Destruction Cavities Research Articles

Association of the Genotype of TNFα with the Efficiency of the Intensive Phase of Chemotherapy and Formation of the Sizes of Destruction Cavities in Patients with Pulmonary Tuberculosis.

The interrelation between the TNFα gene polymorphism and the effectiveness of the intensive phase of chemotherapy in patients with pulmonary tuberculosis, as well as the formation of diameter of the sizes of destruction cavities was studied. It was revealed that the most adverse course of the disease and a high frequency of formation of destruction cavities are associated with the GG genotype of the TNFα gene.

Biofilms in mycobacterial infection

The ability to form biofilms in lung tissue destruction cavities has been described for both the causative agent of tuberculosis (Mycobacterium tuberculosis) and for non-tuberculous mycobacteria. This process is associated with the chronic infection. It is assumed that a change in the biology of the pathogen inside the biofilm (formation of an antibiotic-resistant phenotype) makes ineffective standard chemotherapy regimens, which based on the susceptibility test data of mycobacteria in the “free state”. This review describes the biology of mycobacterial biofilms and the main approaches to combat them. Available information suggests that control of mycobacterial biofilm formation is one potential strategy to improve the effectiveness of treatment for tuberculosis and mycobacteriosis.

Evolution of cavity formation in nontuberculosis mycobacteriosis of the lungs

The results of a long – term observation from practice are presented, which showed the gradual formation of the destruction cavity in a patient with limited focal and peribronchial fibrosis of the lung tissue. Patient H., 54 years old for more than twenty years, was observed by a pulmonologist at the place of residence with a diagnosis of chronic bronchitis with frequent annual exacerbations. She was admitted to the clinic of the FSBSI "CRIT" with complaints of pronounced weakness, fatigue, shortness of breath, prolonged subfebrile temperature mainly at night, cough with difficult-to-separate mucus of a mucous nature. A retrospective analysis of computed tomography of the chest revealed a consistent transformation of local focal peribronchial compaction in the middle lobe of the right lung into a limited area of bronchiectasia and the formation of a small cystic cavity with widespread zones of bilateral pneumonic infiltration. This observation shows the practical significance of CT research in understanding the mechanisms of formation of bronchiectatic cystic cavity in non-tuberculosis mycobacteriosis of the lungs.

Ways to improve the effectiveness of treatment of patients with destructive pulmonary tuberculosis with multiple and broad drug resistance of the pathogen

SummaryTreatment of patients with destructive forms of drug-resistant pulmonary tuberculosis remains a difficult problem. The presence of a destruction cavity in the lung reduces the effectiveness of therapy and is a negative prognostic factor. The objective of the study: to search for the optimal tactics for the treatment of destructive drug-resistant pulmonary tuberculosis and to evaluate the impact of collapsing procedures and surgical interventions on the outcome of treatment according to immediate and long-term observations. Materials and methods. The study included 398 patients with destruc-tive pulmonary tuberculosis with registered multiple (MDR-TB) in 61.3% and extensively drug-resistant (XDR-TB) in 38.7% of patients. Depending on the treat-ment tactics chosen in the clinic, 2 groups of patients were formed who received individualized chemothera-py based on the results of drug susceptibility testing of the pathogen and were comparable in other significant evaluation criteria. The main group consisted of 269 pa-tients, whose management tactics included the staged use of invasive methods of treatment, the comparison group — 129 patients who received only adequately selected anti-tuberculosis chemotherapy due to the im-possibility of using invasive methods. Staged invasive treatment included collapsotherapeutic techniques used in the absence of regression of the tuberculosis process against the background of adequately selected chemo-therapy for 1.5–2 months, and, if the previous stage was ineffective, resection surgery 4–6 months after the start of treatment in the clinic. Results: In the main group, collapse therapy procedures were performed in 179/269 (66.5%) patients, and they were successful in 106/115 (92.2%) patients with MDR-TB and in 51/64 (79.7%) pa-tients with XDR TB (p=0.44). Surgical interventions were performed in 25/269 (9.3%) patients, which were effec-tive in 20/25 (80%). Postoperative complications were registered in 4/25 (16%) patients. In general, microbiolog-ical conversion of sputum and closure of decay cavities were registered in 245/269 (91.1%) patients of the main group and in 75 out of 129 (58.6%) of the comparison group. Conclusion. Timely correction of treatment tac-tics based on the staged application of collapse therapy and surgical methods made it possible to achieve a cure in 91.1% of previously ineffectively treated patients with destructive pulmonary MDR/XDR tuberculosis.

МІНІІНВАЗИВНА ТОРАКОПЛАСТИКА ПРИ ХІРУРГІЧНОМУ ЛІКУВАННІ ДЕСТРУКТИВНОГО ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

Aim: to evaluate results of application of the developed technique of minimally invasive extrapleural thoracoplasty in the surgical treatment of patients with destructive pulmonary tuberculosis. Object and methods. Minimally invasive thoracoplasty was performed in 15 patients (study group): men made up 100 %, in the age range from 26 to 58 years. Chronic forms of pulmonary tuberculosis were diagnosed in 10 (66.6 %) patients, newly diagnosed tuberculosis in 5 (33.4 %). Multidrugresistant tuberculosis was observed in 78 % of patients. Bacterial excretion was observed in 86 % of patients. The size of the cavity in the lung did not exceed 6 cm. All patients in the pre- and postoperative periods received chemotherapy regimens based on the prescription of the CMAC / CRTB treatment regimen. The following effectiveness criteria were assessed: cessation of bacterial excretion 1 month after surgery (negative Bactec culture); closure of the destructive cavity confirmed on chest CT scan, the number of postoperative complications and the presence of relapses in the postoperative period. A new method of minimally invasive thoracoplasty was developed to improve the method of collapse-surgical treatment of patients with destructive pulmonary tuberculosis. It uses a resection of small segments of ribs, both in length and in number, extrapleural apicolysis and mediastinal pneumolysis, fixation of the lowered apex of the lung with polypropylene mesh, sealing the created extrapleural cavity with collagen to achieve adequate collapse of the lung in the cavernous zone and accelerate reparative pericavitary processes. The results. 15 patients were operated on according to this technique. Postoperative complications were observed in 1 (6.6 %) patient. Cessation of bacterial excretion after 1 month of treatment was registered in 100 % of patients, closure of the cavity after 2 months of treatment was achieved in 14 (93.3 %) patients. Key words: minimally invasive thoracoplasty, destructive pulmonary tuberculosis, polypropylene mesh, collagen plates.

Influence of the Distraction Cavity Size on the Choice of the Compression Technique in Thoracoplasty in Patients with Advanced Fibrous-Cavernous Tuberculosis

Introduction. Extrapleural upper-posterior thoracoplasty is the most common non-resectable surgery in the treatment of patients with advanced fibrous-cavernous pulmonary tuberculosis. However, there is still no unified approach in choosing the thoracoplasty and compression options of the destruction cavity.The aim of the study was to assess clinical outcomes of various compression methods in extrapleural upper-posterior thoracoplasty considering the destruction cavity size.Materials and methods. The study included 233 cases of upper posterior thoracoplasty performed in 2012-2019. All cases were fibrous-cavernous pulmonary tuberculosis when the process extended beyond one lobe and was widespread. Group 1 (n=70) involved patients with hybrid thoracoplasty with polypropylene mesh; group 2 (n=60) involved patients with modified osteoplastic thoracoplasty; group 3 (n=103) involved patients with conventional selective extrapleural upper-posterior thoracoplasty. When analysed, attention was paid to elimination of the decay cavity and bacterial excretion.Results. The publications analysed demonstrate that the main criteria for choosing a plastic surgery option are traditions of the clinic and personal preferences of a surgeon. The study evidenced the best performance of hybrid compression over conventional and modified thoracoplasty (p0,05). Obviously, the choice of thoracoplasty option and the number of resected ribs should be based on the data including the total size of the destruction cavity and the compression technique.Conclusion. The proposed distribution of upper-posterior thoracoplasty depending on the compression technique allows individually selecting the most effective treatment options for patients with widespread fibrous-cavernous tuberculosis with destruction cavities up to 6 cm localized in the upper lung.

Аssessment of segmental bronchial blocking success in the comprehensive treatment of patients with destructive pulmonary tuberculosis

The experience of using bronchial valve placement in emphysema treatment and studies on the effect of collateral ventilation in lobar bronchial blocking cast doubt on the effectiveness of this technique at the level of segmental bronchi using a single blocker. The aim of the study is to evaluate the effectiveness of segmental valve placement in the comprehensive treatment of patients with destructive pulmonary tuberculosis. The study is based on the results of evaluation of chest CT data of patients with destructive forms of pulmonary tuberculosis before and after valve placement. The correlations between the selected features were assessed and a model for predicting the cavity closure was built. A statistically significant cor-relation was found between the change in the segment volume after valvular blocking and the closure of the de-struction cavity. As a result, the low efficiency of segmen-tal valve placement in the comprehensive treatment of patients with pulmonary tuberculosis was revealed.

Invasive technologies in the complex treatment of tuberculosis in children and adolescents: from the past to the present (literature review)

Invasive technologies in the complex treatment of tuberculosis in children and adolescents have a long history, which began in the pre-antibiotic period. This is the way of their improvement from independent use of artificial pneumothorax and pneumoperitoneum to the use of these techniques in the complex treatment of respiratory tuberculosis during the development of chemotherapy for the disease. New technology uses valvular bronchial blocking. That procedure creates hypoventilation and atelectasis in the affected region of the lung with preservation of drainage function of the blocked bronchus and destruction cavity, which allow reducing indications for surgical treatment as a method with a high level of injury rate. The approaches to surgical intervention in children and adolescents with respiratory tuberculosis have also changed. It is also part of the comprehensive treatment of the disease. Minimally invasive accesses under the control of video-assisted thoracoscopy are used, which significantly reduced the risk of surgery and increased the immediate efficiency of surgical treatment. New technologies combined with all types of surgeries are being widely developed: electro- and argon plasma coagulation and pleurodesis, vaporization of the tuberculous lesion, and encapsulated pleura by high-energy CO2 laser, new materials (polypropylene implants) are used. Further development of invasive technologies with multiple and extensively drug-resistant Mycobacterium tuberculosis, to children and adolescents compensates for the lack of efficiency of conservative chemotherapy and is an urgent problem at the present stage of pediatric phthisiology.

Surgical treatment of broncho­­pulmonary purulent­inflammatory complications due to permanent coronaviral ihfection — the first experience

Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection.
 Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection.
 Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. 
 Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

ХІРУРГІЧНЕ ЛІКУВАННЯ ТОРАКАЛЬНОЇ ПАТОЛОГІЇ У ХВОРИХ НА КОРОНАВІРУСНУ ІНФЕКЦІЮ

THORACIC SURGICAL TREATMENT IN PATIENTS WITH CORONAVIRUS INFECTION M. S. Opanasenko, B. M. Konik, S. M. Belokon, O. V. Tereshkovich, S. M. Shalagai, L. I. Levanda, M. I. Kalinichenko, V. I. Lysenko, M. U. Shamrai, A. M. Stepanyuk, O. D. Shestakova Abstract Aim. To familiarize physicians of different specialties with thoracic pathology in patients with coronavirus infection (COVID-19). Materials and methods. Since the beginning of the COVID-19 pandemic 63 patients were treated at the department of surgical treatment of tuberculosis and NLD, complicated by purulent-septic infections: 47 (74.6%) — with various complications of coronavirus infection, and 16 (25.4%) — COVID-19 and conditions, requiring thoracic surgery, not associated with COVID-19. Results. Pleural empyema was the most common bacterial complication — 18 (28.5%) cases. Only 6 (9.5%) patients were diagnosed with broncho-pleural fistula, while 12 (19.6%) patients already had a functioning broncho-pleural fistula at the stage of hospitalization. In 15 (23.8%) patients, the destructive cavities remained on admission, and only 3 (4.7%) had isolated pleural empyema without destruction of pulmonary parenchyma (complete scarring of abscesses). 17 (26.9%) patients with empyema underwent videothoracoscopic (VATS) drainage of the pleural cavity with polydrainage and the use of long-term active aspiration in the postoperative period. In 1 (1.5%) case, due to the extremely severe condition of the patient, only drainage of both pleural cavities was performed. 1 (1.5%) patient with bilateral pleural empyema died of progressive respiratory and cardiovascular failure. Nonspecific exudative pleurisy was diagnosed in 8 (12.6%) patients after coronavirus infection. Spontaneous pneumothorax without development of pleural empyema was diagnosed in 7 (11.1%) patients and in 3 (4.7%) cases pneumo hemothorax occurred. in 2 (3.1%) cases there was a need for parietal pleurectomy (there was a significant area of detachment of the visceral pleura and the impossibility of imposing intracorporeal sutures). All patients were discharged from the hospital with recovery. 6 (9,5 %) patients with necrotizing pneumonia comprised a challenging group of patients with large, treatment-resistant cavities. In 4 (6.3%) cases antibacterial therapy was ineffective, so transthoracic cavity drainage was performed. All 6 patients underwent radical resection interventions following long pre-operative period: 3 (4.7%) cases - pleurolobectomy, 2 (3.1%) — sublobar resection and 1 (1.5%) - resection of the 6th segment of right lung). Conclusions. Pulmonary purulent-destructive COVID-19 complications may occur much more rarely if timely treatment was used. Videothoracoscopic intervention is a preferred option of treatment of these conditions. Key words: COVID-19, thoracic pathology pneumohemothorax, pleurodesis. Ukr. Pulmonol. J. 2021;29(3):31–35:

INDICATORS OF CLINICAL, RADIOLOGICAL, AND LABORATORY STATUS IN MALE PATIENTS WITH NEWLY DIAGNOSED INFILTRATIVE PULMONARY TUBERCULOSIS

Introduction. In Ukraine, despite the free medical care in the field of tuberculosis, the effectiveness of tuberculosis treatment does not meet WHO standards. With the lack of resistance of Mycobacterium tuberculosis to the first-line anti-TB agents, the desired improvement in clinical and radiological results in the first 2 months of treatment is not always possible to achieve. The causes of the poor efficiency remain unknown and require detailed study. The objective was to study clinical, radiological, and laboratory data of male inpatients with newly diagnosed infiltrative pulmonary tuberculosis at the beginning of treatment. Materials and Methods. 133 men with newly diagnosed infiltrative pulmonary tuberculosis sensitive to the first-line anti-TB agents were examined. The data of clinical, radiological, and laboratory parameters were studied; immunological parameters of IL‑4, IL-10, IFN-γ, and data of phagocytic activity of neutrophils were additionally examined. All patients were tested for anxiety and depressive disorders using the State-Trait Anxiety Inventory and Beck Depression Inventory. Results. It was found that at the beginning of treatment, patients with pulmonary destruction cavities had a 2.7-fold higher incidence of intensive bacterial excretion and a 1.6-fold reduction in IFN-γ levels as compared with patients without lung tissue destruction. Men with an extended infiltrative process in the lungs presented with fever and symptoms of intoxication more than 2.5 times more often, with cough – more than 4 times more often, with a history of weight loss – more than 2.9 times more often, with Mycobacterium tuberculosis detected by microscopy – more than 6.2 times more often vs. men with a limited process in the lungs. Conclusions. Patients with newly diagnosed infiltrative pulmonary tuberculosis who had destructive changes in lung tissue and a significant extension of the pathological process were characterized by more pronounced clinical manifestations, intoxication, activation of systemic inflammatory response factors, decreased activity of the cellular immune system, and psychological disorders.

ЗАСТОСУВАННЯ КЛАПАННОЇ БРОНХОБЛОКАЦІЇ У ЛІКУВАННІ ХІМІОРЕЗИСТЕНТНОГО ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

O. I. Shpak, V. B. Bychkovskyi, O. B. Randiuk, M. S. Opanasenko, O. V. Tereshkovich, B. N. Konik, O. A. Gaidar, L. I. Levanda Аbstract Endoscopic bronchial valve blocking is a type of interventional bronchoscopy, which makes a therapeutic hypoventilation with the subsequent development of atelectasis in the affected area of the lung while maintaining the drainage function of the blocked bronchus and the cavity of destruction or closure of the bronchial defect by using an endobronchial valve. Aim: to evaluate the results valvular bronchial blocking in patients with chemo-resistant pulmonary tuberculosis (CRPTB) instead of surgical intervention or in the postoperative period. Materials and methods. 94 bronchial blockages were performed in patients with CRPTB. The patients were divided into three groups. Group I (36 patients) — a valve was placed during chemotherapy without surgical treatment. Group II (31 patients) — pyopneumothorax with destruction cavity discharge into the pleural cavity. Group III (27 patients) — volume reduction surgery(lobectomy, bilobectomy and pulmonectomy), complicated by the bronchial stump incompetency. Results. In group I favorable outcomes were observed in 27 cases (75,0 %). In patients with pneumothorax, complicated by empyema of the pleural cavity and bronchopulmonary fistula (group II) the favorable outcomes were achieved in 28 (90,3 %) patients. In postoperative patients, undergoing different volume reduction interventions (group III), favorable otcomes were registered in 23 (85,2 %) patients. Conclusion. Valvular bronchial blocking is highly effective method in the treatment of patients with CRPTB and certain complications (empyema of the pleural cavity with bronchopulmonary fistula, failure of the bronchial stump in the postoperative period), and in patients, who already underwent surgery, as well. Key words: chemo-resistant pulmonary tuberculosis, complications, bronchial valve blocking, surgical treatment.

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

Efficacy of infusion chemotherapy in patients with pulmonary tuberculosis with treatment failure and malabsorption syndrome

Objective. To investigate the effectiveness of infusion chemotherapy in patients with pulmonary tuberculosis (TB) with treatment failure and malabsorption syndrome.
 Materials and methods. We observed 52 patients with newly diagnosed pulmonary TB with treatment failure, who were diagnosed with malabsorption syndrome. Patients were divided into two groups: 1st group (main) included 24 patients who received rifampicin and ethambutol intravenously, pyrazinamide and isoniazid orally; 2nd group (control) – 28 patients who received standard therapy orally. The severity of malabsorption syndrome was determined by a violation of intestinal penetration. Intestinal penetration was determined by the concentration of lactulose and mannitol (lactulose-mannitol test) in urine. The concentration of rifampicin, isoniazid, ethambutol in the serum was determined by liquid chromatography on a chromatograph Perkin Elmer (USA).
 Results and discussion. The examination revealed a violation of the rate of intestinal penetration in all studied patients, compared with healthy donors. The concentration of anti-TB drugs in the serum was significantly lower than the therapeutic average in group 2 compared with group 1 (p<0,05). In patients of group 1 after the intensive phase of treatment, the disappearance of clinical symptoms of the disease was observed in 22 (91.3±5.8 %) and 17 (60.7±6.3 %) patients (p<0.05), cessation of mycobacterial excretion – in 20 (83.3±4.3 %) and 14 (50.4±4.6 %) (p<0.05), resorption of infiltrative changes and healing of destruction cavities in the lungs – in 12 (50.2±5.3 %) and 10 (35.7±4.7 %) (p<0.05) compared with group 2.
 Conclusions. In patients with malabsorption syndrome with ineffective treatment and low intestinal penetration, which leads to reduced serum concentrations of anti-TB drugs in the intensive phase of treatment, it is advisable to increase the effectiveness of intravenous rifampicin and ethambutol.

Pneumonectomy in the treatment of tuberculosis relapse in a previously resected lung

THE OBJECTIVE of our study was to increase the efficiency of treatment of tuberculosis postoperative reactivations in a previously operated lung, by clarifying the medical indications, improving surgical techniques and tactics when removing a previously resected lung.METHODS AND MATERIALS. We analyzed the results of treatment of 220 patients who, in the 2004–2017 timeframe in our institution, had pneumonectomies (76 cases) and pleuropneumonectomies (144 cases) for tuberculosis relapse in a previously operated lung. For more objective planning of surgical treatment and evaluation of its results, we identified three degrees of treatment radicalism: radical, conditionally radical, and palliative.RESULTS. 32 patients, who had carried a radical surgery, were diagnosed as having a complete clinical effect at the time of discharge (absence of destruction cavities in a single lung, bacterial excretion and illiquid complications) in 100 % of cases; in the group of patients operated conditionally radical, there were diagnosed 161 out of 168 (95.8 %) and in the group of patients operated palliative, there were distinguished only 3 cases out of 20 (15.0 %).CONCLUSION. The implementation of the completion pneumonectomy and pleurapneumonectomy is accompanied by high technical complexity and more frequent development of intraoperative and postoperative complications. At the same time, the high efficiency of treatment of tuberculosis relapses in a previously operated lung can be achieved using the recommended tactics and techniques of surgical treatment when performing radical and conditionally radical interventions.

Results of treatment of bilateral destructive pulmonary tuberculosis patients using mini-invasive surgical interventions.

There were analyzed case-histories of patients operated on bilateral destructive pulmonary tuberculosis who underwent treatment at pulmonary-surgical unit of CI “DRCCTPA” Phthisiatria” from 2010 to 2018. Case histories of 259 patients’ were included in the study, in complex treatment of which, surgical stage of treatment was used. Analyzing direct results in 2 months after surgery, the estimation based on clinical, roentgenologic and laboratory studies by criteria of destruction cavities closure, bacterioexcretion termination and clinical stabilization of the tuberculosis process was used. In carrying out a research patients were divided into 2 groups: the main group consisted of 129 patients who underwent mini-invasive methods of surgical treatment with mini-access under the control of video-thoracoscopy (single-step or staging bilateral video-assisted lung resection – 58 patients, collapse-surgical video-assisted single-step or staging interventions – 53, staging mini-invasive pleuropneumonectomy – 18). The comparison group included 130 patients operated according to standard approaches with conventional methods. Comparison groups did not differ reliably (p>0,05) by the gender and the age, by tuberculosis forms, by disease duration, by functional parameters, by main prevalence and severity of tuberculosis. A biggest number of complications in both groups was noted after pleuropneumo­nectomies, lobectomies and thoracoplasty. In the comparison group postoperative complications were observed in 32 (24.6%) patients, that is 2.2 more often (p=0.002). In the main group, bronchopleural complications occurred in 8 cases (6.2%), and in the comparison group – in 16 (12.3%), that is 2 times less frequently, exacerbation of tuberculosis process was noted 3.8 times more often in patients of comparison group. Performed analysis of the nature of postoperative complications in both groups confirms the effect of traumatism of access not only on the course of the wound process, but also on the frequency of pleural, pulmonary and functional complications. A complete clinical effect in the patients of comparison group was achieved in 82 cases (63%), that is by 1.4 times less than in the main group (p<0.001). Abacillation, while maintaining destruction in one of the lungs, occurred at the time of discharge from the hospital in 12 (9.3%) patients of the main group and in 21 (16.5%) – of the comparison one. There were 3 (2.3%) patients discharging bacteria in the main group and 20 (15.4%) patients in the comparison group.

A New Approach for Partial Discharge Modeling in High Voltage Cables Considering Nonlinear Permittivity Using Finite Element Method

Herein, we report a novel technique to develop remote assessment and observation for partial discharge events under high voltage cable systems output. Finite element modeling of the cavities bided in the insulators which are the source of Partial Discharge signals occurred in a 3-d section of a typical 230 KV high voltage XLPE 3-phase cable. All electromagnetic related equations are solved using FEM software. The idea is to consider the permittivity constant in cavities as a nonlinear function during the solving process. This function is related to electric field value inside each cavity. This modeling leads to a new approach in simple modeling of PD phenomena in the H. V. apparatus with the big amount of destructive PD cavities. In continue, the obtained waveform is illustrated respecting to the main power line waveform.

Application of transplants in collapse surgery in patients with lung tuberculosis

Russia is one of the countries with high incidence rate of pulmonary tuberculosis. The existence of Mycobacterium tuberculosis under the persistent antibacterial therapy effect leads to a formation of drug resistant forms especially in immunodeficiency in persons with HIV-infection, the number of which is increasing every year. The use of combination of different types of collapse surgery in order to maintain a larger volume of normal pulmonary tissue enables to increase the number of cured patients. The results of literature review show a development and improvement of collapse surgery techniques. The application of different methods of compression of the affected part of the lung, collapse of destruction cavity and fixing the lung in a collapsed state are presented. The main reason for use of transplants in pulmonary tuberculosis collapse surgery is to create conditions for reparation and increase of efficacy of surgical treatment for destructive forms of pulmonary tuberculosis in cases in which for one reason or another it is impossible to perform a respective surgical operation.

Impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients

To analyze the impact of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality of these patients. Treatment strategy for destructive pulmonary tuberculosis de novo was developed in the Sechenov First Moscow State Medical University. This strategy was applied at the Surgical Department of the Regional Tambov Tuberculosis Dispensary in 2013-2017. We formed a register of patients with pulmonary destruction and bacterial excretion and developed a personal treatment plan. All patients were divided into 3 groups (group A - surgical treatment, group B - no surgery due to refusal or discontinuation of treatment, group C - patients with contraindications or no indications for surgical treatment). Treatment efficacy considering closure of destruction cavities and abacillation was maximal in group A - 97.2%, 41.4% in group B and 39.8% in group C. The number of patients with pulmonary destruction and bacterial excretion has decreased by 3.3 times (from 516 to 158) or 69.8% for 4 years of extensive application of surgical treatment protocol. A significant reduction of 'bacillary core' interrupted infection chain and affected the main epidemiological characteristics. Short-term reduction of the incidence of tuberculosis may be expected. However, even more significant impact of this factor should be expected in the long-term period. Surgical treatment of destructive pulmonary tuberculosis improves efficacy of the management of these patients and reduces mortality rate.

Influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality

To analyze the influence of surgical sanation of patients with destructive tuberculosis on the prevalence of tuberculosis and mortality. The strategy of treatment for new cases of destructive pulmonary tuberculosis was developed in the Perelman Department of Phthisiopulmonology and Thoracic Surgery of the Sechenov First Moscow State Medical University. This strategy was applied in the tuberculosis surgical department of the Tambov Regional Dispensary in 2013-2017. A register of patients with pulmonary destruction and bacterial excretion was developed and personal treatment plans were applied. Patients were divided into 3 groups depending on the treatment mode. The main group A consisted of patients who underwent surgical treatment. Surgery was not performed due to failure or discontinuation of treatment in the comparison group B. Group C included patients without indications or with contraindications for surgical treatment. Treatment efficacy considering destruction cavities closure and abacillation was 97.2% in group A, 41.4% in group B and 39.8% in group C. Surgical approach for patients with destructive tuberculosis reduced the number of patients in the register by 3.3 times (from 516 to 158) within 4 years. A significant reduction of the bacillary core allows breaking the infection chain, that affects the main epidemiological indicators. Reduced incidence of tuberculosis is observed in short-term period, but even greater impact of this factor should be expected in long-term follow-up. Surgical approach in complex treatment of destructive pulmonary tuberculosis is valuable to improve efficacy of management of these patients and reduce mortality rate.