Cavernous Pulmonary Tuberculosis Research Articles

Effectiveness of Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis (Meta-Analysis)

The objective: to study effectiveness of surgical methods for treatment of various forms of destructive pulmonary tuberculosis (meta-analysis).Subjects and Methods. A systematic search was performed in electronic bibliographic databases, including PubMed and Google Scholar. Cohort studies published from January 1, 2019 to June 20, 2023 were selected, those studies were aimed to assess effectiveness of surgical treatment in patients with destructive tuberculosis using resections of various volume. For meta-analysis, 9 studies published in 2019 - 2023 were selected.Results. The effectiveness of comprehensive treatment with resections of various volume in destructive pulmonary tuberculosis patients made 85.3%. The success of surgical treatment in patients with fibrous cavernous pulmonary tuberculosis was somewhat less – 80.3%. At the same time, the incidence of postoperative complications in patients with fibrous cavernous pulmonary tuberculosis was higher and could reach 42.5%, while in the group patients with destructive tuberculosis, it was 27.3%. Some postoperative complications required repeated operations. The ratio of surgeries to patients was the following: 3263 surgical interventions per 1564 patients (average 2.08 surgeries per patient). Hospital lethality among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 2.6%, and tuberculosis mortality within 5 years after surgery was 4.8%. The relapse rate among patients with fibrous cavernous pulmonary tuberculosis after surgical treatment was 7.1%.

Physical Diagnostic Examinations of Cavernous Pulmonary Tuberculosis in the 19th and 21st Centuries

Physical Diagnostic Examinations of Cavernous Pulmonary Tuberculosis in the 19th and 21st Centuries

Chronic Cor Pulmonale in the Structure of Fatal Outcomes of Pulmonary Tuberculosis

The objective: to determine the significance of chronic cor pulmonale (CCP) as a cause of death in pulmonary tuberculosis patients.Subjects and Methods. Out of 194 autopsies of tuberculosis patients who died in Hospital no. 1 of Ulyanovsk Regional Clinical TB Dispensary in 2017-2020, autopsy reports of 87 patients with pathomorphological signs of chronic cor pulmonale were selected. The nature and prevalence of pathomorphological manifestations of tuberculosis and the causes of deaths were analyzed. Statistical analysis of the results was performed using the STATISTICA-10. The significance of differences in the frequency of events was determined using the χ2 criterion in a four-field 2х2 table.Results. Chronic cor pulmonale was confirmed pathomorphologically in 44.8% of deceased pulmonary tuberculosis patients. Chronic cor pulmonale was diagnosed in 67.8% of patients in their lifetime, and in 32.2%, it was diagnosed post mortem. Of 87 deceased patients with pulmonary tuberculosis complicated by chronic cor pulmonale, 28.7% had fibrous cavernous pulmonary tuberculosis, 26.4% had infiltrative form and 44.9% had disseminated form of the disease. Decompensated chronic cor pulmonale leading to death was detected in 42.5% of the deceased, and it was predominant in the structure of causes of death in fibrous cavernous tuberculosis (84%), and this pathology was also found in the patients with infiltrative (52.5%) and disseminated (10.3%) pulmonary tuberculosis.

Comprehensive Treatment of Disseminated Fibrous Cavernous Pulmonary Tuberculosis with Extrapleural Thoracoplasty by Mesh Implant

The objective: to increase the effectiveness of comprehensive treatment of patients with advanced fibrous cavernous pulmonary tuberculosis using the new method of extrapleural upper-posterior thoracoplasty with a mesh implant.Subjects and Methods. It was an open, prospective, randomized, controlled study of treatment outcomes of 233 patients with fibrous cavernous pulmonary tuberculosis who had contraindications to resection surgery. Patients were divided into three groups depending on the type of thoracoplasty: thoracoplasty with a mesh implant was performed in 70 patients, thoracoplasty according to Bjork - in 60 people, and traditional upper-posterior thoracoplasty - in 103 patients.Results. In operated patients, additional support with a mesh implant during the formation of a new pleural dome reduced pathological flotation of chest organs, which prevented decreased respiratory function, the right heart overload, and protected from the development of bronchopulmonary complications in the early postoperative period. The chances of cavity healing and sputum conversion by the discharge from hospital increased by 3,3 times (OR=3,3; 95% CI 1,6-6,7), a year later by 3,0 times (OR=3,0; 95% CI 1,48-7,5); in the long-term assessment it increased chances of survival by 4,8 times (OR=4,8; 95% CI 1,4-16,4) versus the Bjork operation and traditional upper-posterior thoracoplasty.

Impact of Multiple Drug Resistant Tuberculous Mycobacteria on the Outcomes of Lung Resection for Fibrous Cavernous Tuberculosis

The objective: to study the impact of multiple drug resistant tuberculosis (MDR TB) on the outcomes of comprehensive treatment with surgical resection of fibrous cavernous pulmonary tuberculosis.Subjects and Methods. A prospective retrospective cohort study was performed; 526 HIV negative patients with unilateral fibrous cavernous tuberculosis who underwent lung resection were enrolled in the study. Patients were divided into two groups: multiple drug resistant tuberculosis - 216 subjects, drug susceptible tuberculosis - 310 subjects. Each group was divided into three subgroups: with the low (MDR TB - 105 subjects; DS TB 221 subjects), moderate (MDR TB - 67 subjects; DS TB - 68 subjects) and high activity (MDR TB - 44 subjects; DS TB - 21 subjects) of tuberculous inflammation.Results. The chances of adverse outcomes of comprehensive treatment with surgical resections of fibrous cavernous pulmonary tuberculosis are 2.5 times higher in MDR TB Group versus DS TB Group (p < 0.001; χ2, OR = 2.5; 95% CI 1.6-3.9). At the time of the surgery, among patients with MDR TB, there were significantly more patients with moderate and high activity of tuberculous inflammation versus DS TB Group (p < 0.001; χ2). When comparing the groups of patients with a homogeneous degree of tuberculous inflammation activity, no significant impact of MDR TB on the outcomes of comprehensive treatment with resections was found. However, the course of the postoperative period differed, in MDR TB Group, pleural cavity empyema (OR = 3.1; 95% CI 1.7-5.5) and tuberculosis exacerbations (OR = 4.7; 95% - CI 2.1-10.7) were significantly more frequent compared to DS TB Group.

Cavernous Pulmonary Tuberculosis Accompanied by Intestinal Tuberculosis

Cavernous Pulmonary Tuberculosis Accompanied by Intestinal Tuberculosis

Specific course of COVID-19 associated pneumonia in the tuberculosis patient after pleuropneumonectomy

The article describes a clinical case of viral pneumonia associated with COVID-19 of the only lung, it developed in the patient 30 days after pleuropneumonectomy which was done to manage fibrous cavernous pulmonary tuberculosis. The favorable course of COVID-19 was due to its timely detection and initiation of treatment, and possibly, it was due to using anti-tuberculosis chemotherapy containing antibacterial drugs that prevented nosocomial infections.

A Clinical Case of the Personalized Approach to Surgical Treatment of Drug-Resistant Bilateral Fibrous Cavernous Pulmonary Tuberculosis Complicated by Pyopneumothorax and Pleural Cavity Empyema

A clinical case shows the complexity of the choice of surgical strategy for treatment in drug-resistant bilateral fibrous cavernous pulmonary tuberculosis complicated by pyopneumothorax and empyema of the pleural cavity. A non-standard personalized approach to the patient with initially compromised cardiorespiratory system resulted not only in cure of tuberculosis complications but also improved pulmonary functional parameters and allowed avoiding progression of pulmonary tuberculosis.

Control of Pulmonary Bleeding in Disseminated Fibrous Cavernous Pulmonary Tuberculosis

The objective: to study the efficiency and effectiveness of various non-resection ways of pulmonary bleeding control in patients with disseminated fibrous cavernous pulmonary tuberculosis.Subjects and Methods. A retrospective non-randomized study of complex treatment of 68 patients with fibrous cavernous pulmonary tuberculosis was performed. All the patients received treatment from 2012 to 2020 and the course of their disease was complicated by grade 1 pulmonary bleeding.Results. The patients were divided into three groups depending on the treatment used. Patients in Group 1 (n = 16) underwent upper posterior thoracoplasty with a mesh implant; all patients (100%) had good results: hemostasis was stable, cavities were healed and there were positive changes in the course of tuberculosis. In Group 2 (n = 15) with valve bronchial block, good results were observed in 86.7% of patients. Patients in Group 3 (n = 37) received conservative treatment supplemented with pneumoperitoneum; a good result was noted in 43.2% of patients.

Residual changes in patients with cavernous pulmonary tuberculosis in the treatment of chemotherapy drugs

In the pre-antibiotic period, the average life expectancy of patients since the development of the cavern usually did not exceed 5 years. A modern clinic accumulates materials for the treatment of cavernous tuberculosis. However, the nature and dynamics of residual changes formed at the site of former cavernous processes, especially after chemotherapy, in the long-term follow-up, are still insufficiently elucidated.

Cavernous ford pulmonary tuberculosis and kumis therapy

Questions of indications and contraindications for kumis treatment are still. are still in the center of attention of insurance and tuberculosis organizations. Existing instructions for the selection of patients and accounting for the results of sanatorium treatment, resp. kumis treatment, do not give satisfactory indications. For kumis treatment, tbc pulm is usually considered indicated. A I, II, III, B I, II, III. Any doctor working on TBK knows that each of these groups (A I, II, III, B I, II, III) can include and usually include pulmonary processes of different genesis, course and immuno-biological nature. So, for example, relatively benign forms of tbc tbc fibrosa densa, tbc fibro- nodosa and prognostically unfavorable phtisis fibro-caseosa and phtisis ulcero-fibrosa forms that are extremely different in clinical course and prognosis according to the existing classification, are included in the same group A II, III or B II, III.

Characteristics and Treatment Outcomes of Patients with Tuberculosis Receiving Adjunctive Surgery in Uzbekistan.

Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-surgery complications. According to histological examination after surgery, TB was confirmed in 81 (80%) patients. For the other 20 patients, the confirmed diagnoses were: lung cancer (n = 6), echinococcosis (n = 5), post-TB fibrosis (n = 5), non-tuberculous pleurisy (n = 2), hamartoma (n = 1), and pneumonia (n = 1). The majority of patients (94%), who underwent surgery, were considered successfully treated. In conclusion, adjunctive surgical therapy can be an option for TB treatment, especially in cases of complicated TB.

Postponed treatment outcomes in patients with limited fibrous cavernous pulmonary tuberculosis with use of valve bronchial block

The objective of the study: to evaluate postponed outcomes of comprehensive treatment with use of valve bronchial block in patients with limited fibrous cavernous pulmonary tuberculosis.Subjects and methods. Treatment outcomes of 97 patients suffering from chronic destructive pulmonary tuberculosis with lesions within one lobe were analyzed. Valve bronchial block (VBB+) was used in 42 patients, and it was not used in 55 patients (VBB-). In addition to anti-tuberculosis chemotherapy, artificial pneumoperitoneum was used in all patients as a part of the treatment.Results. Postpones treatment outcomes were followed in 83 patients: in 38 from the Group VBB+ and in 45 from Group VBB-. Clinical cure was achieved in 28/38 (66.7%) patients in Group VBB+ and in 16/45 (29.1%) in Group VBB-, p <0.01. A lethal outcome was registered in 2 (4.8%) patients in Group VBB+ and 10 (18.1%) in Group VBB-, p <0.03.

The efficacy of different extrapleural fixations in upper-posterior thoracoplasty in fibrous cavernous pulmonary tuberculosis patients

The objective of the study: to compare the efficacy of different modifications of thoracoplasty in patients with apical fibrous cavernous pulmonary tuberculosis.Subjects and methods. The article describes the analysis of the results of thoracoplasty in 65 fibrous cavernous pulmonary tuberculosis patients performed from 2016 to 2019. Three types of thoracoplasty were used: thoracoplasty with polypropylene mesh, osteoplastic thoracoplasty, and traditional thoracoplasty. The results were assessed by the severity of intraoperative trauma, development of bronchopulmonary complications, lack of compression, and healing of cavities.Results. No significant difference in the degree of intraoperative injury was found when comparing three types of thoracoplasty (p > 0.05). Clinical and X-ray examinations of patients in 3 weeks after surgery revealed that in thoracoplasty with a polypropylene mesh, the frequency of bronchopulmonary complications and lack of compression was lower than in other types of thoracoplasty (p < 0.05). Using the patient's own tissues for extrapleural fixation, especially with large cavities, results in a significant decrease in the thoracoplasty efficacy.

Use of Upper-Posterior Thoracoplasty in the Treatment of Patients 
 with Fibrous-Cavernous Pulmonary Tuberculosis

Introduction. SSurgical care for patients with fibrous-cavernous and cavernous pulmonary tuberculosis (TB) most often ends with thoracoplasty due to impossibility to use resection methods of treatment.The aim of study was to assess results of application of various upper-posterior thoracoplasty options in the treatment of patients with fibrous-cavernous pulmonary TB.Materials and methods. The author analyzed results of 233 thoracoplasties performed in patients with fibro-cavernous pulmonary TB in 2012-2018. Group 1 (n = 70) consisted of patients with selective extrapleural upper-posterior thoracoplasty with polypropylene mesh; Group 2 (n = 60) consisted of patients with osteoplastic thoracoplasty according to Bjork; Group 3 (n = 103) consisted of patients with traditional selective extrapleural upper-posterior thoracoplasty. The following parameters were analyzed: elimination of the destruction cavity, stabilization of the specific process and termination of the excretion of Mycobacterium tuberculosis during the year. The results were summarized in groups based on good clinical effect, satisfactory clinical effect, worsening, death.Results. Thoracoplasty treatment option with a compression device (mesh) application resulted in the increased degree of compression in the intervention area by 30%, compared with the traditional upper-posterior thoracoplasty option and osteoplasty according to Bjork (p 0.05), and reduced the number of bronchopulmonary complications by 15% (p 0.05).Conclusions. The use of a mesh prosthesis leads to an increased effective compression of the destruction cavity, creates conditions for healing of the pulmonary tissue defect and reduces the risk of developing bronchopulmonary complications

A clinical case of successful combined treatment of a patient with fibrous cavernous pulmonary tuberculosis and extensive drug resistance

The article describes a clinical case of successful treatment of a patient with disseminated bilateral fibrous cavernous tuberculosis and extensive drug resistance, with preserved sensitivity to only one anti-tuberculosis drug; the fifth chemotherapy regimen and pleuropneumonectomy were used.

Endobronchial valve in complex treatment of patients with drug resistant fibrous cavernous pulmonary tuberculosis

The objective of the study: to assess the efficacy of complex treatment with endobronchial valve implantation in the patients suffering from drug resistant fibrous cavernous pulmonary tuberculosis.Subjects and methods. Treatment outcomes in 97 patients with limited fibrous cavernous pulmonary tuberculosis were analyzed. Main Group included 42 patients who had bronchial valve block implanted. Comparison Group included 55 patients. Artificial pneumoperitoneum was used in both groups.Results. In Main Group, sputum conversion was achieved in 12 months in 40 (95.2%) patients, and in 32 patients (58.2%) in Comparison Group (p < 0.01). In 12 months after treatment start, positive X-ray changes were observed in 42 (100%) patients of Main Group and 40 (72.7%) patients of Comparison Group. Healing of cavities in 12 months was observed only in the patients from Main Group (26 (61.9%) patients). Upon completion of the study, surgery was still indicated to 4 (9.5%) of patients from Main Group and to 35 (63.6%) patients from Comparison Group.

Immunohistochemical evaluation of surfactant-associated protein in fibrosis-cavernous pulmonary tuberculosis

Background. Despite the progress and development of scientific directions in various fields of medicine, the problem of tuberculosis and its morphological manifestations remains relevant and is not fully disclosed due to complex pathogenesis, the presence of various clinical forms, therapeutic pathomorphosis, torpid to therapy, the presence of relapses. It is known that a surfactant system occupies a special place in the system of local lung protection.Aim. To study the condition of surfactant-assotiated protein A in the foci of specific destruction and in the surrounding intact lung tissue to assess its functional status, degree of respiratory failure and possible dissemination of tuberculous inflammation.Material and Metods. An analysis of 163 lung fragments of the dead or operated on for cavernous pulmonary tuberculosis with active bacterial excretion of 89 fragments and with clinical abacilation – 74 was carried out. Results A morphological study revealed stereotypical dynamic depression of surfactant-associated protein A in all the samples studied, both in the areas of cavernous destruction and pericavernouse zone, and in intact lung tissue. The maximum intensivity of the immunohistochemical expression of this surfactant protein was recorded in the alveolar macrophages, which indicated intensive recycling and utilization of the components of the surfactant.Conclusion. Minimizing the production of surfactant components and its active utilization in intact lung tissue leads to a collapse of the alveoli with subsequent progression of respiratory failure.

Electron Microscopic Characteristics of The Blood-Air Barrier Interstitium in Fibrous Cavernous Pulmonary Tuberculosis in Comparison with Chronic Nonspecifi c Lung Diseases

Aim. To describe the ultrastructural characteristics of the blood-air barrier (BAB) interstitium in fi brous cavernous pulmonary tuberculosis (FCT) in comparison with chronic nonspecifi c lung diseases (CNSLD).Materials and methods. The fragments of the pericavernal zone and lung tissue were taken for the study at the resection border from the dead or operated for CNSLD persons (n = 163), and the perifocal and boundary zone of lung tissue. 116 CNSLD patients were divided into 3 subgroups: 1) chronic lung abscess (n = 42); 2) bronchiectasis (n = 44); 3) lung cyst (n = 30). The lung fragments of 30 patients who died from pathology not associated with lung diseases (myocardial infarction, acute cerebrovascular accident) were used as a control group to compare the morphological parameters. The criteria for inclusion of patients in the study: age from 18 to 65 years, negative clinical and laboratory data on the presence of comorbid pathology (viral hepatitis B, C and HIV). For TEM, lung fragments 1×1×1 mm in size were cut out and fi xed in a 2.5% glutaraldehyde solution in phosphate buffer (pH = 7.2–7.4) and washed in 0.1 M phosphate buffer (pH = 7.4), followed by dehydration in alcohols of an ascending concentration and placing in a mixture of Epon and Araldite resins according to the scheme. Ultrathin sections were made with Reynolds staining. Viewing and photographing preparations was carried out on a PEM-100 transmission electron microscope (Ukraine) (magnifi cation range from ×1000 to ×30 000). Results. It was established that changes in BAB components in all groups had similar features in the form of severe interstitial fi brosis, the signs of endothelial cell degeneration and destruction of varying degrees of severity, as well as the heterogeneity of the endothelial and epithelial basement membranes.Conclusion. Ultrastructural changes in the BAB components of the removed lung part in patients with FCT and chronic nonspecifi c lung diseases are characterised by a polymorphism with prevailing dystrophic and destructive changes in the perifocal zone of infl ammation, and compensatory-adaptive processes on the peripheral, especially at the resection border.

Immunophenotype of the macrophage population in fibrous, cavernous pulmonary tuberculosis

Objective: to study the immunophenotype of the macrophage population and the mechanisms of their vectorial redistribution in fibrous cavernous pulmonary tuberculosis.Materials and methods. The material for the study was fragments of the fibrous cavern wall and pericavernous lung tissue of the dead or surgical patients diagnosed with fibrous cavernous tuberculosis (n = 163). All patients were divided into 2 main groups: patients with active bacteria excretion (MTB+, n = 84) and patients with clinical abacillation (MTB–, n = 79) for immunohistochemistry with a panel of markers for: macrophages and histiocytes – CD68; vascular growth factor A – VEGF-A; T-helpers – CD4, and T-cytotoxic lymphocytes – CD8.Results. Following the analysis of CD68 expression, the population heterogeneity of macrophages was revealed depending on the intensity of the cytoplasmic reaction, functional activity, localization and quantitative characteristics. Three groups were identified: highly active, moderately active and weakly active. Based on the reaction with vascular growth factor A, it was determined that VEGF+ cells correspond to weakly active CD68+ macrophages and are located on the border between the specific granulation tissue and fibrous layer as well as in the pericavernous zone and intact lung tissue with a statistically significant predominance in patients with MTB– (p < 0.05). Regardless of the scope of bacterial secretion, the number of VEGF+ cells in the lymphoid follicle zone directly correlates with that of CD68+ macrophages in the pericavernous zone (R = 0.68) and indirectly correlates with the number of diffusely scattered VEGF+ cells in the fibrous capsule (R = –0.75). In the meantime, CD68+/VEGF+ are visualized in the zone of CD8+ T-lymphocytes, and CD68+/VEGF- – in the zone of CD4+ cell clusters. Such correlation indicates the redistribution of macrophages into type 2, which has a remodeling effect on the surrounding tissues with the potentiating participation of lymphoid cells.