therapy of pulmonary tuberculosis

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[Application of pneumoperitoneum in collapse surgical procedures during tuberculosis outbreak]. / Zastosuvannia pneumoperytoneumu pry kolapsokhirurhichnykh vtruchanniakh v umovakh epidemiï tubercul'ozu.

Under conditions of tuberculosis epidemic resective methods come to be used more and more seldom, the causes of which fact being resistance of Koch's bacilli to antibacterial drugs, extension and duration of the process. Collapsosurgical interventions constitute an alternative to resecting methods but such operations are accompanied by complications in 11 to 22 percent of cases. The author suggests that pneumoperitoneum be used to prevent complications developing in thoracoplasty, substantiating his suggestion, validating it by submitting the relevant statistical material.

Fatty infiltration of osseous structures: a long-term complication of oleothorax--case report.

Thoracic imaging of a patient treated for pulmonary tuberculosis with oleothorax therapy before the antibiotic era demonstrated a rare complication. Gross invasion by lipid with subsequent pathologic fracture of the adjacent thoracic vertebra may give rise to symptomatic spinal cord compression. Magnetic resonance imaging is a useful modality for help in diagnosing treatment complications of oleothorax.

[A complication of oleothorax--after 38 years]. / Komplikation til oleothorax--38 år efter.

We present a case-history of a 50 year-old woman who 38 years earlier had been operated for pulmonary tuberculosis by plugging of the pleural cavity with oil (oleothorax). She developed a tumour under the scapula, which it turned out was due to migration of the oil plug to the subscapular area, an unusual complication to oleothorax. Other complications are described.

[Therapeutic choices in spontaneous pneumothorax]. / Lechebnaia taktika pri spontannom pnevmotorakse.

Questions of conservative and operative treatment are considered on the basis of studying 259 patients with spontaneous pneumothorax. In most of the patients the lung was spreaded by a single or permanent active aspiration of air from the pleural cavity. However, due to great amount of recurrences after the conservative treatment it should be more often followed by operative methods of treatment. Indications to operation are: failure of conservative spread of the lung, repeated collapse, recurrent pneumothoraxes and detection of subpleural bullas during thoracoscopy.