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Objectives: Cavitary disease and bilateral lesions are among the risk factors for poor outcome of pulmonary tuberculosis (TB). Our aim was to explore the value and limits of surgery in patients with advanced TB., Methods: A retrospective study of 57 consecutive patients who underwent thoracic surgery for culture-positive bilateral cavitary pulmonary TB was performed. Forty-four (77.2%) patients were men and 13 (22.8%) patients were women; their ages were in the range of 18-61 years. Twenty-two (38.6%) patients had multidrug-resistant (MDR) TB and 35 (61.4%) patients had extensively drug-resistant (XDR) TB confirmed with cultures. On admission, 49 (86.0%) patients had sputum smear microscopy positive for acid-fast bacilli. The main indication for surgery was treatment failure manifested as contagious persisting cavities despite best available therapy. The surgical procedures included combinations of pulmonary resections of different levels, selective thoracoplasties and/or endobronchial valve treatment. The operations were performed consecutively, starting with the most affected side. TB therapy preceded the operation for a minimum of 6 months and was continued after the operation on the basis of the patient's susceptibility to drugs for Mycobacterium tuberculosis., Results: We performed 121 operations: 42 in 22 patients with MDR TB (1.9 operations per patient) and 79 procedures in 35 patients with XDR TB (2.3 operations per patient). No deaths occurred in the 1st year. Two late deaths followed, 1 unrelated to and 1 due to TB progression. Ten major complications (1 complication per patient) developed: main bronchus stump fistula (n = 4), prolonged air leak (n = 3), respiratory failure (n = 2) and wound seroma (n = 1). At the 1-month follow-up visit, sputum smear conversion was observed in 11 (68.8%) patients with MDR and in 15 (45.5%) patients with XDR TB. At the late (20-36 months) follow-up visit, culture negativity was achieved in 21 (95.5%) patients with MDR TB and in 23 (65.7%) patients with XDR TB (P = 0.015)., Conclusions: Thoracic surgery may significantly improve patients' outcomes and even result in a cure in a good portion of patients with bilateral cavitary MDR and XDR TB and should be considered as the essential element of multimodality treatment for MDR and XDR TB, even in patients with bilateral cavitary disease and borderline respiratory reserves., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: To study the possibilities of enhancing the efficiency of differential diagnosis of solitary lung masses by optimizing the quantitative analysis of positron emission tomography (PET) data when two radiopharmaceuticals (RP) (18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine) are used alone and in combination., Material and Methods: A comprehensive examination involving 18F-FDG and 11C-methionine PET was made in 116 patients with solitary lung masses of various genesis. A final diagnosis in the examinees was established from the results of postoperative material morphological analysis and/or laboratory tests and those of X-ray follow-up., Results: No 18F-FDG and 11C-methionine hyperfixation was found in patients with benign tumors and in the majority of patients with focal pneumofibrosis. At 18F-FDG and 11C-methionine PET, RP accumulation was recorded in all patients with lung cancer (LC) and in patients with inflammatory diseases. Three patients with 18F-FDG PET-negative typical carcinoid tumors were noted to have increased 11C-methionine uptake. At 11C-methionine PET, RP accumulation was recorded in the projection of formation in all the patients with LC and in 38 of the 42 patients with inflammatory diseases. Regardless of the used RP, the Standardized Uptake Value (SUV) was significantly lower in the patients with inflammatory diseases than in those with LC (p ≤ 0.05)., Conclusions: When RP is used alone, the diagnostic efficiency of C-methionine PET in the differential diagnosis of lung tumors and inflammations is higher than that of 18F-FDG PET. At the same time, the highest PET is seen when 18F-FDG and 11C-methionine are used in combination.

Sixty-three patients with fibrocavernous pulmonary tuberculosis were examined before and 1 month after preoperative therapy with antituberculosis agents. The time course of changes in the clinical and X-ray characteristics of the severity of the disease were compared with the alterations of different biochemical indices, including acute-phase proteins, proteolysis inhibitors, intoxication severity. It was demonstrated that improvement of clinical and X-ray characteristics of the severity of a process after preoperative preparation could be predicted with an accuracy of 83% from the baseline serum concentrations of albumin and ceruloplasmin. The accuracy of prediction does not increase when the levels of protease inhibitors, C-reactive protein, adenosine deaminase, medium-weight molecules are simultaneously studied. The likelihood of the clinical and X-ray characteristics becoming better is higher with enhanced ceruloplasmin activity and decreased albumin levels.

The paper deals with the effect of glutoxim included into a preoperative preparation regimen on immunological parameters in patients with fibrocavernous pulmonary tuberculosis. On admission, all the patients had inadequate cellular immunity and activated humoral immunity. After termination of a course of glutoxim therapy, there was an increase in the baseline low values of lymphocytic proliferative activity, in the count of mature T lymphocytes, and in the production of IL-2 induced by phytohemagglutinin. At the same time the similar parameters remained unchanged in the control group. The drug exerted the most noticeable stimulating effect on cellular immunity in patients with a limited process. Glutoxim produced no noticeable effect on humoral immunity. The immunomodulating effect of glutoxim was followed by improvement of the clinical and X-ray pictures of the disease. In glutoxim-treated patients with baseline immunological disorders, progression was found to occur 1.5-2 times more infrequently than in the control group. Indications for the use of glutoxim in the treatment of tuberculosis are specified on the basis of the baseline immunological parameters of each patient.

The outcomes of surgical treatment of 546 patients with pulmonary tuberculosis were analyzed in relation to the bacteriological characteristics. Seeding detected sputum bacterial isolation in 52.4% of cases. Mycobacterial drug resistance was detected in 83.6% of the tested cultures. It has been concluded that the resistance is a first-order infectious agent whose action is shown in lowering the efficiency of preoperative courses of chemotherapy by 2.5 times, in increasing the incidence and severity of postoperative pleural and pulmonary complications by 6-7 times, in deteriorating the immediate outcomes of surgical treatment to 82.4% with a 7.4% mortality rate. Intensive bacterial isolation unarrested by surgery is a second-order infectious agent which more clearly shows a relationship of the efficiency of surgical treatment to a reduction in the cure rate to 74.2% with a total mortality of 15.2%. There is evidence for that it is advisable to apply an active surgical policy in a group of patients having an infectious risk factor.