Fibro-cavernous Pulmonary Tuberculosis Research Articles

The level of neutrophil elastase as an indication for surgical treatment of pulmonary tuberculosis

The pathogenesis of tuberculosis is complex. The participation of the proteolytic system in it is not in doubt, at least in the decay phase. Clarification of this link in the pathogenesis, in our opinion, will be able to expand the diagnostic capabilities and treatment of pulmonary tuberculosis, including surgery. However, in practice, the state of the proteolytic system and its components in tuberculosis have not been studied, which emphasizes the urgency of the problem.
 Objective — to study the level of neutrophil elastase (NE) as a leading enzyme of the proteolytic system in patients with pulmonary tuberculosis to expand the diagnostic possibilities in suspected tuberculosis and clarify its features and possible volume and indications for surgery.
 Materials and methods. Under our clinical observation were, 66 patients with pulmonary tuberculosis were divided into two groups depending on the resistance of Mycobacterium tuberculosis to anti-tuberculosis drugs. The first group consisted of 39 (59.1 %) individuals whose mycobacteria were susceptible to anti-TB medicines. The second group included 27 (40.9 %) patients with multidrug-resistant pulmonary tuberculosis.Results and discussion. In patients with susceptible forms of a specific process, the level of elastase was in the range of 35.2—215.1 nmol/min ⋅ ml and averaged 110.1 nmol/min ⋅ ml. In patients with multidrug-resistant tuberculosis (group II), the elastase level was in the range of 34.6—163.1 nmol/min ⋅ ml, which averaged 78.4 nmol/min ⋅ ml (p < 0.05). The highest level of NE (93.0 nmol/min ⋅ ml) occurred in patients with infiltrative pulmonary tuberculosis. In disseminated pulmonary tuberculosis, the level of NE was 74.5 nmol/min ⋅ ml, which is significantly less (18.5 nmol/min ⋅ ml, or 1.25 times) than in infiltrative tuberculosis. In tuberculoma, the level of elastase was 68.1 nmol/min ⋅ ml. In fibrocavernous pulmonary tuberculosis, the level was not the lowest (30.9 nmol/min ⋅ ml).
 Conclusions. The level of neutrophil elastase in patients with susceptible pulmonary tuberculosis compared to patients with multidrug-resistant pulmonary tuberculosis was significantly higher (1.4 times). Decreased levels of neutrophil elastase characterize the reduced activity of the proteolytic blood system and may be a sign of chronicization of tuberculosis, which justifies the use of surgical treatment.

The effectiveness of the main course of chemotherapy for drug-resistant tuberculosis

SummaryThe article is devoted to the effectiveness of treatment of tuberculosis with MDR-TB and XDR-TB mycobacteria after the main course of chemotherapy. The treatment of tuberculosis with multiple and broad MD MBT is a com-plex and urgent task. Prescribing the latest generation of drugs (thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid) in the complex composition of tu-berculosis therapy with MDR and XDR-MBT significantly increases the effectiveness of the main course of treat-ment, compared with the control group, respectively (85.0% and 65.8%). Мaterials and methods. The main course of chemotherapy was completed by 119 patients with pulmonary tuberculosis with drug-resistant patho-gen, who were diagnosed for the first time, treated in anti-tuberculosis hospitals in St. Petersburg and on an outpatient basis in St. Petersburg “Inter-district Petro-grad-Primorsky TB dispensary No 3”. Clinical, radiological, and laboratory data are presented. All patients were iden-tified with Mycobacterium tuberculosis with multiple and broad drug resistance MBT. The patients were divided into 2 groups: the main group (OG) — 40 people, received the latest generation drugs; 79 patients (KG) — received standard therapy without the inclusion of the latest gen-eration of drugs. Half of the patients in all age groups were identified during a preventive examination (50.4%), a third when applying for complaints (31.9%), and one — when examining for contact with a patient with tubercu-losis. Infiltrative tuberculosis was most often diagnosed in 75 (63.0%), disseminated tuberculosis was detected in 20 (16.8%), and fibrocavernous pulmonary tuberculo-sis — in 24 (20.2%). The decay phase was diagnosed in 88 (73.9%) patients. Three-quarters of the studied patients had 90 comorbidities (75.6%). Results and discussion. The groups are comparable in terms of clinical, radiologi-cal, and bacteriological parameters. By the fourth month of the therapy, the cessation of bacterial excretion was significantly more often determined in patients taking bedaquiline, thioureidoiminomethylpyridinium perchlo-rate, linezolid as part of HT, compared with the group not receiving the above drugs 47.5% and 35.4%, respectively, (p<0.05); by the end of the intensive phase of treatment, the cessation of bacterial excretion occurred in OG in 92.0%, KG — 57.0% (p<0.001). Conclusions. The inclu-sion of drugs thioureidoiminomethylpyridinium perchlo-rate, bedaquiline, linezolid in the complex chemotherapy of tuberculosis with multi-resistant tuberculosis increases the effectiveness of the main course of treatment com-pared to the KG.

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

Особенности цитотоксического иммунофенотипа макрофагов при фиброзно-кавернозном туберкулезе легких

Особенности цитотоксического иммунофенотипа макрофагов при фиброзно-кавернозном туберкулезе легких

The use of polypropylene mesh in thoracoplasty: an experimental and clinical study

Relevance. Thoracoplasty is an effective way to close the cavity of destruction of the lung tissue and achieve clinical recovery in case of fibro-cavernous pulmonary tuberculosis. A promising direction of creating selective collapse in thoracoplasty is the use of synthetic mesh implants.
 The purpose of the study was to assess the effect of synthetic implants from the “Surgipro" polypropylene mesh on the inflammatory and reparative reaction in thoracoplasty.
 Materials and methods. The work was performed on male Wistar rats weighing 250±50 grams (n=12). The “Surgipro” polypropylene mesh was implanted on the right posterolateral surface of the chest (n=9). As control, the material was taken from intact rats (n=3), which were kept in the same conditions as experimental animals. The study material was biopsy specimens of the muscular aponeurotic scar of the posterolateral surface of the chest of rats. The cellular composition and total number of mast cells were determined. A clinical study was conducted on 26 cases of thoracoplastic with the use of polypropylene mesh in the pulmonary-surgical department of the Seaside regional antituberculous dispensary in Vladivostok.
 Results. During the experimental study, it was recorded that the implant used in the reconstruction of the chest has a pronounced reactogenicity from the first day, which manifests itself as a local inflammatory reaction with the concentration of mast cells. The population of mast cells progressively declined by the 30th day, while an increase in the number of macrophages and fibroblasts was observed with the advent of giant multinuclear cells of foreign bodies. On the 30th day after the operation, a widespread post-inflammatory reactive fibrosis and angiomatosis with chronic productive inflammation was observed in the experiment. In clinical observation, the resulting inflammatory reaction around the endoprosthesis spreads to the surrounding tissues and lung, which contributes to the formation of pronounced pulmonary fibrosis and restriction of a specific process.

Personality characteristics of patients with fibro-cavernous pulmonary tuberculosis

There is represented to be relevant to clarify what personal characteristics contribute to the formation of fibro-cavernous tuberculosis, to prevent its formation in the course of treatment. The aim is to identify the personal features ofpatients with fibro-cavernous pulmonary tuberculosis to develop psychological support in the subsequent treatment of newly diagnosed patients, preventing the formation of chronic specific process. Material and methods. 96 patients participated in a study: 48 cases with fibro-cavernous tuberculosis and 48 healthy volunteers. To study the personality characteristics there was used «Combined Personality Inventory (CPI)» based on the Raymond Cattell’s 16 Personality Factors (adaptation by G.A. Leevik). Results. In comparison with the control group patients with fibro-cavernous pulmonary tuberculosis had higher averages in scales A (reserved demeanor - openness), F (poverty - wealth of emotional reactions), Н (reservedness - activity in communication), L (credulity - suspicion), M (practical - dreamy style of thinking), N (easy - the sophistication of behavior), O (confidence - lack of confidence), Q1 (conservatism - the desire for new), Q2 (conformity - non-conforming), Q4 (relaxed - alertness), P (plasticity - rigidity) and Tr (anxiety). They have reduced the level of logical intelligence, they are both less balanced and easier to subjugate, not disciplined, have low self-control, low level of claims, a less favorable climate in the family, coupled with introversion. Conclusion. Thus, patients with fibro-cavernous tuberculosis are distinguished by reservedness in communications, reserved demeanor, suspicion, alertness, anxiety, lack of discipline, poor self-control. Creation of a special social and psychological support services for this group ofpatients can elevate the efficiency of the complex treatment and improve prognosis.

Generation TNF-α, IL-1β in newly diagnosed patients with different clinical forms of pulmonary tuberculosis in the Astrakhan Region

Objective: To study the spontaneous production of proinflammatory cytokines (TNF-α and IL-1β) in newly diagnosed patients with different clinical forms of pulmonary tuberculosis, Russian population groups living in the Astrakhan region. Materials and Methods: on the basis of hospital № 1 "Regional Clinical TB Dispensary" Astrakhan, performed a comprehensive clinical and immunological examination of 60 patients newly diagnosed with pulmonary tuberculosis. Men 44 (73.3%), 16 women (26.7%). Age – from 18 to 56 years. Residents of the city of Astrakhan was 29 (48.3%), rural area – 31 (51.7%). The level of proinflammatory cytokines in peripheral blood was measured before the start of a specific treatment, using a firm "VECTOR-BEST" Russia reagent kits. Results. In a study comparing the two groups were formed: Ι – 31 patients with limited specific changes in lung tissue with a predominance of the productive component of inflammation; ΙΙ – 29 patients with bulky specific changes with the collapse of the lung tissue with a predominance of exudative inflammation component. In patients with disseminated tuberculosis patients Ι group serum TNF-α was detected in higher concentrations than patients ΙΙ group (8,16 ± 0,14 pg / ml vs. 4,01 ± 0,09 pg / ml; p <0.05 ). The same trend was observed at infiltrative tuberculosis patients, comparison groups, p <0.05. Development of IL-1β in serum, previously without a history of patients with tuberculosis compared groups is as follows: with disseminated - in group Ι concentration 10,11 ± 1,07 пг / мл vs. 8,91 ± 1,07 pg / ml in group ΙΙ, p> 0.05; in infiltrative - in group Ι concentration 9,04 ± 0,94 pg / ml vs. 18,01 ± 1,04 pg / ml in group ΙΙ, p <0.05; when Tuberculomas only Ι group concentration was 6,81 ± 0,21 pg / ml; at the cavernous and fibro-cavernous pulmonary tuberculosis concentration was 9,15 ± 1,09 pg / ml.Conclusion. High concentrations of interleukin-1b potentiate the development of exudative-necrotic component specific inflammation and destruction of the lung tissue.

Modern methods of diagnostics and control of treatment efficacy new-onset with fibro-cavernous pulmonary tuberculosis, induced with Mycobacterium multidrug-resistant

The clinical observation of the successful treatment of newly diagnosed fibro-cavernous pulmonary tuberculosis caused by mycobacteria of multidrug-resistant tuberculosis and the results of control of the effectiveness of treatment with modern high-tech radiation methods are presented. The necessity of an individual approach to the treatment of tuberculosis in this category of patients is shown.

STUDY OF QUALITY OF LIFE OF PATIENTS WITH PULMONARY TUBERCULOSIS

The pulmonary disease reduces all parameters of quality of life. Using a questionnaire of WHO Q0L-100, there has been performed a study of parameters of quality of life in patients with fibro-cavernous and focal forms of pulmonary tuberculosis. Mean values of different areas of quality of life in patients with fibro-cavernous pulmonary tuberculosis were 2-3 times (p ≤ 0,01) lower than those in patients with focal tuberculosis. The patients in both groups suffered morally mostly. It has been revealed that tuberculous patients with a favorable clinical prognosis had a moderate decrease in the level of well-being and satisfaction with conditions of life. The analysis of the values of the exponent falsity according to the questionnaire by V. G. Norakidze (1975) has detected that all respondents answered the proposed questions quite truthfully, as values on the scale of falsity did not exceed 6 points. The results of the study of the parameters of the tuberculous patients’ quality of life can be used for targeted psycho-social rehabilitation with regard to the form of the disease.

Peculiarities of functional activity of circulating phagocytes in patients with different forms of drug-resistant pulmonary tuberculosis

Functional activity of circulating phagocytes (macrophages and neutrophils — Ns) was studied in 30 patients with infiltrative and 30 patients with fibro-cavernous pulmonary tuberculosis (IPT and FCPT, respectively), characterized by similar biological properties of mycobacterium tuberculosis (MTB), dissemination of the process, and manifestations of intoxication. Differences of the functional activity of both types of cells depending on the PT form were found: a more significant increase in the oxygen-depending activity in FCPT while bactericide potential estimated with the zymosan induced NST-test was more pronounced in IPT patients. These data correlate with the blood levels of neopterin and elastase, the markers of the mononuclear and neutrophil activity, respectively. Involvement of adenosine deaminase (ADA) and neopterin in realization of intracellular oxygen-dependent processes was demonstrated. Results of the multivariate analysis of the whole set of the studied phagocyte parameters, reflecting their different roles in this pathological process demonstrated a prevailing role of mononuclears in newly diagnosed IPT and neutrophils in the chronic progressive process.

Clinical analysis of treating 174 cases with pulmonary tuberculosis by pneumonectomy

To evaluate the efficacy and indication of pneumonectomy in patients with pulmonary tuberculosis. From January 1992 to the end of 2008, 174 patients with pulmonary tuberculosis underwent pneumonectomy. According to the classification of pulmonary tuberculosis, there were tuberculous destroyed lungs (n = 106), chronic fibro-cavernous pulmonary tuberculosis (n = 27), cavernous pulmonary tuberculosis with aspergilloma (n = 5), tuberculous tracheobronchial stenosis (n = 16), pulmonary tuberculosis with encapsulated empyema (n = 5), tuberculous empyema with broncho pleural fistula (n = 4) and massive hemoptysis (n = 11). The surgical approaches were pneumonectomy (n = 146), pleuropneumonectomy (n = 21), chlorine pneumonectomy (n = 3), pneumonectomy with thoracoplasty (n = 1) and pneumonectomy with tracheoplasty (n = 3). The overall clinical cure rate was 93.0%, the rate of complications 11.5% and the operative mortality 2.3%. There were 3 dead cases resulting from operations in six months. Tuberculosis chemotherapy is an important modality for pulmonary tuberculosis, but surgical therapy remains essential for some patients. Pneumonectomy may increase the cure rates of severe pulmonary and multiple drug resistant tuberculosis.

Computed tomographic assessment of the surgical risks associated with fibrocavernous pulmonary tuberculosis.

We evaluated the surgical risks associated with fibrocavernous pulmonary tuberculosis by retrospectively examining chest computed tomography (CT) scans. We reviewed the records of 40 patients who underwent pulmonary resection for fibrocavernous pulmonary tuberculosis, for whom preoperative CT scans were available. The disease was categorized as class I, defined as a cavity within one lobe without remarkable pleural thickness, in 21 patients; class II, defined as a cavity extending beyond one lobe or within one lobe with remarkable pleural thickness, in 10 patients; and class III, defined as bilateral cavities, in 9 patients. Four of the nine patients with bilateral cavities underwent bilateral pulmonary resection and five underwent unilateral pulmonary resection. The study parameters were intraoperative blood loss, operative time, hospital stay, major operative morbidity, and hospital death. Intraoperative blood loss and operative time were significantly greater and hospital stay was significantly longer in patients with advanced disease (P = 0.046, P = 0.000, and P = 0.143, respectively). Major surgical morbidity mainly occurred in association with advanced disease (P = 0.028) at the following incidences: class I, 5%; class II, 30%; class III, 44.4%. Two hospital deaths occurred, both following bilateral pulmonary resection for class III disease, accounting for an overall 5% mortality rate. The surgical risks associated with fibrocavernous pulmonary tuberculosis were well correlated with anatomic involvement, according to the extent of cavitation and the severity of pleural thickness, as depicted by CT. Staged pulmonary resection or the combination of one-sided resection with other modalities is recommended for the treatment of bilateral cavities.

Intrathoracic muscle flap transposition in the treatment of fibrocavernous tuberculosis.

Conventionally, pulmonary resection with thoracoplasty is used to treat fibrocavernous complication of pulmonary tuberculosis. This operation is usually bloody, time-consuming with complicated postoperative course. To prevent massive blood loss and preserved pulmonary function, a more simplified operative procedure, cavernostomy combined intrathoracic muscle flap transposition was used and the outcome was evaluated in this study. Retrospective review. Between December 1989 and June 1996, a total of ten patients with fibrocavernous pulmonary tuberculosis were managed using cavernostomy combined with intrathoracic muscle flap transposition. Five of them had concomitant aspergilloma within the cavity while three had multiple drug resistant pulmonary tuberculosis. The muscle flap was used to plombage the cavity and reinforce the closure of bronchopleural fistula after cavernostomy. Six postoperative complications occurred in five patients, including reformation of cavity (2), bronchopleurocutaneous fistulae (3), and postoperative bleeding (1). The success or failure of intrathoracic muscle flap transposition on patients with fibrocavernous tuberculosis was significantly correlated with the size of the cavity (194.0+/-11.2 vs. 283.0+/-44.6 cm(3), P=0.016) and the number of bronchopleural fistulae (1.6+/-0.4 vs. 4.0+/-0.4, P=0.008). There was no operative death and in long term follow-up, there was no recurrence of hemoptysis or deterioration of pulmonary function in the successful group of patients. Cavernostomy combined with intrathoracic muscle flap transposition can be used to treat well-selected fibrocavernous pulmonary tuberculosis patients, except on patients with large size cavity, multiple bronchopleural fistulae or multiple drug resistance tuberculosis.

Variants of destructive pulmonary tuberculosis and the necessity of their differentiated treatment

The results of observations of 1196 patients being first ill with destructive pulmonary tuberculosis are analysed. By quantitative and qualitative characteristics of destructive pulmonary process, 5 categories are revealed differing widely in rate and terms of the decay cavities close and results by the action of chemotherapy. pulmonary tuberculosis with minimum destruction, bounded destructive, tuberculomas with decay and fibrocavernous pulmonary tuberculosis. The necessity to develop the differenciated therapy methods of destructive pulmonary tuberculosis depending on its quantitative and qualitative characteristics is stressed.

Some questions of the epidemiology of chronic fibrocavernous pulmonary tuberculosis

We examined 150 foci, in which lived, in addition to patients with fibrocavernous pulmonary tuberculosis, 353 people who were in family contact with them. 22 had a tuberculous process in the lungs. In these patients, it was not possible to establish a connection between diseases and contact with a bacillus-releasing agent, or this connection was very doubtful, and 331 people. were healthy and during the initial clinical and radiological examination in the dispensary, no pathological changes in the lungs were found.