[TREATMENT OF NON-SMALL CELL CARCINOMA OF LUNG IN SENILE PATIENTS].

A comparative analysis of surgical treatment of non-small cell carcinoma of lung was made in 64 patients of senile age and more young patients. It was stated, that preference should be given to the partial lung resections (lob- and segmentectomies). The authors recommended to avoid pneumoectomy and typical resection of the lung as non-radical operations accompanied by high rate of local recurrences. The comorbidity background of patients should be thoroughly investigated before planning of surgery. If necessary, a surgical treatment of accompanied vascular pathology should be fulfilled as the first stage before oncology surgery.

[Surgical treatment of multiple isolated intrapulmonary metastases].

An analysis of treatment results was made in 226 patients with multiple isolated intrapulmonary metastases of solid tumors. It appears that surgical removal of metastases was possible in patients with satisfactory functional resources and accurate evaluation in order to validate the indications for surgery. The operation shouldn't result in considerable reduction of quality of life and didn't prevent using other methods of treatment such as medicamental and radiation therapy. The indications to surgical intervention have to be set as individual in consideration of the number of metastases and potential of the patient to undergo the surgery.

[An experimental study of the efficiency of cycloferon in the complex chemotherapy of generalized drug-resistant tuberculosis].

The results of an experimental study of the efficiency of cycloferon included in a complex chemotherapy of generalized drug-resistant mycobacterium tuberculosis (MBT) are presented. It is established that cycloferon (3.6 mg/kg) produces a significant therapeutic effect, which is manifested by an increase in the lung clearance from MBT, a decrease in the spread of specific inflammation in the lungs, and the disappearance of MBT-induced alterations. In addition, activation of the signs of tension in the local immunity of lung tissues is observed as manifested by changes in the cellular composition of granulomas and more frequent detection of large lymphocytic and macrophage infiltration. The administration of cycloferon significantly increases the absorptive and digestive activity of phagocytosis by peritoneal macrophages, which has been inhibited during the development of experimental MBT infection.

[Investigation of remaxol efficacy in complex therapy of experimental generalized tuberculosis on mice].

Efficacy of remaxol in complex chemotherapy of generalized drug resistant tuberculosis was studied on mice. Mycobacterium tuberculosis 5419 SPBNIIF isolated from a patient with freshey diagnosticated pulmonary tuberculosis resistant to isoniazid (10 mcg/ml), rifampicin (40 mcg/ml), streptomycin (10 mcg/ml) and ethionamide (30 mcg/ml) was used in the experiments. The main polychemotherapy included 4 antituberculosis drugs in the highest therapeutic doses: isoniazid, amikacin, ethambutol and tavanic, the treatment course was 8 weeks. Remaxol was administered in a dose of 25 ml/kg intraperitoneally 5 times a week (14 injections). Significant activating effect of remaxol on the tension of the lung tissue local immunity was revealed by changes in the granuloma cell composition (from mainly epitheliod to mainly lymphoid) and by more frequent large lymphohistiocytic infiltrates. The use of remaxol also greatly increased the absorptive and digestive activity of the peritoneal macrophages phagocytosis, inhibited in the process of the experimental tuberculosis development.

[Peculiarities of the circulating phagocytes functional activity in patients with different forms of drug-resistant pulmonary tuberculosis].

Functional activity of circulating phagocytes (macrophages--Ms and neutrophils--Ns) was studied in 30 patients with infiltrative (I) and 30 patients with fibro-cavernous (FC) pulmonary tuberculosis (PT). Difference of the functional activity of both types of cells depending on the PT form was revealed: more significant increase in the oxygen-depending activity in FCPT while bactericide potential estimated with a zymosane induced NST-test was more pronounced in IPT patients. These data correlate with the blood levels of neopterin and elastase, the markers of the M and N activity, respectively. Participation of intracellular ADA in realization of oxygen-depending processes was demonstrated. Results of the multivariant analysis of the whole complex of the studied phagocyte characteristics, reflect their different roles in ther pathological process a prevailing role of Ms in the firstly diagnosed acute tuberculosis process (IPT) and Ns in the chronic progressive process (FCT).

[Adjuvant lymphotrophic chemotherapy in the surgical treatment of progressive pulmonary tuberculosis].

The study was undertaken to enhance the efficiency of surgical treatment for progressive drug-resistant pulmonary tuberculosis, by applying adjuvant lymphotropic chemotherapy (ALCT). Seventy-one patients were examined and operated on; of them 35 patients received ALCT and 36 patients formed a control group. The determinants of the efficiency of the performed treatment were the frequency of specific postoperative complications. ALCT used in combination with the conventional antituberculous treatments made it possible to enhance the efficiency of surgical treatment, by halving the number of postoperative complications, reducing the duration of a postoperative period, and enhancing the intensity of chemotherapy, by taking into account the data on the resistance of a pathogen, without causing adverse reactions, and to improve the psychoemotional status of patients.

[Assessment of a risk for postoperative infectious complications in patients with fibrocarvous pulmonary tuberculosis].

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

[Differential approach to lymphadenectomy in patients with progressive fibrocavernous pulmonary tuberculosis].

The resection specimens from 31 patients with fibrocavernous tuberculosis (FCT) underwent a complex clinical andimmunological study, as well as a morphological one. It was ascertained that partial or extended lymphadenectomy did not always positively correlate with an adequate postoperative immune response and it depended on the morphological features of lymphatic apparatus lesion. The direct results of surgical treatment of patients with FCT suggest that in patients with specific lymphadenitis and cell-mediated immunodeficiency, the frequency of postoperative specific pleuropulmonary complications and their severity considerably exceed those if there is an adequate immune response. In patients with progressive FCT, baseline cell-mediated immunity deficiency is aggravated by surgery, increasing the risk of postoperative specific and nonspecific infectious pleuropulmonary complications.

[The experience of applying of exogenous monoxide of nitrogen and argon plasma coagulation by cavernotomy in patients with fibro-cavernous pulmonary tuberculosis with the presence of multiple drug resistance].

The presented paper discusses the experience with exogenous nitric oxide (NO) and argon plasma coagulation (APC) used at cavernotomy in 31 patients with multidrug-resistant fibrocavernous pulmonary tuberculosis. Supplementary treatments depending in infectious risk factors were comprehensively evaluated. The application of APC and NO significantly improved the results of open cavern sanitation, as evidenced by the bacterial excretion index, and doubled the immediate efficiency of surgical treatment.

[Functional activity of phagocytes of bronchoalveolar lavage in patients with fibro-cavernosis and infiltrative pulmonary tuberculosis].

Functional activity of the bronchoalveolar lavage fluid (BALF) phagocytes was studied in 33 and 16 patients with fibro-cavernosis (FC) and infiltrative (I) pulmonary tuberculosis (PT), respectively. Complex examination of BALF, alveolar macrophages (AM) and neutrophils (N) sedimented from BALF revealed interrelationship between functional activity of the cells and the form of PT. Higher activities in BALF of neopterin and elastase mainly secreted by activated AM and N respectively, reflect a higher secretory activity of both types of cells in FC - PT. These patients are also characterized by more pronounced bactericide activity of Ns, which significantly correlates with adenosine deaminase (ADA) activity. It is suggested that changes in BALF of various biochemical parameters examined (neopterin, elastase, ADA and its isoenzymes, 2-deoxyADA) and bactericide activity of the sedimented cells represent are the consequences of differend sides of BALF phagocytes functioning. According to modem notions about the mechanisms of their regulation different intercellular relations are suggested in different form of PT.

[Thirty-five years' experience of thoracic surgery].

The paper pools the experience gained in the surgical treatment of lung malformations in children and adults, which has been used to develop their current classification. It also presents the outcomes of surgical treatment of acute infectious lung destructions, by taking into account the Marchuk severity index. Modes of surgical treatment of bullous pulmonary emphysema have been provided, which yield minimum postoperative mortality rates (3%). The experience of surgical treatment of 110 patients with cicatrical tracheal stenosis is summarized. The authors also present the results of operations made in 390 patients with Stage III non-small cell carcinoma of the lung, specify indications and procedures for resection of the bifurcation of the trachea when the latter is involved in the tumorous process. They also summarize the experience gained in having performed more than 300 operations in the past 5 years for progressive pulmonary tuberculosis, with 2.7% mortality, and 106 final pneumonectomies for postoperative recurrent pulmonary tuberculosis. The experience with allografting of the trachea (n = 2) and lung (n = 3) is important and little studied in our country.

[Pathological characteristics of drug-resistant fibrocavernous pulmonary tuberculosis].

A histological examination of the pulmonary and bronchopulmonary lymph nodes was made in 47 patients treated surgically for fibrocavernous pulmonary tuberculosis. The speed of immunopathological reactions development is the main reason of differences between drug-resistant and drug-sensitive primary tuberculosis. Formation of cellular immunity in drug-resistant tuberculosis has all necessary morphological prerequisites both in the lungs and lymph nodes but their realization is delayed. Immunogenesis concentrates on the early stages when initial paraspecific reactions prevail. Morphologically, they are most demonstrative in the bronchial walls where in different patients or even in one patient but in various bronchi all reactions of delayed type (contact, tuberculine type and granulematous) can be simultaneously observed.

[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%.

[Morphological features of fibro-cavernous pulmonary tuberculosis according to the surgical material]. / Morfologicheskie osobennosti fibrozno-kavernoznogo tuberkuleza legkikh na operatsionnom materiale.

The lungs and bronchopulmonary lymph nodes were studied in 203 patients aged 20-60 years operated for fibrocavernous tuberculosis. Histological, immunohistochemical and histoenzymological tests demonstrated that clinically diagnosed fibrocavernous tuberculosis comprises a heterogenous group. Specific alterations in the lymph nodes indicate progression of primary tuberculosis while the absence of such alterations is the sign of real fibro-cavernous tuberculosis.

[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%.

[Immunological changes in patients with pulmonary tuberculosis during glutoxim therapy]. / Dinamika immunologicheskikh pokazatelei u bol'nykh tuberkulezom legkikh pri lechenii glutoksimom.

The paper deals with the effect of glutoxim included into a preoperative preparation regimen on immunological parameters in patients with fibrocavernous pulmonary tuberculosis. On admission, all the patients had inadequate cellular immunity and activated humoral immunity. After termination of a course of glutoxim therapy, there was an increase in the baseline low values of lymphocytic proliferative activity, in the count of mature T lymphocytes, and in the production of IL-2 induced by phytohemagglutinin. At the same time the similar parameters remained unchanged in the control group. The drug exerted the most noticeable stimulating effect on cellular immunity in patients with a limited process. Glutoxim produced no noticeable effect on humoral immunity. The immunomodulating effect of glutoxim was followed by improvement of the clinical and X-ray pictures of the disease. In glutoxim-treated patients with baseline immunological disorders, progression was found to occur 1.5-2 times more infrequently than in the control group. Indications for the use of glutoxim in the treatment of tuberculosis are specified on the basis of the baseline immunological parameters of each patient.

[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.

[Molecular genetic characteristics of Mycobacterium tuberculosis isolated from patients operated on for pulmonary tuberculosis]. / Molekuliarno-geneticheskaia kharakteristika shtammov Mycobacterium tuberculosis, vydelennykh ot bol'nykh, operirovannykh po povodu tuberkuleza legkikh.

The RFLP-IS6110 assay was used to genotype 67 Mycobacterium tuberculosis isolated from different specimens (including intraoperative ones) of 24 patients operated on for chronic progressive pulmonary tuberculosis who lived in north-western Russia. More than half (53%) of 17 types of RFLP profiles of isolates are identical and typical of M. tuberculosis of the Beijing family. Comparing the results of isolate genotyping with clinical, microbiological, and pathomorphological findings allows cases of endogenous reactivation to be differentiated from exogenous (nosocomial, in particular) reinfection in recurrence. Beijing genotype strains are shown to cause more severe unarrested course of drug-resistant fibrocavernous tuberculosis. At the same time such strains are more frequently detected in relatively young persons with a shorter duration of the disease, which reflects current clonal Beijing genotype dissemination that present a severe epidemiological hazard.