Search

A misdiagnosis of isolated pulmonary tuberculosis (pTB) is highly likely when a patient has nontuberculous mycobacterial pulmonary disease (NTMPD) or a combination of nontuberculous mycobacterium pulmonary disease and pulmonary tuberculosis. Frequently, bacterial excretion is absent or only Mycobacteria tuberculosis (MBT) is found. This often results in an incorrect diagnosis and subsequent misinformed treatment regimes. In order to determine possible clinical and radiographic differences between patients with NTMPD (Group 1), destructive drug-resistant pulmonary tuberculosis (Group 3) and a combination of NTMPD and pTB (Group 2) we compare clinical and radiographic signs for these three patient groups. When comparing with Group 3 (2.5%), Groups 1 (25%) and 2 (17.4%) have a substantially higher incidence of pulmonary haemorrhages. Thus, upon clinically observing the combination of pTB and NTMPD, there are no pathognomonic clinical and radiographic detected symptoms. However, the presence of an indolent course, hemoptysis and bronchiectasis in the presence of acid-fast bacteria (or identified MBT) in the sputum makes it possible to suspect not simple pTB, but a combination of pTB and NTMPD. To clarify this necessitated in-depth bacteriological examination.

Background: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI)., Aim: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period., Materials and Methods: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666)., Results: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

Objective: To increase an efficiency of surgical treatment of bronchopleural complications after lung resections and pleurectomies through the development of modern indications, treatment strategies, techniques and postoperative management., Material and Methods: We analyzed data in 252 patients with bronchopleural complications after lung resections and pleurectomies. The study included patients who underwent treatment at the Central Research Institute of Tuberculosis for the period 2004-2010, Clinical Hospital of Phthisiopulmonology of the Sechenov First Moscow State Medical University for the period 2011-2017 and Thoracic Center of the Republic of Ingushetia for the period 2015-2019. The study included patients with postoperative pleural empyema divided into two groups: group I - 138 patients with empyema and bronchial fistula; group II - 114 patients with empyema and no bronchial fistula. In the 1 st group, 1 patient had bronchial and esophageal fistulas., Results: At discharge, empyema and bronchial fistula were eliminated in 245 (97.2%) patients of both groups. Overall in-hospital mortality was 1.6% (4 cases). Two (1.4%) patients died within 30 days in group I and 1 (0.9%) patient died in group II. Within 90 days after surgery, another patient died from acute cerebrovascular accident in group I. In long-term period, overall effectiveness of treatment of bronchopleural complications was 97.2% (208 out of 214 cases)., Conclusion: The original surgical approach for bronchopleural complications considers timing of postoperative empyema, its spread and duration. This method together with minimally invasive interventions reduces mortality and ensures stable recovery after bronchopleural complications in 97.2% of patients.

Objective: To improve the treatment of destructive tuberculosis of a single lung by using of collapse surgery., Material and Methods: The authors analyzed an experience of collapse surgery for destructive tuberculosis of a single lung., Results: Collapse surgery was effective in 77.5% of patients., Conclusion: Endoscopic surgical collapse improves the outcomes in patients with destructive tuberculosis of a single lung and expands the possibilities for surgery in these patients when resection is not applicable.

Background: Tracheal bifurcation resection remains the greatest challenge in airway reconstruction, especially with extensive lesions. Additionally, lung cancer and pulmonary tuberculosis comorbidity complicate the chemoradiotherapy treatment due to the TB reactivation. This case describes tracheal resection in a patient with both tuberculosis (TB) and lung cancer., Case Presentation: The patient was diagnosed with right lung tuberculosis and upper lobe cancer with trachea invasion complicated by hemoptysis. A right pneumonectomy with circular trachea bifurcation resection was performed. Radiotherapy and chemotherapy were not administered to avoid TB reactivation. At 5.5 years post-surgery, there was cancer recurrence that was treated with radiation therapy. At 10 years post-surgery, an invasive squamous-cell carcinoma of a three-segment bronchus on the left was revealed. Radiation therapy and a course of chemotherapy were carried out with almost complete tumor regression., Conclusions: TB presence should not serve as a basis for the refusal of cancer treatment. Combined treatment may be recommended when the main infection focus in the pulmonary parenchyma is removed during surgery.

Thoracoplasty was invented for removing cavities between thoracic wall and remnant lung or mediastinum. It was initially used in cases of tuberculosis or unspecific infections, while currently it is used mainly for space problems after lobectomy/pneumonectomy.This article presents an overview of the historical and current techniques of this surgical procedure.Nowadays, thoracoplasty is rarely performed due to the low incidence of diseases for which this method is necessary. Therefore, this method has even been discredited. Furthermore, certain technical aspects of the thoracoplasty are not very well known because of the infrequent application of this procedure.Unfortunately, a look into the literature of thoracoplasty is not always usefull due to the biased views of advocates of different techniques such as Schede's thoracoplasty, Heller's Jalousie-Plastik, Alexander's extramusculoperiosteal thoracoplasty, Bjork's osteoplastic thoracoplasty, etc.Not to forget, there has always been a lack of research on the relevance and on the several techniques of thoracoplasty.The point is precise indication and correct execution of thoracoplasty as a final therapeutic option, which allows a safe and definitive solution of the space problem even in complex cases, without creating serious functional and cosmetic impairment for the patient.The main types of thoracoplasty are described in this article. Although the core principle of this operation remains unchanged, modern techniques are often cosmetically more considerable and less destructive, compared with techniques that were used in the past., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality., Material and Methods: The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment., Results: Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up., Conclusion: Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.

Objective: To analyze the impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients., Material and Methods: Treatment strategy for destructive pulmonary tuberculosis de novo was developed in the Sechenov First Moscow State Medical University. This strategy was applied at the Surgical Department of the Regional Tambov Tuberculosis Dispensary in 2013-2017. We formed a register of patients with pulmonary destruction and bacterial excretion and developed a personal treatment plan. All patients were divided into 3 groups (group A - surgical treatment, group B - no surgery due to refusal or discontinuation of treatment, group C - patients with contraindications or no indications for surgical treatment)., Results: Treatment efficacy considering closure of destruction cavities and abacillation was maximal in group A - 97.2%, 41.4% in group B and 39.8% in group C. The number of patients with pulmonary destruction and bacterial excretion has decreased by 3.3 times (from 516 to 158) or 69.8% for 4 years of extensive application of surgical treatment protocol. A significant reduction of 'bacillary core' interrupted infection chain and affected the main epidemiological characteristics. Short-term reduction of the incidence of tuberculosis may be expected. However, even more significant impact of this factor should be expected in the long-term period., Conclusion: Surgical treatment of destructive pulmonary tuberculosis improves efficacy of the management of these patients and reduces mortality rate.

Objective: To analyze surgical treatment of tuberculous pleural empyema in children depending on the stage of the process., Material and Methods: There were 82 patients aged 4-17 years with tuberculous pleural empyema. Clinical and X-ray features of different stages of disease are described. Certain types of surgical interventions at each stage of the process are analyzed., Results: In 72 children with empyema stage III 76 surgeries were performed. Postoperative complications occurred in 2 (2.6%) cases (delayed lung inflation) that required thoracocentesis with pleural drainage. There was no postoperative mortality., Conclusion: Complex treatment of tuberculous pleural empyema in children and adolescents with the use of modern surgical methods is followed by satisfactory outcomes in all patients. However, surgical technique, postoperative morbidity and hospital-stay depend on the stage of the process. Unfortunately, almost 90% of patients had empyema stage III. Therefore, minimally invasive surgery was not advisable and extensive, traumatic surgeries were required.

The literature data of 18 authors about surgical treatment of 1723 patients with recurrent tuberculosis are presented in the article. Also authors reported their own experience in repeated lung resection in 50 patients. Intraoperative complications were observed in 7 patients including empyema cavity dissection in 2 cases, scalping lung injury in 2 cases, peristump abscess dissection in 1 case, v. azygas injury in 1 patient and rupture of membranous part of trachea due to swollen cuff of intubation tube in 1 case. In postoperative period complications developed in 5 patients including early intrapleural bleeding in 1 case, later intrapleural bleeding in 1 case, empyema with bronchial fistula in 1 patient, residual pleural cavity in 1 patient and wound complication in 1 case. All postoperative complications were eliminated and there was no postoperative mortality. The authors concluded that although severe patients' condition, technical complexity and higher surgical risk of repeated resections compared with organ-preserving and collapsosurgical interventions satisfactory remote results and high proportion of labour rehabilitation earnestly prove advantages of repeated lung resections for recurrent tuberculosis of operated lung.

Aim: To improve the efficiency of treatment of single lung destructive tuberculosis., Material and Methods: 15-year experience of operations for destructive tuberculosis performed by the same surgeon including 18 resections of the single lung and 19 pneumonectomies after previous partial lung resection is presented in the article., Results: Surgical management of patients with destructive tuberculosis of single lung provides positive results in more than 90% of cases. However the frequency of its application is still low according to literature data. In case of destructive tuberculosis of single lung partial resection is more frequently indicated if fibrous-cavernous tuberculosis of the upper lung (up to 4 damaged segments), persistent bacterial excretion on the background of adequate chemotherapy and pathogen's drug resistance are present.

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.

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

Personal 10-year experience of 2412 operations on the thorax is summarized. 1394 (57,8%) of interventions were performed videothoracoscopically. Technical aspects of gross videothoracoscopic operations (552 lung resections and 162 pneumonectomies), indications for the use of the method are discussed. Own results are supplemented with meta-analysis of the literature.

The immediate results of partial resections were analyzed in 120 patients with drug-resistant pulmonary tuberculosis, among whom 70 patients had multidrug resistance. A complete clinical effect (abacillation and no decay cavities) was achieved in 117 (97.5%) patients, including in 67 (95.7%) patients with multidrug resistance who showed improvement in 3 (2.5%) cases, fatal outcomes being absent.

The paper analyzes morphological changes and results of surgical treatment in 515 patients with destructive pulmonary tuberculosis. Two hundred and seventy-four patients underwent mediastinal lymphadenectomy and in 241 patients lung resections or pneumonectomies were not followed by lymphadenectomy or solitary caseous molten lymph nodes were removed during an operation. In disseminated destructive pulmonary tuberculosis, active tuberculosis of intrathoracic lymph nodes (ILN) was found in 97%. The latter's significant signs are an enlarged lymph node of more than 2.0 cm, consolidation, periadenitis, and fluctuation. The incidence, extent, and pattern of ILN lesion varied in a lung tuberculous process depending on its site, form, and inflammation phase.

The paper pools some experience with 6 videothoracoscopic and 505 video-assisted thoracoscopic (VATS) resections of the lung and 105 VATS pneumonectomies. The bulk of the operations [451 (73.2%)] was made for pulmonary tuberculosis in patients aged 7 to 77 years. 81% operations by separately treating root elements, including all pneumonectomies and major lung resections, were performed. A new SOMI-80 suturing apparatus designed for mini-invasive surgery was employed to suture lung tissue in most cases. Intraoperative and postoperative complications occurred in 5 and 8 cases, respectively. The efficiency of operations for tuberculosis was 98.6%.

The paper first describes the experience in performing operations in 34 children and adolescents with different forms of tuberculosis of the lung and intrathoracic lymph nodes via mini-invasive access (a 4-6-cm skin cut), by applying video-assisted thoracoscopy. Practice has provided evidence that lung resections of any scope can be made in children and adolescents with pulmonary tuberculosis and nonspecific lung diseases during video-assisted thoracoscopic operations. The latter have a lot of advantages over the traditional thoracic operations; these included decreases in the duration of operations, in intraoperative and early postoperative blood and plasma losses and the duration of inpatient treatment of pulmonary tuberculosis in children and adolescents, and earlier activation.

The immediate and late outcomes of treatment of acute pulmonary tuberculosis with and without surgical treatments (337 and 271 patients, respectively) were analyzed. The vast majority of patients in both groups were those with caseous pneumonia and fibrocavernous tuberculosis complicated by caseous pneumonia. A complete clinical effect was achieved in 14% of non-operated patients at their discharge, with a hospital mortality of 15.5%. A surgical treatment provided a 6.5-fold early effectiveness with a less (8.6-fold) hospital mortality. In a follow-up periods (up to 11 years), the number of cases of recurrences and progression of tuberculosis in patients in whom surgery was indicated, but non operated cases was 5.7 times higher than that in those radically and arbitrarily radically operated on; 5-, 7-, and 10-year survival rates in the non-operated patients were 1.6, 2.3, and 4.9 times less, respectively (85.7% versus 17.6%).

Diabetes mellitus accompanying tuberculosis complicates the course of the latter and remains a topical problem of phthisiology. Surgical treatment of patient with both conditions presents a high risk and is employed unreasonably rarely. The results of medical (173 patients) and surgical (107 patients) treatments were studied in patients with destructive tuberculosis concurrent with diabetes mellitus. Analyzing early and late results of treatment showed a more steady-state effect in the group of surgically treated patients. Thus, surgery should be desirably used in all patients with preserving destructive changes after the basic course of antibacterial therapy.

A high temporal resolution magneto-optical system is employed to observe the time evolution of the vortex structure in Bi(2)Sr(2)CaCu(2)O(8+delta) crystals after a sudden application of a magnetic field. The magneto-optical images reveal dynamic coexistence of two vortex phases: a quasiordered phase in the sample interior and a transient disordered phase near the sample edges. The border between these two phases, marked by an abrupt change in the gradient of the local induction, moves with time. This motion enables tracing the decay of the transient state and the concurrent growth of the thermodynamic vortex phases. The growth rate is sensitive to the location in the field-temperature phase diagram.

The results of pneumonectomy with resection of tracheal bifurcation in 779 patients reported by 54 authors for the period of 44 years are reviewed. The analysis of all the data showed that this operation remains one of the most dangerous and rare surgical procedures. Lethality in total bifurcation resection averaged 24.3% and in partial resection--10.2%. Because of lack of experience there is no distinct indications for the operation in cancer patients. The authors have performed 111 pneumonectomies with bifurcation resection (39 with circulatory resection) with lethality of 2.7% and 5-year survival of 25%. This proves the ability of updated surgical technique to decrease surgical risk and extend indications for surgery of local cancer.

Two hundred-sixty four radical combined surgical operations (237 pneumonectomies and 27 lobectomies) were performed in 1981-1994. Two hundred-fifty four patients were operated on for cancer, 7-carcinoid and 3 patients for sarcoma. In 159 cases, tumors were identified as T3 and in 70 cases--as T4. Metastases into lymph nodes of the root and mediastinum--another 121 patients. Surgery alone was received by 90.5%. Mortality for the first 30 days was 1.9%. Twenty-six percent of patients with non-small cell carcinoma survived 5 years, small cell carcinoma-12.5% and carcinoid-100%. No significant difference in survival time was registered for T3 and T4 process.

Bronchial plastic reconstruction has been performed in 136 patients aged 8-82. Of them 86, 23, 1, 6, 13, 6, 1 had cancer, carcinoid, sarcoma, benign tumor, nonspecific stenosis, post-tuberculous stenosis, traumatic detachment of the main bronchus, respectively. The patients underwent: lobectomy (101 operations), bilobectomy (24 operations), bisegmental bronchial resections (2 operations), isolated bronchial resections (9 operations). An original technique of narrowing of the central stump in circulatory bronchial resections is described. Neither postoperative complications in anastomoses nor lethal outcomes were recorded. In all cases of nontumor stenosis and benign tumors functional benefits were achieved. A 5-year survival of cancer patients reached 66.7%. The procedures and surgical outcomes are discussed.

Incompetence of the main bronchus within the first 3 postoperative weeks (early incompetence) is proposed as a criterion of efficacy of the main bronchus closure in pneumonectomy. The authors have performed 495 pneumo- and pleuropneumonectomies according to 5 original techniques. No cases of the main bronchus incompetence were registered. Indications to each of the bronchus treatment techniques are detailed.

Radical surgical manipulations at the peak of pulmonary hemorrhage are a great operative risk. Operations for bleeding destructive acute processes of the lungs cause the highest mortality and terminate, at best, by loss of the lung and invalidation of the patient. The method suggested by the authors for arresting pulmonary hemorrhage by ligation of the pulmonary artery with a ligature of absorbable material makes it possible to arrest the bleeding due to temporary blocking of the blood flow in the pulmonary artery of the diseased lung for the time needed for curing acute destruction which has a positive clinico-radiological dynamics due to nonoperative treatment.

The article generalizes experience in 118 bilateral resections of the lungs carried out within 4 years at the Chelyabinsk Regional Antituberculosis Hospital, among which 63% (74) were one-stage bilateral operations. A clinical effect was produced in 97.5% of patients. Postoperative mortality was 1.7%. The authors prefer one-stage bilateral resections and resort to stage-by-stage operations only in cases with severe concomitant diseases, marked respiratory insufficiency, in a large volume of the resection, particularly if it is combined with thoracoplasty. A transsternal approach in one-stage bilateral resections is indicated when the upper parts of the lung must be resected in a large volume, in cases in which difficulties in exposure of the lungs are not expected; one-stage opening of both pleural sacs is recommended in this case for adequate inspection of the lungs before their resection.

For the last 3 years 77 reconstructive and plastic operations on the trachea and bronchi, including 25 pulmonectomies with tracheal bifurcation resection, were performed at the Chelyabinsk regional antituberculous dispensary. Postoperative complications were registered in 11.7% of the cases. Postoperative mortality (3.9%) is not associated with surgical complications. In 5 cases of left upper lobectomies with a circular resection of the primary bronchus, an original mobilization technique of the lower lobe of the left lung, enabling one to exclude the tension of an anastomosis and decrease the volume of hemithorax after resection, was applied. The rise in death from cancer and other diseases of the tracheobronchial tree with concurrent tuberculosis in some cases makes it advisable to widely integrate phthisiology and pneumology.