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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.

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%).