Fibrous Cavernous Pulmonary Tuberculosis Research Articles

Intraoperative use of a polymer mesh implant in common destructive pulmonary tuberculosis complicated by empyema with bronchopleural fistula

The article observes a clinical case – intraoperative use of anterior mediastinal plastic surgery with a mesh implant for transsternal occlusion of the main bronchus in a patient with widespread destructive pulmonary tuberculosis complicated by pleuralempyema with bronchopleural fistula. A control examination after 1.5 years showed a clinical cure of tuberculosis of a single lung. When comparing functional indicators, there was a slight increase in vital capacity (VC) and forced expiratory volume in the first second (FEV1). There were no changes in the indicators of pO2, pCO2. Also, unchanged left ventricular ejection fraction and a substantial decrease in pulmonary artery pressure positively affected the patient's general condition.

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%.

Organ-preserving technologies of surgical treatment of pulmonary tuberculosis using VAC therapy

This article demonstrates the possibilities of vacuum-assisted closure (VAC therapy) in surgical treatment of one of the most severe categories of patients — patients with chronic pulmonary tuberculosis with widespread drug resistance. The authors show the effectiveness of VAC therapy in various clinical situations: VAC therapy in combination with endoscopic valvular bronchoblocation, as an independent treatment method in a patient with bilateral fibrous-cavernous pulmonary tuberculosis, as well as a combination of VAC therapy with retrograde occlusion of bronchial fistula. The special feature of these cases is the performance of low-trauma organ-preserving operations in patients with no prospect of cure by conservative methods.

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.

ОЦЕНКА ПОСЛЕДСТВИЙ ВЛИЯНИЯ ПАНДЕМИИ COVID-19 НА СИСТЕМУ АКТИВНОГО ВЫЯВЛЕНИЯ СЛУЧАЕВ ТУБЕРКУЛЁЗА В РОССИЙСКОЙ ФЕДЕРАЦИИ

Significance. The COVID-19 pandemic has disrupted the system of active detection of many diseases, including tuberculosis (TB). However, the assessment of this effect based on the decreased TB incidence alone is not correct, since the regiment to fight COVID-19 has created conditions for preventing the spread of other infectious diseases. The purpose of the study was: to assess dynamics in active TB detection, as well as the number of late detected TB cases due to the COVID-19 pandemic. Material and methods. The study analyzed statistical observation forms # 8 and #33. The excess number of newly diagnosed cases of fibrous-cavernous pulmonary tuberculosis (FCPTb) was calculated as multiplied by the number of newly diagnosed TB cases to the difference in the average share of fibrous-cavernous pulmonary tuberculosis cases in 2016-2019 and the share of fibrous-cavernous pulmonary tuberculosis cases in the year under study (2020, 2021, 2022). The excess number of TB patients diagnosed postmortem was calculated as multiplied by the number of newly diagnosed TB cases to the difference in the average share of TB cases detected postmortem in 2015-2019 and the share of TB cases detected postmortem in the year under study (2020, 2021, 2022). Results. In 2020, the population coverage with preventive medical examination for TB decreased to 66.7%, which is close to the 2015 level (68.1%) followed by a growth to 70.6% in 2021 (the 2017 level) and further to 73.6% in 2022 (the 2019 level). The share of newly diagnosed fibrous-cavernous pulmonary tuberculosis cases in 2016-2019 equaled to 1.1%, increased to 1.4% in 2020, to 1.5% in 2021, and 1.4% in 2022. The share of TB cases detected postmortem equaled to 1.6-1.8% in 2008-2019; to 2.7% in 2020, and to 2.9% in 2021 and 2022. The excess number of newly diagnosed fibrous-cavernous pulmonary tuberculosis cases equaled to 109 in 2020, 188 in 2021, and 128 in 2022. The excess number of TB cases detected postmortem equaled to 480 in 2020, 566 in 2021, and 540 in 2022. Conclusion. The impact of the COVID-19 pandemic on the system of active TB detection in the Russian Federation was strong, yet rather short-run. However, the three years of the COVID-19 pandemic has resulted in the delay in detection of 2011 TB patients (1.5% of the total number of newly diagnosed TB cases)

Syndromes of gas exchange disorders in patients with pulmonary tuberculosis

Introduction. Measurement of diffusion in the lung is important in the diagnosis and management of most pulmonary diseases. The analysis of diffusion lung capac-ity (DLCO) in combination with body plethysmography is useful for the interpretation of the causes of pulmo-nary gas exchange disorders. The aim: to determine the leading syndromes of pulmonary gas exchange disorders in patients with pulmonary tuberculosis (PT). Materials and methods. 608 patients (244/364 M/W) with veri-fied PT with smoking history of less than 10 pack/years were examined. Spirometry, body plethysmography, and DLCO were performed by the single-breath breath-hold-ing method. Results. DLCO decrease was detected in the majority of patients with PT (76%): in 94% of patients with massive fibrous-cavernous PT, 79.4% with disseminated PT and more than 60% of patients with infiltrative foci, local cavities, tuberculomas. In patients without ventilation dis-orders (58.4%), DLCO decrease was caused by damage to the alveolar capillary membrane, less often by air trapping (35.1%), other cases were rare. In the obstructive variant, mixed disorders of gas exchange (38.2%) and air trapping (34.1%) were most typical. In the restrictive variant, gas exchange surface reduction (62.5%) and mixed disorders (30%) prevailed. In mixed ventilation disorders, the mixed pulmonary gas exchange disorders were most often de-tected (63.8%) and the gas exchange surface reduction was quite common (36.2%) also. Conclusion. Alveolar cap-illary membrane damage (35.1%) and air trapping (28.1%) were most common in patients with PT. The mixed variant and gas exchange surface reduction were detected less frequently (24.7 and 12.1%, respectively), but these syn-dromes led to the most significant DLCO decrease.

Matrix Metalloproteinases in Pathogenesis of Ventilation Disorders of the Respiratory System in Patients with Chronic Pulmonary Tuberculosis

The imbalance in matrix metalloproteinase (MMP)/inhibitors system leads to degradation of extracellular matrix of connective tissue and pathological remodeling forming the morphological basis for respiratory dysfunction.The objective: to study the relationship between parameters of MMP/inhibitors system in blood and parameters of ventilation and gas exchange disorders in patients with chronic pulmonary tuberculosis (PTB).Subjects and Methods. Patients with the verified diagnosis of tuberculoma (n = 45) and fibrous-cavernous pulmonary tuberculosis (n = 85) were examined. All patients underwent computed tomography of the chest and assessment of respiratory function. Serum concentrations of MMP-1, -3, -8, -9 and their inhibitors TIMP-1 and α2-macroglobulin (MG) were tested by ELISA (R&D Systems, Minneapolis, MN, USA). Statistica 7.0 and an ANCOVA model were used for statistical analysis which considered the diagnosis and smoking status as factors, and the respiratory function parameters were considered as covariates.Results. In pulmonary tuberculosis patients, the concentrations of MMP-9 and MMP-8 in the blood correlated with extension of lung parenchyma lesions when compared to tuberculomas and fibro-cavernous tuberculosis, MMP-9 and TIMP-1 with changes in lung volumes (R2 = 0.60 and 0.80; p = 0.001), and MMP-8 correlated with functional disorders of gas exchange (R2 = 0.60 and 0.80; p = 0.001). Changes in MMP-1, MMP-3, and α2-MG (R2 = 0.60 and 0.80; p = 0.45) did not correlate with extension of lung parenchymal lesions and decreased lung function.

Long-term results of 10 years of observation of cured cases of pulmonary tuberculosis

Aim of the study: Conduct long-term monitoring of recovered patients with pulmonary TB and study the frequency of relapses of pulmonary TB and factors contributing to their development in the Republic of Tajikistan. Material and research methods: Of the total number of patients with pulmonary TB, 820 people in 2010-2011 after successful treatment, were transferred for further dispensary observation to PHC facilities, whose health status we monitored for 10 years (including 2020). Of the 820 patients, we were able to track the health status for 10 years in 622 patients (320 men and 302 women, age groups 19-44 years old - 330 people and 45-69 years old - 292 people). The rest - for various reasons were lost from further dispensary observation. All patients in PHC facilities annually during the period of dispensary observation underwent clinical, instrumental, laboratory, and X-ray examinations to exclude the recurrence of TB. Data for each patient were tracked using the National TB Registry OpenMRS data. Research results: The elimination of preventive anti-relapse measures in people with residual post-tuberculosis changes in the lungs led to an increase in the number of relapses of the disease. The analysis of the conducted studies shows that the incidence of relapses of pulmonary TB does not depend on the regions and the severity of TB burden, they often develop with insufficient follow-up after the end of treatment and inadequate preventive measures in dispensaries patients. The study of the reasons for the development of relapses makes it possible to timely identify a group of patients who need anti-relapse measures and prolongation of dispensary observation. Conclusion: Thus, the results of this observation revealed the occurrence of relapses within 10 years in 19.3% of cases. A retrospective analysis of the initial forms of the disease showed that relapses of pulmonary tuberculosis occurred more often in patients who had had fibrous-cavernous pulmonary tuberculosis, than in patients who had disseminated pulmonary TB, and less often after suffering infiltrative pulmonary TB. Relapses of the disease occurred more often in men aged 19-44 years. The results obtained indicate the development of relapses of pulmonary tuberculosis has a statistically significant dependence on the form of the initial disease, the presence of RPTCL, comorbid diseases such as HIV, diabetes mellitus, COPD, and the regularity of taking anti-TB drugs. At the same time, it turned out that the social status of all patients with relapses corresponds to the level of poverty, which should also be taken into account.

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.

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.

The structure of intra- and postoperative complications after surgery for fibrous-cavernous pulmonary tuberculosis and their impact on the surgery outcome

The objective: to study the frequency, structure and impact on the surgery outcome of intra- and postoperative complications after lung resections for fibrous-cavernous tuberculosis.Subjects and Methods. A retrospective cohort analysis of intra- and postoperative complications was performed in 847 patients who underwent surgery for fibrous-cavernous pulmonary tuberculosis. Their influence on the surgery outcome was determined in accordance with the modified Russian classification of surgical errors assessment by R. M. Satava and the Accordion classification for severity of surgical complications. It has been established that the most dangerous complications that adversely affect the result of the operation are the following: injury to the cavity, vessels of the root of the lung and systemic circulation, empyema of the pleural cavity, exacerbation of tuberculosis, and pulmonary heart. These complications caused an unfavorable outcome in all 47 patients with such an outcome and led to a fatal outcome in 22 (78.6%) patients out of 28 deceased patients. Additions to the Accordion classification of postoperative complications are proposed taking into account the specific features of surgeries for 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.

Tuberculosis Situation in the Years of the COVID-19 Pandemic – 2020-2021

The article presents the analysis of changes in preliminary and estimated epidemiological rates: tuberculosis (TB) incidence, TB mortality, and clinical and social structure of new TB cases. It has been found that against the background of continuing improvement of the epidemic situation (reduction of TB incidence and mortality), the clinical structure of TB cases detected in 2020-2021 deteriorated compared to 2015-2019 which was manifested by higher frequency of pulmonary tissue destruction, massive bacterial excretion (by smear), and fibrous cavernous pulmonary TB. The number of TB cases detected post mortem has increased, as well as one-year mortality. These changes indicate low detection of TB cases in 2020. Changes in the incidence of TB/HIV co-infection and the number of new cases with bacterial excretion and multiple drug resistant TB essentially repeat the changes in TB incidence in the resident population during this period.

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.

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.