[Therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis].

Therapeutic plasmapheresis was performed in 159 patients with pulmonary tuberculosis treated in the clinic in 2000 to 2005. Four hundred and seventy-seven manipulations were made. Among its clinical forms, there was prevalent fibrocavernous tuberculosis (in 136 patients); 9 had infiltrative tuberculosis; caseous pneumonia was present in 5 patients; 4 had tuberculoma; 3 and 2 patients had focal and disseminated tuberculosis, respectively. Out of the 159 patients, 42 (26.4%) underwent therapeutic plasmapheresis at the stages of surgical treatment. Plasmapheresis was made in 61.9% (26/42) before surgery and in 38.1% (n = 16). The study defined indications for and contraindications to therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis, including adolescents and patients at the stages of surgical treatment. A procedure has been developed for discrete and membranous plasmapheresis for this category of patients. In patients with destructive patients, therapeutic plasmapheresis was shown: 1) to level the symptoms of antituberculous chemotherapy intolerance; 2) to correct homeostatic disorders; 3) to enhance the efficiency of basic drug therapy and to promote timely preparation of patients for surgery; 4) to improve the quality of life.

[Role of echocardiography in surgery of pulmonary tuberculosis]. / Rol' ekhocardiografii vo ftiziokhirurgii.

Doppler echocardiography was used to examine 26 patients aged 18 to 65 years who had undergone different surgical interventions for disseminated and acutely progressive pulmonary tuberculosis. Nineteen patients were diagnosed as having fibrocavernous pulmonary tuberculosis; 6 and 1 patients had caseous pneumonia and disseminated pulmonary tuberculosis. Echocardiography was performed with a LSC-700 echotomograph (Piker International, USA) by the routine procedure. Analyzing central hemodynamic parameters in the patients identified 3 types of hemodynamics: hypokinetic, eukinetic, and hyperkinetic, which made it possible to perform a course of cardial therapy adequately in the preoperative period. Preoperatively, 21 (80.8%) patients were found to have elevated mean pulmonary pressures and 5 patients had pulmonary pressures in the normal ranges. In the uncomplicated postoperative period, pulmonary pressures gradually decreased and reached normal values in some patients.

[Effectiveness of the surgical treatment of patients with pulmonary tuberculosis and multidrug resistance of its causative agent]. / Effektivnost' khirurgicheskogo lecheniia bol'nykh tuberkulezom legkikh pri polirezistentnosti vozbuditelia.

In 1996-1998, the Central Institute of Tuberculosis, Russian Academy of Medical Sciences performed more than 600 operations. Of them 90 (15%) patients isolated mycobacteria. The drug resistance of M. tuberculosis was found in 69 (76.7%) patients. In 60.9% of cases, the resistance of M. tuberculosis to isoniazid and rifampicin was concurrently accompanied by that to one (21.4%), two (61.0%), and even 3 (14.8%) tuberculostatics. Removal of the lung or its remnants in the extrapleural layer was most common (67.7%); thoracic cavernomyoplastic operations were made in 17.4% of cases, and partial resections accounted for only 13%. Postoperative complications were more frequently encountered in patients with drug-resistant tuberculosis than in controls (6.7%). Among them, tuberculosis progression and empyema were prevalent (13%). The clinical efficiency and duration of surgical treatment were directly related to the rates of progression and to the magnitude of drug-resistance of Mycobacteria.

[Ultrasound evaluation of the hemothorax of patients operated on for pulmonary tuberculosis and control of the development of fibrous thorax]. / Ul'trazvukovaia otsenka sostoianiia gemitoraksa i kontrol' za formirovaniem fibrotoraksa u operirovannykh bol'nykh tuberkulezom legkikh.

The paper deals with the ultrasound study of the hemothoracic cavity in pulmonary tuberculosis patients undergone pulmonectomy. Ultrasound study provides objective data on the time course of processes occurring the hemothorax operated on and controls the development of fibrothorax, such as the formation of effusions, in all its details.

[Myocardial contraction and intensive therapy in phthisiosurgical patients]. / Sokratitel'naia sposobnost' miokarda i intensivnaia terapiia u ftiziokhirurgicheskikh bol'nykh.

The changes in myocardial contractility were studied in 88 patients operated on for pulmonary tuberculosis in pre- and postoperative periods using echocardiography. It was found that among patients operated on for acute and common forms of pulmonary tuberculosis tahere was a considerable proportion of those with hypo- and hyperkinetic types of central hemodynamics which were characterized by unstable hemodynamic parameters and needed corrective therapy both in pre- and postoperative periods. Strategy of preoperative preparation and postoperative management of patients was elaborated by the status of the central hemodynamics.

[Significance of radionuclide study in early diagnosis of chronic pleural empyemas]. / Znachenie radionuklidnogo metoda issledovaniia v rannei diagnostike khronicheskikh émpiem plevry.

Forty-five patients aged 17 to 70 years with exudative pleurisy were examined. Among them there were 31 patients with exudative pleurisy of tuberculous etiology, 7 with parapneumonic pleurisy and 7 with malignant pleurisy. In addition to clinical and X-ray examination, all the patients were studied for the functional status of the parietal pleura by using the radionuclide technique. The study indicated that the peripheral blood levels of radio pharmaceuticals (RP) ranged in relation to the duration of the disease: 0.33%, 0.31, 0.29, and 0.26% with a duration of 1-3, 4-6, 7-9, and over 10 months, respectively. With the least changes in the parietal pleura, the peripheral blood content of RP was highest and in pleural cirrhosis it was the lowest. The study showed that 66% were diagnosed as having early pleural empyema and 13 underwent pleurectomy.

[Immunogenetic factors in pulmonary tuberculosis surgery]. / Immunogeneticheskie faktory vo ftiziokhirurgii.

Distribution of HLA antigens, haptoglobin phenotypes (Hp), ABO blood groups and rhesus factor was investigated in 60 patients with fibrocavernous tuberculosis and 50 patients with tuberculomas. All the patients were Russian and had a history of surgery for tuberculosis. Carriers of antigens B27, DR2 of HLA system, HP 2-2 and blood group 0 (I) were encountered more often in the group of tuberculosis patients. Antigens A1, B12, DR3 and A2 occurred among tuberculoma patients more frequently and less frequently, respectively. Among those who developed postoperative complications carriers of blood group A (II) were found significantly less frequently. Antigens HLA and Hp types were unrelated to the incidence of pleuropulmonary and infectious postoperative complications. Tuberculosis reactivation in the postoperative period and postoperative recurrences occurred more often in carriers of HLA antigen DR2.

[Surgical treatment of patients with disseminated and progressing pulmonary tuberculosis]. / Khirurgicheskoe lechenie bolnykh s rasprostranënnym i progressiruiushchim tuberkulëzom lëgkikh.

The results of surgical treatment have been summarized for 97 patients with disseminated progressive and complicated tuberculosis associated with respiratory disorders. Of them, 89 (91.8%) had fibrous-cavernous disease and empyema, 72.2% exhibited bilateral advanced process. Noticeable disturbances of ventilation capacity were registered in 47 patients, grave ones in 22 cases. Restrictive and obstructive types predominated. External respiration was impaired most seriously when the process was disseminated and progressive. Respiratory failure increased with growing rates of the disease progression. Pulmonectomy was performed in 58, primary and staged trans-sternal transpericardial occlusions of the main bronchi in 25 cases. The effect was reached in 83.5%, 16.5% of patients died. Lethal outcomes occurred due to bronchopleural complications in 43.8%, pulmonary artery thromboembolism in 18.7% of surgical cases. It is inferred that pulmonary dysfunction cannot be a principal criterion for rejecting operative treatment in progressive and complicated pulmonary tuberculosis.

[Surgical treatment of cavernous pulmonary tuberculosis]. / Khirurgicheskoe lechenie kavernoznogo tuberkuleza legkikh.

Analysis is given of the results of a surgical treatment of 75 patients with cavernous pulmonary tuberculosis that was characterized by the prevalence of pathomorphological features (79%) of the process development. It is shown that signs of chemotherapy inefficiency can be established as early as 4-6 months after the treatment of destructive tuberculosis was begun. The distinguishing features of surgical interventions during this period comprise a small volume of resection, minimal intraoperative blood loss and little time spent on the operation. These interventions have high effectiveness (98.7%) in the absence of fatal outcomes and can be recommended for wide use in the practice of antituberculosis therapeutic institutions.

[New surgical tactics in the treatment of patients with complicated tuberculosis of the lungs and pleura]. / Novaia khirurgicheskaia taktika pri lechenii bol'nykh s oslozhnennym tuberkulezom legkikh i plevry.

Stepwise surgical tactics by using transsternal transepicardial preocclusion of the main bronchus and lung root vessels, opening of the empyema cavity and pneumotomy has been proposed to treat patients with progressive fibrocavernous tuberculosis complicated by pneumothorax and pleural empyema and extended into the thoracic wall. After 1.5-2 months the main stage of the operation, pleuropulmonectomy, is performed. Among the 25 patients operated on, the clinical effect was achieved in 15, 5 patients continued to take treatment, 5 patients died. The first results show that active care may be delivered to patients with complicated pulmonary and pleural tuberculosis who have recently had no hope to be recovered and the process be steady.

[Thoracomyoplastic operations in the surgery of tuberculosis of the lungs]. / Torakomioplasticheskie operatsii v khirurgii tuberkuleza legkikh.

Different variants of thoracomyoplasty were performed on 532 patients with fibrous-cavernous tuberculosis and tuberculous empyema of the pleura. Treatment outcomes have shown that the range of applications of thoracomyoplastic procedures is wide enough: (1) as an independent procedure; (2) as prevention of postresection complications; and (3) as one-stage method to eliminate caverns and empyemas in the presence of bronchial, esophageal, thoracic fistulas and defects of the chest wall. Improvement of the operative technique, application of new technical means enable one to increase the efficacy of surgical treatment of patients with common and complicated tuberculosis of the respiratory organs and chronic non-specific diseases of the lungs.

[Pulmonectomy in tuberculosis surgery]. / Pul'monéktomiia vo ftiziokhirurgii.

The results of surgical treatment of 550 patients who were subjected to pulmonectomy for tuberculosis (74.7%) and other respiratory diseases (25.3%) were analysed. Pulmonectomy was either used as an emergency procedure or performed after a short-term intensive preparation depending on the severity of the clinical picture and life-threatening syndrome. New surgical tactics consisting of stage-by-stage and combined surgical interventions has been developed and is used in clinical practice. Pulmonectomy which is performed at the stage of the clinical stabilization of the process is the most effective. Despite high surgical risk, pulmonectomy in progressive and complicated tuberculosis provides clinical effectiveness in 76.9-83.7% of patients.