Treatment Of Surgical Tuberculosis Research Articles

Study of functional outcome of surgical treatment of tuberculosis of spine

Study of functional outcome of surgical treatment of tuberculosis of spine

On climatic and solar treatment of surgical tuberculosis. Prof. Bernhard id St. Moritz (Deutsch, medizinische Wochenschr. 1932, no. 6)

Prof. Bernhard id St. Moritz (Deutsch, medizinische Wochenschr. 1932, no. 6) shares thirty years of experience in the treatment of surgical tuberculosis in the high mountains with the sun.

Сhylothorax

Objective — to determine and analyze, on our own experience, effective methods of treating chylothorax.
 Materials and methods. For the last 15 years on the basis of the department of surgical treatment of tuberculosis and invasive diagnostic methods of the SI «National Institute of Phthisiology and Pulmono­logy named after F.G. Yanovsky NAMS of Ukraine» was treated 21 patients with a diagnosis of chylothorax. Among the concomitant pathologies, the following diseases were most often diagnosed: ischemic heart disease 5 (23.8 %) cases, gynecological diseases 7 (32.9 %), obesity 4 (18.8 %).
 Results and discussion. An analysis was perfomed, which allows us to conclude that most often (10 cases, 47.6 %) chylothorax was diagnosed in women as a manifestation of lymphangioleiomyomatosis (LAM). It should be noted that in 4 (36.3 %) patients, LAM was diagnosed only by lung biopsy. In 2 (18.1 %) women, chylothorax was bilateral. In 6 (54.5 %) cases, a history of spontaneous pneumothorax (a characteristic diagnostic sign of LAM). The second place among the causes of chylothorax was by intrathoracic lymph node dissection during surgery for lung cancer. In all 3 (14.2 %) cases, the patients underwent left­sided pulmonectomy. Chylothorax usually developed by about 5—7 days, which coincided with the mobilization of patients and the restoration of adequate nutrition. In 2 (9.5 %) patients, the cause of chylothorax was damage to the thoracic duct during neurosurgical intervention through the transpleural approach. Such chylothorax is characterized by an aggressive course, quickly leads to exhaustion of the patient and requires immediate surgical intervention to ligate the thoracic duct below the level of injury. In 2 (9.5 %) patients, chylothorax was one of the manifestations of idiopathic pulmonary ossification. It should be noted that the diagnosis of pulmonary ossification was established only after a histological examination of a biopsy specimen, while such patients were admitted to the clinic with a diagnosis of recurrent pleurisy. In both cases, it was possible to achieve cessation of lymphorrhea by using parietal pleurectomy and conservative therapy. A feature of these patients is the fact that even with the elimination of chylothorax, moderate manifestations of respiratory failure remained in them. Chylothorax in lymphoproliferative diseases — in 2 cases (9.5 %) was the result of the prevalence of the oncological process, and therefore after its diagnosis, only pleural punctures and symptomatic treatment were performed. In no case was it possible to achieve complete cessation of lymphorrhea. In 1 (4.7 %) patient, idiopathic right­sided recurrent chylothorax was observed with moderate hilar lymphadenopathy. Videothoracoscopic biopsy of the intrathoracic lymph nodes was supplemented with parietal pleurectomy. This made it possible to achieve a reliable cessation of lymphorrhea, however, according to the data of a histopathological study, only reactive nonspecific changes were presented in the lymph nodes. In another 1 (4.7 %) case, on the 4th day after right­sided parietal pleurectomy for chronic pleural tuberculosis, lymphorrhea developed on the side of the operation. Short­term conservative therapy made it possible to achieve a positive result.Thus, the overall effectiveness of the treatment of such a pathological condition as chylothorax was 85.7 %. 
 Conclusions. Chylothorax is a complex medical problem, the effective solution of which depends on a complex of conservative and surgical methods of treatment.The most common cause of chylothorax is lymphangioleiomyomatosis (47.6 %). The overall effectiveness of chylothorax treatment in the clinic is 85.7 %.

The Efficacy and Safety of Surgical Treatment\xa0for Patients With Tuberculosis Destroyed Lung With or Without Chronic Pulmonary Aspergillosis

BackgroundTo evaluate the efficacy and safety of surgical treatment of tuberculosis destroyed lung (TDL), and the influence of chronic pulmonary aspergillosis (CPA) on the outcomes of surgical treatment of TDL.MethodsWe performed a retrospective analysis of 113 patients with TDL who underwent surgical treatment from January 2005 to December 2019. Among them, 30 of these cases were complicated with CPA. The patients were divided into two groups: TDL group and TDL + CPA group. We analyzed the effectiveness and safety of surgical treatment of TDL, and further compared the effectiveness and safety of surgical treatment of TDL with or withoutthe presence of CPA.ResultsThe TDL + CPA group had a significantly higher age (P=0.003), symptoms of hemoptysis (P=0.000), and a higher proportion of patients with preoperative serum albumin <30 g/L (P=0.014) as compared with TDL group. For all enrolled patients, the incidence of severe postoperative complications was 12.4% (14/113) and the postoperative mortality within 30 days after discharge was 4.4% (5/113). 86.7% (98/113) of the patients recovered and discharged, the incidence of severe postoperative complications in the TDA + CPA group was higher than that of TDL group (23.3% vs 8.4%, P = 0.034), although there was no difference in mortality between the two groups (P = 1.000). A binary logistic regression analysis showed that the independent risk factors for severe postoperative complications were male (OR 25.24, 95% CI 2.31–275.64; P = 0.008) and age ≥ 40 years (OR 10.34, 95% CI 1.56–68.65; P = 0.016).ConclusionSurgical treatment for patients with TDL is effective with an acceptable mortality rate whether or not the disease is complicated with CPA. The independent risk factors identified for severe postoperative complications in patients with TDL were male and ≥ 40 years old. It implies that when treating patients with TDA + CPA, particular attention should be paid to these patients who have these independent risk factors to avoid a poor outcome.

Improvement of Anterior Extraperitoneal Approaches in The Surgical Treatment of Tuberculosis of The Lumbar and Lumbosacral Spine

Improvement of Anterior Extraperitoneal Approaches in The Surgical Treatment of Tuberculosis of The Lumbar and Lumbosacral Spine

Surgical treatment of tuberculosis of spine: Nepalese experience

Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management.&#x0D; Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months).&#x0D; Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up.&#x0D; There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C.&#x0D; Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities.&#x0D; Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach)&#x0D; Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.

Invited Commentary

Invited Commentary

Frequency of previous tuberculosis history in patients with and without active tuberculosis admitted to our hospital in 1980-83 and in 1997-99

To study recurrence rate over a long period after recovery from previous tuberculosis history, we examined the frequency of previous tuberculosis history in patients who were admitted to our hospital in 1980-83 and in 1997-99 and the comparison was made between cases with and without culture-positive tuberculosis. The tuberculosis groups comprised of 297 patients in 1980-83 and 688 patients in 1997-99. The non-tuberculosis groups (control groups) comprised of 373 patients in 1980-83 and 1092 patients in 1997-99 with non-tuberculosis diseases other than the tuberculosis-related diseases such as non-tuberculosis mycobacteriosis, pulmonary aspergillosis, bronchiectasis, chronic bronchitis and tuberculosis sequelae. The patients with viral chronic hepatitis previously operated and transfused were also excluded as they might be operated because of pulmonary tuberculosis in the era of surgical treatment for tuberculosis. In both tuberculosis and control groups, they had previous tuberculosis history most frequently when they were twenties. In the control groups, the frequency of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39, 40-49 were 15/84 (17.9%), 22/93 (23.7%), 11/77 (14.3%) and 3/43 (7.0%), respectively, and those admitted in 1997-99 were 11/70 (15.7%), 30/231 (13.0%), 28/288 (9.7%), and 10/230 (4.3%), respectively. In these 4 birth year groups, frequency of previous tuberculosis history among cases admitted in 1997-99 were significantly lower than that admitted in 1980-83 (p < 0.05, one-sided paired t-test), and the fact suggests that persons with tuberculosis history died earlier than those without it. In the tuberculosis groups, the frequencies of previous tuberculosis history among cases admitted in 1980-83 and were born in 1910-19, 20-29, 30-39 and 40-49 were 20/35 (57.1%), 31/58 (53.4%), 19/48 (39.6%), and 11/53 (20.8%), respectively, and those among cases admitted in 1997-99 were 30/99 (30.3%), 58/125 (46.4%), 22/102 (21.6%) and 17/136 (12.5%), respectively. The frequency of previous tuberculosis history among cases admitted in 1997-99 was significantly lower than that admitted in 1980-83 (p < 0.01) as was the case in the control groups. As recurrence within 5 years had occurred in only 4 out of 113 tuberculosis patients (3.5%) in the above-mentioned 4 birth year groups, almost all tuberculosis patients were assumed to have recovered completely from previous tuberculosis. Comparison between the recurrence rate from previous tuberculosis and the incidence rate from the remotely infected persons without previous tuberculosis history in the same birth year group can be done by calculating the prevalence of tuberculosis infection for each birth year group using a model of annual risk of tuberculosis infection appropriate for Japanese. The ratios between the recurrence rate from previous tuberculosis patients and the incidence rate from remotely infected persons without previous tuberculosis history were 4.71, 2.33, 1.78 and 1.11 in 1980-83 and 1.84, 3.99, 1.80 and 1.11 in 1997-99 for groups born in 1910-19, 20-29, 30-39 and 40-49, respectively. The ratio did not change systematically with time in these groups, indicating the recurrence rate did not change with time more than ten years after recovery from previous tuberculosis. The ratio was about 3 for groups born in 1910-19 and 20-29 and 1 for group born in 1940-49. Almost all patients born in 1940-49 could receive chemotherapy for tuberculosis in their twenties, while most of the patients born in 1910-29 could not. Therefore, the above-mentioned fact may reflect the recurrence rate of patients treated successfully with chemotherapy is almost the same as the incidence rate from remotely infected persons, while that the recurrence rate from previous tuberculosis patients spontaneously recovered is 3 times higher than the incidence rate from remotely infected persons.

The role of surgery in the management of pleuropulmonary tuberculosis - seven years' experience at a single institution

Pleuropulmonary tuberculosis (TB) is a relatively frequent condition (the incidence of (TB) was 176/100,000 in our county in 2004) and some of these patients with TB are undergoing surgical interventions. The authors share their experience in surgical treatment of pleuropulmonary tuberculosis, based on minimal invasive techniques such as VATS and filling the residual cavities with muscle or skin-muscle grafts. The authors are retrospectively revising 144 patients between 1 January 2001 and 31 December 2007 who underwent surgical treatment for tuberculosis in this period. Two hundred and thirteen surgical procedures were performed for pleuropulmonary tuberculosis, representing 4% of all the procedures done in the department. For most of the patients the etiological diagnosis was not established until the operations, all the patients were sputum-negative. The diagnoses at the admittance were: pulmonary nodules or tumors (42 patients), pleural collections (46), pleural thickening and post-tuberculosis syndromes (46), fibrocavitary tuberculosis (6), and tuberculous pericarditis (4). Of all the procedures applied, 14 were pulmonary resections, 50 atypical (wedge) resections, 70 video-assisted thoracic surgery (VATS) procedures, and nine patients needed muscle or skin-musle flap for residual pleural cavities. Eleven patients (7.6%) had to undergo secondary surgery due to complications. No in-hospital mortality was registered. The mean hospitalisation period was 10.1+/-4.2 (S.D.) days.

19歳で発症した膀胱結核

A 24-year-old man experienced gross haematuria and dysuria several times a year from the age of 19, presenting to this Department for the first time at age 21, when he was given standard antibiotic treatment for acute cystitis. Although urinary symptoms persisted, he failed to attend for follow-up. He attended another clinic at the age of 24 with increased urinary frequency. Transrectal ultrasonography revealed thickening of the bladder wall, concavity of the right bladder neck, and nodular changes extending from the left bladder neck to the left bladder wall, so he was referred to this department for further investigation. Mycobacterium tuberculosis was detected in the urine by the referring doctor, so the diagnosis was made of bladder tuberculosis (TB). We treated him with rifampicin (RFP), isoniazid (INH) and pyrazinamide (PZA) triple therapy for 2 months, followed by RFP and INH dual therapy for 4 months. His urinary frequency improved markedly after one month, and his bladder capacity was 420 ml after 4 months of treatment. After 2 and half year follow-up he remains well without any signs of relapse. To our knowledge, this is only the ninth case of teenage onset of urinary tract TB in Japan since 1995. As specified in Clause 22 of the Enforcement Regulations of the Tuberculosis Control Law, chemotherapy and surgical treatment of TB, the mainstays of treatment, should be administered in accordance with the 'Standards for the Treatment of Tuberculosis', issued by the Japanese Minister of Health and revised in 2004. The level of recognition of the 'Standards for the Treatment of Tuberculosis' is low, however. Although the incidence of TB of the urinary tract has dropped dramatically, as urologists we must be aware that treatment of this condition must be given in accordance with the Standards.

The microbiology, chemotherapy, and surgical treatment of tuberculosis

Tuberculosis is a disease that has plagued humankind for centuries. The "white plague" is not only treatable and curable but also preventable. Initially, tuberculosis fell in the province of the general physician. With the advent of technologic advances in thoracic surgery, surgical management of tuberculosis was brought to the forefront. Effective bactericidal drug therapy became available by 1954 after the development of streptomycin in 1945 and isoniazid in 1952. Additional effective antituberculous drugs have relegated surgical therapy for tuberculosis to a relatively minor role.

20 Surgical Treatment of Tuberculosis of the Hip in Children

20 Surgical Treatment of Tuberculosis of the Hip in Children

Surgery in the treatment of pulmonary tuberculosis.

With the advent of antituberculous chemotherapy and antibiotics, marked changes have been permitted in the surgical attack on tuberculosis. Whereas previously surgery had been limited to collapse procedures, now the residual tuberculous lesions are much more frequently excised. This progressive change in surgical methods is indeed a reflection of changing concepts. It is the purpose of this paper to present our experience in the surgical treatment of tuberculosis over a five-year period. In particular, we wish to show the changing trends in the surgical approach, to outline the methods we use in evaluating patients, and to present our results in terms of morbidity and mortality. Material The data in this report were compiled from the analysis of 1,041 consecutive surgical procedures performed for tuberculosis during the five-year period, commencing Jan. 1, 1954, at the Veterans Administration Hospital, Hines, Ill., and the Chicago State Tuberculosis Sanitarium, Chicago. In general,the

Thoracic surgery.

TuberculosisThe past four years, the first of the streptomycin era, have seen great changes in the surgical treatment of tuberculosis. Many of these undoubtedly represent progress. As a general rule, they have been along the lines of widening indications and reducing hazards of resection. A brake to enthusiasm, however, is provided by the words of Morriston Davies,103 speaking before the Thoracic Society of Great Britain in 1948:There always has been and will be the feeling of necessity to show one's erudition by doing something. In the past it was incantations and the brewing of loathsome concoctions: then venesection: . . .

Tuberculosis Among Children And Adults

This book is a monumental addition to the literature on the problem of tuberculosis. It is well written in the author's clearcut orderly style. He tells the whole story of tuberculosis, especially in infants and children and young adults. The book is divided in 4 parts: 1. Tuberculosis in Infancy; 2. Tuberculosis in Childhood; 3. Tuberculosis Among Young Adults; 4. Recent Progress in Tuberculosis Control with special articles on the Surgical Treatment of Tuberculosis by Authorities on the Subject.

The treatment of surgical tuberculosis in adults

The treatment of surgical tuberculosis in adults

A universal stretcher splint for treatment of surgical tuberculosis

A universal stretcher splint for treatment of surgical tuberculosis

Heliotherapy in the Treatment of Surgical Tuberculosis

Heliotherapy in the Treatment of Surgical Tuberculosis

Salt free diet in the treatment of surgical tuberculosis

Salt free diet in the treatment of surgical tuberculosis

The treatment of surgical tuberculosis with horse serum injections

The treatment of surgical tuberculosis with horse serum injections