Three new molecular approaches were developed to identify drug-resistant strains of Mycobacterium tuberculosis using biochips with oligonucleotides immobilized in polyacrylamide gel pads. These approaches are significantly faster than traditional bacteriological methods. All three approaches-hybridization, PCR, and ligase detection reaction-were designed to analyze an 81-bp fragment of the gene rpoB encoding the ␤-subunit of RNA polymerase, where most known mutations of rifampin resistance are located. The call set for hybridization analysis consisted of 42 immobilized oligonucleotides and enabled us to identify 30 mutant variants of the rpoB gene within 24 h. These variants are found in 95% of all mutants whose rifampin resistance is caused by mutations in the 81-bp fragment. Using the second approach, allele-specific on-chip PCR, it was possible to directly identify mutations in clinical samples within 1.5 h. The third approach, on-chip ligase detection reaction, was sensitive enough to reveal rifampin-resistant strains in a model mixture containing 1% of resistant and 99% of susceptible bacteria. This level of sensitivity is comparable to that from the determination of M. tuberculosis drug resistance by using standard bacteriological tests.

Tracheoesophageal fistula is an uncommon clinical problem, and can be either congenital or acquired in origin. In this report, we present our experience in the management of 41 patients with tracheoesophageal fistula (28 male, 13 female; age ranging from 8 to 69 years) who were seen during the period spanning 1968 to 1989 at the National Research Center of Surgery, Moscow. During this time frame fewer malignant and correspondingly more posttraumatic and postoperative fistulas were observed. The most common clinical findings were cough associated with eating, production of sputum mixed with food, and weight loss with profound weakness. In the vast majority of patients, diagnosis was made using radiologic contrast studies, with endoscopic assessment being occasionally necessary. We classify our surgical approaches as "radical" (the isolation and ablation of the communication), "conditionally radical" (implying creation of a neoesophagus or thoracoplasty with muscle flap obliteration of the fistula and associated chronic empyema cavity), or "palliative" (usually entailing gastrostomy alone). Of the 32 patients undergoing surgical treatment in this series, 21 underwent radical or conditionally radical procedures; there was no operative mortality, and long-term follow-up shows that 19 of the 20 long-term survivors report satisfactory, good, or excellent status. This report summarizes the indications, timing, technique, and results of the various surgical approaches, and also delineates measures for the prevention of postoperative tracheoesophageal fistula.

During the period 1990 -1994 a total of 578 operations were performed in 502 patients with various forms of tuberculosis. Most of the patients (68%) were men aged 20 to 50 years (70%). Sputum cultures were positive in 55% of the patients. More than half of all patients were chronic smokers, and about 10% were alcoholics or drug addicts. There were no human immunodeficiency virus-infected patients, and none with acquired immunodeficiency syndrome. The most frequent surgical interventions were, according to the classification adopted in Russia, for cavernous or fibrocavernous tuberculosis (196 cases) and tuberculomas (161 cases). The main operative procedures used were pulmonary resection (n ‫؍‬ 280) and pneumonectomy or pleuropneumonectomy (n ‫؍‬ 80). Diseased intrathoracic lymph nodes were ablated in 62 patients. Thoracoplasty or thoracomyoplasty were performed in 46 cases, thoracostomy in 37, closure of a thoracic wall defect in 27, and reamputation of the main bronchial stump in 6. Postoperative complications arose in 20% of the patients. More than half occurred in the pleural cavity or bronchi and were associated with tuberculous infection. The postoperative hospital casefatality rate was 2%. The overall clinical efficacy by the time of discharge was 82.7% (95% in tuberculomas). Reactivation of tuberculosis over the first 3 years after discharge occurred in 6.6% of the patients. Most patients with large or multiple caverns, tuberculomas, intrathoracic caseous lymphadenitis, or various complications of pulmonary tuberculosis cannot be cured (or are not amenable to cure in principle) by means of antibacterial therapy because of irreversible morphologic changes in the lungs, bronchi, pleura, lymph nodes, or thoracic wall. For this reason, indications for surgical management of pulmonary tuberculosis should be generally expanded. Excessively long antibacterial therapy for tuberculosis is often inadvisable. Although the availability of standardized regimens of antibacterial therapy is strategically essential, each patient must be treated according to an individual plan. In certain cases thoracic surgeons should be enlisted to participate in the development of such plans.

Experience with surgical treatment of 164 patients with various diseases of the trachea at the All-Union Institute of Clinical and Experimental Surgery in Moscow since 1963 is summarized. The main diagnostic methods used in tracheal diseases were tracheography and tracheoscopy with biopsy. Operations were performed for malformation, trauma, exflammatory disease, benign and malignant tumors, nontumoral stenoses, and esophagotracheal fistula. A bypass respiration system was used in the majority of patients after tracheal transection. Hyperbaric oxygenation added to the bypass respiration system made it possible to interrupt lung ventilation during operations on the trachea for long periods.The best operative approach to the thoracic trachea was a partial sternotomy and posterior thoracotomy. The standard approach to the tracheal bifurcation was a posterior right thoracotomy.The various operations performed on the trachea included sleeve resection with end-to-end anastomosis, resection of the tracheal bifurcation, window resection, tumoral incision in the opened trachea, plastic repair of esophagotracheal fistula, and strengthening of the membranous trachea. Six variations of resection of the tracheal bifurcation were performed. In cases of sleeve resection, operative risk was minimized by suturing the left main bronchial stump closed, leaving the left lung in a state of atelectasis.Of the 164 patients who underwent operation, 138 were discharged from the hospital and 26 (16%),died in the postoperative period. Bleeding from the brachiocephalic artery, pneumonia, thromboembolism of the pulmonary artery, and anastomotic leak were the causes of death. Op-Translated by Jerome Katsell, Ph.D.

This paper is devoted to the construction of the mathematical model of the tuberculosis morbidity dynamics. The model takes into account the peculiarities of morbidity epidemiology and its control. The model is adjusted to the data collected in the Orlovskaya oblast. The results obtained will be used for the analysis of the epidemiological situation and designing the effective strategy of tuberculosis control.