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The authors evaluated influence of Alfetin new Russian biologic preparation on pulmonary surfactant system and phospholipid metabolism in workers at risk of occupational pneumoconiosis, who suffer from infiltrative pulmonary tuberculosis. Considering positive changes in serum phospholipids subunits under alfetin treatment, the authors proved membrane protective effect of the drug. Alfetin was proved to weaken toxic effects of tuberculostatic drugs on lung surfactant.

The time course of changes in current epidemiological indices and epidemically significant features of the pathomorphism of infiltrative pulmonary tuberculosis in those living in the Perm Region are mainly characterized by negative trends. They lie in the increase or stable maintenance of high rates of morbidity, mortality, and destructive pattern of a lesion accompanied by bacterial isolation. The reason for the established situation is incomplete realization of potentialities of improving actions to detect the disease early, to optimize diagnosis and medical therapy, and to considerably expand an phthisiosurgical aid.

Based on the data available in the literature and their own findings, the authors have established that the pathomorphism of infiltrative pulmonary tuberculosis in the preantibiotic age was characterized by negative features, then underwent phases of positive changes and relative stabilization, thereafter it again acquired obviously marked negative peculiarities. At present, the clinical features of new cases of infiltrative pulmonary tuberculosis in Perm residents are the predominance of acute onset (67.3%), disseminated (55.8%) and destructive (91.6%) pattern of specific lesion accompanied by bacterial isolation (84.6%).

The immediate outcomes of treatment were studied in 119 patients with caseous pneumonia whose age was 20 to 64 years. In most cases, caseous pneumonia was found to preserve its classic traits by characterizing by acute onset (85.8%), prompt progression, high proportion of fatal outcomes in the early postoperative period (54.1% within 3 early postoperative months). There is an increase in cases of more "benign" course of this form of tuberculosis (subacute onset and prolonged slow progression) at the same time. The use of current methods for combined intensive antibiotic and pathogenetic therapies substantially improves the outcomes in this most severe group of patients, reduces the initiation of a phase of relative stabilization of a specific process and of cessation of bacterial isolation.

The specific features and outcomes of surgical treatment were analyzed in 122 newly detected patients with pulmonary tuberculomas without prior specific therapy. Postoperative complications developed in 4.1% of the patients undergone surgery, recurrent tuberculosis was observed in 1.6%. Early surgical interventions in this group of patients were found to reduce the time of treatment and working rehabilitation. A value of intraoperative rapid cytological verification of diagnosis was shown while choosing the adequate volume of lung resection in difficult diagnostic cases.

Among the various methods of antibacterial preparation injection for the management of pulmonary tuberculosis the intrapulmonary injection techniques with the help of a needle-stream injector (NSI-1) still remain little studied. The experience of using these techniques for treating more than 200 patients, among whom 23 patients were later operated on, showed that the early use of the method (immediately after the diagnosis was established) helped to stabilize the process in 1-1.5 months. This made it possible to perform operations within 3 months after the diagnosis was made. The method proved effective also in patients who did not present favourable dynamics during 3-6 months of the use of the traditional therapeutic methods. The results obtained allow for the use on a wide scale of needle-stream injections in the preoperative management of destructive tuberculosis patients.

The ventilation function was studied in 103 pulmonary tuberculosis patients of pneumoconiosis-risk occupations in the absence of pneumoconiosis and in 51 patients who were not exposed to dust. Patients of "dust" occupations were found to have a decrease in the parameters of external respiration and bronchoscopic findings more often showed chronic bronchitis. The initial signs of pneumoconiosis were revealed in the histological examination of surgically removed lung segments in 83.4% of the patients.

Operations were performed on 102 patients (93 with tuberculomas, 2 with fibrocavernous tuberculosis, and 7 with infiltrative tuberculosis of the type of caseous pneumonia) without preoperative chemotherapy. Certain difficulties in identification of the nature of the disease in tuberculomas are pointed out. It is shown that only emergency histological study helps to avoid errors. Postoperative complications occurred in 5.9% of patients. Exacerbation of tuberculosis after economical resections in tuberculomas occurred in 2.1% of patients due to a nonradical intervention. The expediency of early interventions which allow the term of treatment to be shortened is shown.

Data are reported on 66 tubercular patients. In 59 of them enterosorption along with traditional treatment were used to control side-effects of antibacterial treatment, correction of liver function, reduction of tubercular intoxication. The obtained results indicate efficiency of enterosorption that removes during a short time period the side-effect allowing to treat efficiently the main disease.

Diffuse fibro-cavernous tuberculosis was managed in 44 patients by interventions on the cavern, the bronchi draining it, and the thoracic wall. It is shown that these operations are combined and are organ-preserving in character. The choice of the type of the operation is determined by the character of the affection of the bronchi and the activity of the tuberculous inflammation in the wall of the cavern. The use of modern technical measures (laser, ultrasonics, hemosorption) is promising.

The experience with surgical treatment of 134 patients with extended destructive tuberculosis of the lungs was studied. Among them 79 patients were subjected to lung resection in combination with thoracoplasty, 14 patients were subjected to thoracoplasty and 41 patients were subjected to various forms of cavernoplasty. It was shown that corrective thoracoplasty carried out simultaneously with lung resection lowered the risk of tuberculosis aggravation.