[The efficiency of complex treatment of tuberculous spontaneous pneumothorax and its complications].

The incidence of spontaneous pneumothorax and pleural empyema and the outcomes of their medical and surgical treatments in 1982 to 2003 were studied in 541 patients with destructive pulmonary tuberculosis. In the past decade, the incidence of spontaneous pneumothorax and pleural pneumonia has increased from 2.6 to 12.1% due to the aggravated epidemic situation and the worse structure of pulmonary tuberculosis. The clinical severity of the disease and the extent of a pulmonary-and-pleural process did not allow radical reparative operations to be performed in 11.3%. Complex medical and surgical treatment for pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema could yield good and fair results in 71.5% of patients with severe pulmonary-and-pleural comorbidity despite high hospital mortality (17.2%).

[Pulmonectomy in disseminated destructive tuberculosis complicated by spontaneous pneumothorax and pleural empyema]. / Pul'monéktomiia pri rasprostranennom destruktivnom tuberkuleze, oslozhennnom spontannym pnevmotoraksov i émpiemoi plevry.

The results of pulmonectomy performed in 75 patients with disseminated destructive pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema were analyzed. The long course of the disease, the extent and progression of tuberculous and purulent processes in the lung and pleura caused its grave condition of patients and lower functional parameters of respiration and cardiac performance. After 2-4-month comprehensive preoperative preparation, pulmonectomy and pleuropulmonectomy were made in 78.7% of the patients after stabilization of their pulmonary and pleural process and in 21.3% of the patients in the active phase of the disease. Good results of treatment were achieved in 70.7% of the patients, death occurred in 18.6%. In the late postoperative period among 60 patients, clinical cure was noted in 80% and death rates were 13.3%.

[Removing of the remaining parts of the lung by the pulmonectomy type in tuberculosis reactivation after partial resect ions]. / Udalenie ostavshikhsia otdelov legkogo po tipu pul'monéktomii pri reaktivatsii tuberkuleza posle chastichnykh rezektsii.

The outcomes of reoperation--removal of the remaining parts of the lung by the pulmonectomy type--for tuberculosis reactivation after partial lung resections were studied in 51 patients. A 3-5-month comprehensive preoperative preparation promoted stabilization of a tuberculous process in the lung in 31 (60.8%) patients, partial stabilization in 13 (25.5%). A progressive clinical course was observed in 7 (13.7%) patients receiving antibiotic therapy. The good immediate efficiency of pulmonectomy (76.9%) and postoperative clinical recovery (84.1%) show that this treatment is justifiable and expedient for critically ill patients.

[Pneumonectomy in disseminated fibrous-cavernous tuberculosis]. / Pul'monéktomiia pri rasprostranennom fibrozno-kavernoznom tuberkuleze.

The paper analyzes the outcomes of pulmonectomy in 60 patients for fibrous-cavernous tuberculosis in the presence of a destructive process in the contralateral lung. It covers the clinical picture, diagnosis, and preoperative treatment policy. The destructive process in the contralateral lung was limited to 1-2 segments in the upper lobe of the lung. Pulmonectomy yielded a good clinical effect in 45 (75.0%) patients, the mortality was 6.6% (n = 4). Despite a high surgical risk, pulmonectomy in this cohort of patients was quite justifiable and a highly effective treatment.

[Partial resection of the lungs in patients with newly detected destructive tuberculosis]. / Chastichnye rezektsii legkikh u bol'nykh s vpervye vyiavlennym destruktivnym tuberkulezom.

The efficacy of partial pneumonectomies in 700 patients with newly-diagnosed destructive tuberculosis preceded by an ineffective antibacterial therapy for 3-15 months was studied. Operations were performed in 411 (58.8%) patients with fibrocavernous tuberculosis, in 173 (24.7%) with cavernous tuberculosis, in 10 (1.4%) with disseminated tuberculosis and cavitation, and in 106 (15.1%) with tuberculoma. Segmental resections were carried out in 214 (30.6%) cases, lobectomies in 309 (44.1%), and combined resections in 177 (25.3%). Immediately good and satisfactory clinical efficacy was achieved in 687 (98.1%) and 7 (1.0%) subjects respectively, the remaining 6 (0.9%) patients died. 3-15 years after the operation, the reactivation of tuberculosis was observed in 14 (2.3%) cases out of the 603 examined. An intensive antibacterial therapy as well as repeated operations made it possible to cure 6 patients, with 5 still under treatment and 3 dead. Later on a stable clinical cure was registered in 595 (98.7%) patients out of the 603 examined.

[Use of carbon dioxide laser in the surgery of pulmonary tuberculosis]. / Primenenie uglekislotnogo lazera v khirurgii tuberkuleza legkikh.

Results of 120 operations for pulmonary tuberculosis performed by using a carbon dioxide laser were analyzed. Eighty patients were subjected to saving resection of the lung. Lobectomy, pulmonectomy and pulmonary cystorhaphy were carried out in 15, 6 and 8 patients, respectively. Thoracoplasty with myoplasty of the residual pleural cavity was applied to 11 patients. The early results of the surgical treatment of pulmonary tuberculosis in all the patients were satisfactory.

[Effectiveness of therapeutic and surgical treatment after delayed detection of destructive pulmonary tuberculosis]. / Effektivnost' terapevticheskogo i khirurgicheskogo lecheniia pri nesvoevremennom vyiavlenii destruktivnogo tuberkuleza legkikh.

The authors studied the results of antibacterial therapy in 647 and the results of surgical treatment in 837 patients. Complex modern antibacterial therapy led to recovery of only 65% of patients, in 20-25% of patients tuberculosis progressed with the formation of chronic forms, lethality was up to 13.0%. Timely undertaken surgical treatment after an ineffective course of antibacterial therapy facilitated stable recovery of 98% of patients with complete restoration of working capacity in 93.2%.

[Use of autologous blood for elimination of the residual pleural cavity after pneumonectomy]. / Primenenie autokrovi dlia likvidatsii ostatochnoi plevral'noi polosti posle rezektsii legkikh.

The authors describe a method of liquidation of a postresectional residual cavity by the introduction of the patient's autoblood with antibiotics. When using this method all the factors of the coagulating system of blood are involved in the formation of fibrin and the following formation of fibrothorax, which accelerates the formation of fibrothorax. The proposed method was used in 26 patients with residual pleural cavities after resection of the lungs and facilitated their liquidation and formation of fibrothorax.