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Two hundred and eighty seven cases of tuberculous pleurisy are analyzed. According to the pleural contents, four phases of development of this disease are identified. These include: 1) free pleurisy; 2) partially encysted pleurisy; 3) encysted pleurisy, and 4) adhesive pleurisy. An algorithm of use of draining procedures and surgical interventions depending on the phase of pleurisy is proposed. Among other things, indications for thoracoscopy that was performed in 66 patients with tuberculous pleurisy for its therapy were stated. Thoracoscopy is ineffective in adhesive pleurisy, in the presence of a rigid residual cavity in particular, and thus preference should be given to thoracotomy with pleurectomy and decortication of the lung. This operation was made in 39 cases. Timely use of draining procedures and surgical interventions make it possible to achieve recovery from tuberculous pleurisy over shorter periods of time and with minimal residual changes.

Forty three patients undergone pulmonectomy/pleuropulmonectomy were studied 1-3 days to 1.5 months after surgery. The content of total protein (TP), fibronectin (FN), medium-weight molecules, fibrinogen and fibrin degradation products (FFDP). In the absence of complications within the first 3 weeks after surgery, exudate was concentrated along with intensive cavitary proteolytic clearance, then there was deposited fibrin lysis concurrently with increased local FN synthesis. The magnitude of the two latter processes was directly relate to the rates of residual cavitary fragmentation and obliteration. In patients with empyema, fluid drainage from the residual cavity and exudate was impaired in the early postoperative period and the exudate was characterized by very low concentrations of TP, FN, FFDP. Subsequently, the phenomena of exudate dilution remained, which was associate with a decrease in the rate of proteolytic processes and a slow increase in local FN synthesis.

A dynamic morphologic examination and surgical treatment analysis in connection with 184 patients with chronic empyema of the chest appeared to be the basis to refer to it as an independent form of pleuropulmonary pathology with a typical undulatory clinical course and morphologic picture. The disease is evolving progressively, with predominant hyperplastic processes in the changed pleura leaves at the initial, and as a rule lengthy stage in relation to a stable course, accompanied by subsequent aggravation and easing of the process in addition to the development of complications. Depending on the clinical course stage, a surgical treatment tactics is elaborated together with the use of different surgical methods. The application of surgical intervention of a restorative nature at early stages of the disease is stipulated, since it gains good results and prevents the development of serious, hardly curable forms.