Fibrous Cavernous Tuberculosis Research Articles

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.

The complexities of complex treatment of a patient with widespread destructive pulmonary tuberculosis against the background of severe pulmonary bullous dystrophy after exogenous exposure to fine particles of coal dust in the anamnesis

An observation from practice is given – a staged surgical treatment of a patient with widespread destructive pulmonary tuberculosis with preXDR MBT against the background of severe bullous lung dystrophy after prolonged exogenous exposure to fine particles of coal dust in the anamnesis. Patient M., 42 years old, smoker, has been working as a loader at a railway station since the age of 20, unloading wagons with bags of coal at high temperatures without using personal protective equipment. He was ill with pulmonary tuberculosis 12 years ago, the original form: infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and insemination. He was treated with positive dynamics, was removed from the register 10 years ago, the real changes were revealed during a routine examination when applying for a vertebral hernia. According to computed tomography of the chest organs, a picture of fibrous-cavernous tuberculosis of the right lung with a system of polymorphic caverns with multiple foci of dropout in the left lung against the background of pronounced emphysema of both lungs was noted upon admission. He was admitted to the clinic with complaints of shortness of breath at rest (mMRC 3). The patient was selected therapy based on sensitivity data and individual intolerance. The patient underwent EC installation at the mouth of the upper lobe bronchus on the right, successfully, then at the mouth of the bronchus B6, the blocker was coughed up. Against the background of treatment, tuberculomas formed in the left lung. S1-2 resection of the left lung was performed. The patient suffered SARS CoV-2. After that, spontaneous pneumothorax occurred on the left, and therefore the pleural cavity was drained. Against the background of the lack of dynamics, a month after drainage, the patient was taken for revision of the left pleural cavity with suturing of defects, partial pleurectomy and decortication of the left lung. After 3 months, the patient had a bronchoblocker removed from the mouth of the ULB on the right and a combined resection of the right lung (upper lobectomy with S6) was performed, after which, in order to reduce the right hemithorax and reduce the overstretch of the right lung, thoracoplasty was performed with resection of the I-IV ribs on the right. Histological examination confirmed pulmonary tuberculosis against the background of exogenous exposure to fine particles of coal dust (by the type of hypersensitive pneumonitis of chronic course). As a result of treatment, the patient's symptoms of shortness of breath (mMRC 1) decreased, the patient was steadfastly abaculated and returned to a normal lifestyle.

Modification of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant in the surgical treatment of widespread destructive pulmonary tuberculosis

An observation from practice is given – surgical treatment of a patient with widespread destructive pulmonary tuberculosis due to a modified technique of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant. Patient A., 37 years old, has been suffering from pulmonary tuberculosis for 2 years. She was admitted to the clinic with complaints of shortness of breath during exercise (mrc 3), cough, back pain. On computed tomography of the chest organs: a picture of fibrous-cavernous tuberculosis of the left lung with extensive mediastinal pulmonary hernia. The patient underwent transsternal occlusion of the left main bronchus with plastic surgery of the anterior mediastinum with a polymer mesh implant. The result of the treatment was the stabilization of the process and the clinical cure of the patient.

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.

Анализ эпидемиологической ситуации по туберкулезу в Республике Татарстан за период с 2012 г. по 2021 г.

In the Republic of Tatarstan, in the period 2012 to 2021 we observed a twofold decrease in the incidence of tuberculosis: from 48 cases per 100 thousand population to 23.4 cases per 100 thousand population. However, there is an increase in the proportion of patients with respiratory tuberculosis in the decay and contamination phase, as well as fibrotic-cavernous and multiple drug-resistant forms of tuberculosis. It is important to analyze the epidemiological situation over a ten-year period, that will allow to develop or adjust measures for the prevention of tuberculosis in the Republic of Tatarstan. Objective: To establish patterns of manifestations of the epidemic process based on the indicators of the general incidence of tuberculosis in the Republic of Tatarstan for the period 2012-2021. Materials and methods: The study design is a descriptive epidemiological study. A retrospective epidemiological analysis of the incidence of general tuberculosis in the Republic of Tatarstan for 2012-2021 was carried out. The analysis of the long-term dynamics of the tuberculosis incidence in the population of the Republic of Tatarstan was carried out. Intensive indicators of morbidity in general, by contingents and ages were calculated. The structure of tuberculosis incidence in the Republic of Tatarstan was assessed, extensive morbidity rates in percentages (%) were calculated. Results: The long-term dynamics of annual morbidity rates of newly diagnosed tuberculosis in the Republic of Tatarstan in 2012-2021 is characterized by a statistically significant downward trend (р = -0,973 р < 0,001) at a rate of 7.8% per year. The indicated speed of the trend has reduced the incidence of newly diagnosed tuberculosis in 10 years from 48 cases per 100 thousand of population to 23.4 per 100 thousand of population, or twofold. Conclusion: Despite a significant decrease in the overall incidence of tuberculosis over a ten-year period, both in newly diagnosed patients and registered patients, in the Republic of Tatarstan the clinical structure of tuberculosis becomes more severe, namely, we experience an increase in the proportion of patients with respiratory tuberculosis in the phase of decay and contamination among newly diagnosed patients, with fibrous-cavernous tuberculosis among registered patients with multidrug-resistant tuberculosis.

Clinical example of effective treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung

ntroduction. The combination of destructive tuberculosis and chronic pulmonary aspergillosis remains a pressing and understudied problem. Respiratory tuberculosis is a significant risk factor for bronchopulmonary aspergillosis in 40–72% of cases. The current treatment strategy for pulmonary tuberculosis and bronchopulmonary aspergillosis is governed by clinical guidelines. However, the issues of surgical treatment tactics in complicated forms of the combination of active tuberculosis and pulmonary aspergillosis require discussion and remain relevant at present. Material and methods. A clinical case of complex treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung is described. Patient S., 42 years old, became ill with infiltrative tuberculosis of the right lung in August 2008. On the background of a 9-month anti-tuberculosis chemotherapy according to the I regimen she was cured and in 2012 was removed from the dispensary registration. In February 2018, an episode of pulmonary hemorrhage (volume 200 ml) occurred, and was stopped by conservative methods. At the follow-up examination, tuberculosis recurrence was verified in the right lung with the formation of fibrous-cavernous lesion. On the background of the repeated 6-month course of treatment according to the I regimen no dynamics was obtained, pulmonary hemorrhage of the Ia stage recurred regularly. In September 2018, the patient was hospitalized to SPb NIIF. Pre-examination revealed chronic pulmonary aspergillosis. Voriconazole therapy was started, and correction of the ongoing antituberculosis therapy was carried out, taking into account drug interaction. Surgical treatment was indicated. Results. On 09.25.2018, an upper bilobectomy was performed on the right side. There were no intraoperative complications. The operation was completed by draining the pleural cavity with two drains and suturing the thoracotomy wound. Postoperative period without complications. In order to correct the volume of hemithorax, an artificial pneumoperitoneum of 1000 ml was applied. The drains were removed on the 4thand 5th days after surgery, the surgical wound healed by primary tension. At the follow-up examination after five years, there was no evidence of disease recurrence or late surgical complications. Conclusion. Providing medical care to patients with a combination of tuberculosis and pulmonary aspergillosis requires the organization of full-fledged primary diagnosis and routing of patients to a specialized hospital. A complex approach to treatment allows for successful treatment outcomes with minimal risks.

Surgical Treatment of Cavernous and Fibrous-Cavernous TB in Children.

Treatment of cavernous and fibrous cavernous tuberculosis in children, especially in the presence of multiple drug resistance-tuberculosis or extremely drug resistance-tuberculosis, presents a major challenge. We analyzed results of treatment of 65 patients (mean age 14.8 + 2.9 years) with cavernous TB (group I) and 116 patients (mean age 15.6 + 1.9 years) with fibrous-cavernous TB (group II). Evaluation of treatment efficiency was performed directly at discharge and 1 year after treatment according to Lazerson's criteria. In group I, after 80 operations, two (2.5%) cases showed delayed expansion of the lung after combined resections, in group II, postoperative complications after 160 operations occurred in eight (5.0%) cases (the difference is reliable p ≤0,05). There was no hospital fatality. The effectiveness at the time of discharge from surgery (cessation of bacterization and elimination of decay cavities in the lung) was 100% in groups I and II, respectively. A year later, according to Lazerson's criteria, the efficiency in group I was 100%, in group II was 97.4%. Operations in patients with cavernous tuberculosis performed after 10 to 12 months of conservative treatment present a lower risk of postoperative complications and relapses of cavernous tuberculosis than operations in patients with fibrous cavernous tuberculosis performed after 22 months or more of treatment.

An example of successful treatment of advanced tuberculosis with simultaneous correction of postpneumonectomy mediastinal pulmonary hernia with a polymer mesh implant

An observation from practice is given – surgical treatment of a patient with widespread tuberculosis of the only left lung and a pronounced displacement of the mediastinal organs into the right hemithorax. Patient P., 43 years old, has been suffering from pulmonary tuberculosis for 11 years, 8 years ago, a pneumonectomy on the right side was performed due to fibrouscavernous tuberculosis of the right lung. According to computed tomography of the chest organs, upon admission, a picture of cavernous tuberculosis of the lower lobe was noted, a pronounced displacement of the mediastinal organs and the only left lung to the right. She was admitted to the clinic with complaints of shortness of breath at rest, weakness, dizziness. The patient underwent resection of a lung containing a cavity with simultaneous correction of the mediastinal pulmonary hernia with a mesh implant. Histological examination of the removed preparation revealed a high level of activity of tuberculous inflammation. As a result, the manifestations of dyspnea decreased in the patient, radiographically, the only left lung was visualized in the hemithorax of the same name.

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.

Histamine-containing lung cell structures in certain forms of secondary tuberculosis

The aim of research was to study the distribution of histamine in macrophages and mast cells of the lung structures in autopsy material in certain forms of secondary tuberculosis.Material and methods. The authors examined 165 cases of secondary pulmonary tuberculosis. The study included 500 histological specimens of male patients, aged 30 to 55 years, divided into 5 groups depending on the forms of secondary tuberculosis., The luminescent-histochemical method of Cross was used to determine the content of histamine in the lung structures; the specimens were further exposed to re-staining with hematoxylin and eosin.Results. Histamine-containing specific alveolar and interstitial macrophages and mast cells were detected when studying autopsy material from the lungs of "nominally healthy" people. The highest content of histamine in the lung structures of this group was recorded in interstitial macrophages. In acute focal tuberculosis, there was an increased content of histamine in intra-alveolar and interstitial macrophages, with a simultaneous decrease of this bioamine in mast cells. In fibro-focal tuberculosis, the content of histamine exceeded the control parameters in all the studied cellular lung structures, with the highest content in mast cells. In infiltrative tuberculosis, there was detected an infiltrative luminescent track from lymphocytes together with the maximum luminescence of histamine. In acute cavernous and fibrous-cavernous tuberculosis, total degranulation of mast cells was observed. The content of the studied bioamine significantly decreased in interstitial macrophages compared to the control group.Conclusion. The study of small forms of secondary tuberculosis detected an increased concentration of histamine in intra-alveolar and interstitial macrophages. Its maximum accumulation in all cellular structures was registered in the infiltrative form of tuberculosis. In destructive forms of tuberculosis, histamine was detected only in macrophages, which appeared to be the regulatory link of specific inflammation. The literature data and the results obtained allow us to report on the influence of Mycobacterium tuberculosis as a corpuscular antigen that causes destruction of structures that produce and metabolize neuroamines in the lungs.

РЕЗУЛЬТАТИ ПАТОГІСТОЛОГІЧНОГО ДОСЛІДЖЕННЯ ОПЕРАЦІЙНОГО МАТЕРІАЛУ З ВИЗНАЧЕННЯМ СТУПЕНЮ МОРФОЛОГІЧНОЇ АКТИВНОСТІ ТУБЕРКУЛЬОЗНОГО ПРОЦЕСУ ТА КЛІНІЧНА КАРТИНА ХВОРИХ З ТБ ПІСЛЯ VATS РЕЗЕКЦІЙ ТА VATS ПЛЕВЕКТОМІЙ З ДЕКОРТИКАЦІЄЮ ЛЕГЕНІ

RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG M. S. Opanasenko, I. V. Liskina, V. I. Lysenko, L. M. Zagaba, O. V. Tereshkovich, B. M. Konik, L. I. Levanda, S. M. Shalagai, M. I. Kalinichenko, M. U. Shamrai Abstract Patients with pulmonary tuberculomas of different histological structure, as well as pulmonary fibrous-cavernous tuberculosis (FCT) are subject to surgical treatment. These phase-forms require careful morphological examination, which provides an objective determination of the degree of activity of a specific inflammatory process. Materials and methods. 165 patients were examined: 130 (78,8 %) patients with different forms of tuberculosis and 35 (21,2 %) patients with tuberculosis of pleura. Morphological determination of the degree of activity of specific inflammation was performed according to the developed classification using hematoxylin and eosin staining. Specific lung lesions were detected in 130 (78.8 ± 3.2)% of cases, pleural TB was histologically detected in 35 (21.2%). Results and discussion. Most VATS resections were performed on tuberculosis - 98 (75.4%), 19 (14.6%) cases were operated on with FCT, 11 (8.5%) patients had post-tuberculosis changes. 2 (1.5%) patients underwent surgery for infiltrative tuberculosis. The following degree of morphological activity of tuberculous inflammation was established in the resection samples: high - 28 (21.5%), moderate - 42 (32.3%) and low - 60 (46.2%) cases. The degrees of morphological activity of the operative material and clinical symptoms were compared: low activity was found in 60 (46.2%) patients, 14 (10.8%) of them had typical symptoms of TB; measurable activity was found in 42 (32.4%), of which 21 (16.2%) patients had a clinical picture of TB; 28 (21.5%) patients had high activity, 22 (78.6%) of them showed symptoms, and in 8 (36.4%) patients of this subgroup the sputum was positive for Mycobacteria. These data do not demonstrate clear correlation, but suggest a a significant difference between groups. Chronic TB pleurisy was detected in 18 (51.4%) cases. It was characterized by the growth of coarse fibrous connective tissue with the presence of epithelioid-cell granulomas, and typical clinical and radiological symptoms. Conclusions. Determining the morphological degree of activity of specific inflammation allows to prescribe additional courses of anti-TB therapy. Low activity - 60 observations (46.2%), moderate degree - 42 cases (32.3%), high morphological degree - 28 (21.5%) cases. Different types of tuberculoma show different degrees of morphological activity. A significant difference was found between the presence of the clinical picture of TB in morphologically high and low levels of specific inflammatory activity. In tuberculosis of pleura patients with subacute or chronic course should receive surgery. Typical clinical presentation is usually observed in these patients. Key words: tuberculosis, morphological degree of activity, tuberculoma. Ukr. Pulmonol. J. 2022;30(4):28–33.

Tongue cancer in a patient with pulmonary tuberculosis. Case report

Tuberculosis and malignant neoplasms are a global threat, these diseases claim millions of lives and cause tremendous suffering to people worldwide. Tuberculosis can mask cancer and create preconditions for carcinogenesis. The article presents a clinical case of tongue cancer in a patient with pulmonary tuberculosis. Patient B.N., 45 years old, was admitted to the FSBI Novosibirsk Tuberculosis Research Institute with complaints of a "sore place" on the tongue, pain in the right half of the tongue, enlargement of the submandibular lymph nodes on the right The tongue hurts for about 1,5 years, but over the last 2 months, condition has worsened. The patient noticed an increase in the size of lesion on the tongue and increased pain, especially during meals (he can eat only after pain relief, for which he takes Nimesulide 4 pills a day). In recent days, he felt also epigastric pain for which he didnt visit a doctor. Tongue biopsy was performed, and histological analysis revealed cancer. The patient was diagnosed with fibrous-cavernous tuberculosis of the upper lobe of the right lung, infiltration and seeding phase; mycobacterium tuberculosis (+); broad drug resistance (HRSECmKmPasCsOfl); gastric ulcer (0,5 cm), exacerbation stage; chronic erosive gastritis, exacerbation stage; malignant neoplasm of the floor of the mouth on the right T3(4)N1M1. With this diagnosis, the patient was discharged for further treatment by oncologists. Physicians need to have a high alertness for cancer in patients with tuberculosis, especially those in the high-risk group. A minimum of standard diagnostic procedures will allow you to verify the diagnosis timely.

Morphological characteristics of pulmonary tuberculosis concurrent with lung cancer

To study the pathogenetic relationship between pulmonary tuberculosis and lung cancer. The investigators examined surgical material from 51 patients (41 men) aged 41-73 years (mean age, 63.7 years) with pulmonary tuberculosis concurrent with lung cancer. They also studied tumors, tuberculous caverns, infiltrates, and foci with surrounding macroscopically intact lung tissue, as well as fibrotic changes by histological, histochemical and immunohistochemical examinations. Previous tuberculosis can be considered as a risk factor for lung cancer. Central cancer was more common in patients with inactive, chronic tuberculosis with a predominance of fibrotic processes in the root of the lung and in its hilar zones. Fibrous-cavernous tuberculosis and cavernous tuberculosis were more frequently concurrent with central cancer; peripheral tumors mainly occurred in infiltrative tuberculosis and tuberculomas. The findings suggest that in a number of cases, cancer and tuberculosis may be anatomically close, developing in the same anatomical unit - the lung. However, this does not indicate an unambiguous etiopathogenetic relationship between pulmonary tuberculosis and lung cancer. The relationships between pulmonary tuberculosis and lung cancer are much more complex and do not fit into the simple scheme of cause-and-effect relations.

Clinical manifestations and outcomes of pulmonary tuberculosis in patients with different genotypes of the pathogen

Objective: to study the clinical manifestations and effec- tiveness of treatment of patients with pulmonary tubercu- losis with different genotypes of M. tuberculosis. Materi­ als and methods. Clinical and microbiological data of 120 patients were stratified on the M. tuberculosis epidemic variants: subtypes of Beijing CC2 / W148, CC1, other sub- types of Beijing, and other genotypes other than Beijing (nonBeijing). The DNA of M. tuberculosis strains obtained were genotyped by RD 105/207 for Beijing genotype iden- tification. The CC2/W148 subtype was identified by the presence of a specific deletion in the kdpD gene, the CC1 subtype was done by the SNP in the pks17 gene. Results. It was found that in tuberculosis caused by the CC2/W148 subtype of the Beijing genotype, multiple and broad drug resistance occur in 87.5% of patients. The CC2/W148 ge- no type contributes to the chronization of the tuberculosis process, the formation of fibrous-cavernous tuberculo- sis. Miliary tuberculosis is more common (37.5%) among newly diagnosed patients with CC2/W148 than in other genotypes (15.7%), which is also associated with a high incidence of concomitant HIV infection (56.3%). Total lung tissue damage in patients with infiltrative tuberculosis is observed in 41.7% of patients with the CC2/W148 MBT subtype. The clinical cure rate in patients with CC2/W148 is significantly lower (18.7% compared to 47.4%) than in tuberculosis caused by other genotypes. Conclusion. The results obtained indicate the presence of clinical features of tuberculosis caused by the w148 / CC2 subtype of the Beijing genotype, and the expediency of further study of the clinical, radiological and microbio- logical characteristics of the tuberculosis process caused by MBT of different subtypes of the Beijing genotype and non-Beijing genotypes.

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.

Medical and social characteristics of tuberculosis patients who died in in-patient units in 2017-2018 (based on data from Kemerovo Region)

The objective of the study : to analyze the medical and social characteristics of tuberculosis cases died in hospitals of Kemerovo Region in 2017-2018 including those with HIV infection Subjects and methods . Clinical, radiological and morphological data of 372 patients who died in in-patient units of Kemerovo Regional Clinical Phthisiopulmonary Medical Center in 2017-2018 were studied. Results. HIV infection was the major cause of death in tuberculosis patients in Kemerovo Region - in 74.7% (278 patients). Only 21.7% died of tuberculosis, and 3.6% - died of other diseases. The main clinical form of tuberculosis in patients with TB/HIV co-infection was a generalized form with lesions in multiple organs, of them, lesions of intrathoracic lymph nodes, spleen, liver, kidneys, pleura, and central nervous system were the most frequent. In patients who died of tuberculosis, the leading clinical form was fibrous cavernous tuberculosis, mainly complicated by caseous pneumonia.

First experience of simultaneous extrapleural lung resection with silicone plombage for widespread drug-resistant destructive pulmonary tuberculosis: a case report

Background. The increase of the number of patients with drug-resistant forms of disseminated destructive lung tuberculosis dictates not only expansion of indications for a surgical treatment but development of new intraoperative techniques, which may reduce the risks of postsurgical complications and further progressing of tuberculosis. For a long-lasting chronic course of destructive drug-resistant tuberculosis, it is often impossible to reach the process stabilization necessary for a successful lung resection. Toracoplasty usually performed when the resection intervention is contraindicated is not only traumatic for a patient but also does not provide the proper lung compression.
 Clinical case description. The clinical case is presented by disseminated fibrous-cavernous tuberculosis with a wide drug resistance of the pathogen, with the cavernous changes observed against the background of the pronounced lung tissue cirrhosis. To achieve the effect, we performed extrapleural lung resection followed by the immediate extrapleural silicone plombage in order to prevent overextension of the remaining part of the lung. The histological study data confirm the significant degree of the tuberculosis inflammation activity, in spite of the preceding long-term antituberculosis therapy.
 Conclusion. Due to the low trauma and high efficiency, the operation of simultaneous extrapleural pneumolysis with silicone implant plombage may be used in the complex treatment of disseminated destructive pulmonary MDR/XDR TB with a chronic relapsing course of the disease.

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.

Use of polypropylene mesh in superior posterior thoracoplasty

Theobjectivewas to evaluate the possibilities of using the polypropylene mesh “Surgipro” to increase the compression and reduce the operational injury in extrapleural superior posterior thoracoplasty.Material and methods.64 cases of surgical treatment of fibrous-cavernous tuberculosis were studied. The volume of compression of the lung tissue and the effectiveness of the intervention were compared.Results.Clinical and radiologic examination of patients in three weeks after the operation indicates that occurrence of exacerbation, preservation of bacterial excretion and lack of compression are much lower in the group using polypropylene mesh. The use of polypropylene mesh “Surgipro” increases the degree of compression in the field of intervention and the effectiveness of thoracoplasty.Conclusion.The use of a mesh implant in thoracoplasty is reasonable and effective.

АНАЛИЗ ЭФФЕКТИВНОСТИ РЕЗЕКЦИЙ ЛЕГКОГО И ПНЕВМОНЭКТОМИЙ У БОЛЬНЫХ ФИБРОЗНО-КАВЕРНОЗНЫМ ТУБЕРКУЛЕЗОМ В ЗАВИСИМОСТИ ОТ АКТИВНОСТИ ТУБЕРКУЛЕЗНОГО ПРОЦЕССА

The objective : to study the frequency of post-operative complications and outcomes of lung resections and pneumonectomies in patients with fibrous cavernous tuberculosis depending on the activity of tuberculous inflammation. Subjects and methods . 722 patients were enrolled into the study, they all underwent radical surgery for fibrous cavernous pulmonary tuberculosis in the Krasnoyarsk Regional TB Dispensary No. 1. In all cases, the diagnosis of fibrous cavernous tuberculosis was confirmed by pathomorphological tests after surgery. The severity of tuberculous inflammation was evaluated based on the following generally available indicators: massivity of bacterial excretion, erythrocyte sedimentation rate, x-ray changes over 2 months before the surgery. Depending on the activity of the disease, patients were divided into three groups: those with low activity (479 patients), medium activity (171 patients) and high activity (72 patients). Results . The outcome of resection surgery due to fibrous cavernous pulmonary tuberculosis performed in patients with low tuberculosis activity was more favorable compared to moderate and high exacerbation activity and especially pronounced exacerbation, as indicated by the achievement of a complete clinical effect in 92.7, 74.3, and 37.5%, respectively, and a more favorable course of the postoperative period. Thus, the frequency of severe postoperative complications made in 12.1, 26.3, and 55.6% of patients, respectively. This situation was also confirmed in operations of the same type (among patients with pneumonectomy and among patients with lung resection). The high activity of tuberculosis should be considered a relative contraindication to surgical resections.