ФГБНУ «Центральный научно-исследовательский институт туберкулеза», Москва, РоссияЦель: исследование эффективности профилактики возникновения медиастинальной грыжи (МСГ) и эффективности коррекции имевшейся до операции МСГ путем пластики переднего средостения (ППС) во время проведения пневмонэктомии (ПЭ)� Материалы и методы. Результаты ПЭ у 30 пациентов (22 мужчины и 8 женщин, возраст от 20 до 56 лет) с фиброзно-кавернозным туберку-лезом легких с множественной/широкой лекарственной устойчивостью возбудителя� В 1-й группе -17 пациентов, которым проведена ПЭ с ППС, из них у 10 (58,8%) пациентов до операции не было МСГ, а у 7 (41,2%) пациентов уже была МСГ малого объема� Во 2-й группе -13 пациентов, у которых ПЭ не сопровождалась ППС� Результаты. При ПЭ МСГ не формируется: у 82,4% (95%-ный ДИ 59,0-93,8%) пациентов, если выполняется ППС, и у 7,7% (95%-ный ДИ 1,4-33,3%) пациентов, если пластика не используется, p < 0,01� Проведение ППС во время ПЭ устранило имевшуюся до операции МСГ малого размера у 71,4% (95%-ный ДИ 35,9-91,8%) пациентов, вы-полнив коррекционную функцию� После ПЭ по поводу фиброзно-кавернозного туберкулеза риск формирования МСГ у пациентов, не имевших ее до операции, при выполнении пластики средостения составляет 10,0% (95%-ный ДИ 1,8-40,4%), у имевших МСГ -28,6% (95%-ный ДИ 8,2-64,1%)� При неиспользовании ППС риск составляет 90,0% (95%-ный ДИ 59,6-98,2%)� Ключевые слова: хирургия туберкулеза, осложнения пневмонэктомии, медиастинальная грыжа, пластика переднего средостения ANTERIOR MEDIASTINAL PLASTICS DURING PNEUMONECTOMY AS PREVENTION AND TREATMENT OF A MEDIASTINAL HERNIA IN FIBROUS CAVERNOUS PULMONARY TUBERCULOSIS PATIENTS M. А. BАGIROV, E. V. KRАSNIKOVА, А. E. ERGESHOVА, O. V. LOVАCHEVА, N. L. KАRPINА, R. А. PENАGI Central Research Institute of Tuberculosis, Moscow, RussiaThe objective is to study the efficiency of prevention of a mediastinal hernia and efficiency of its treatment through anterior mediastinal plastics performed during pneumonectomy� Subjects and Methods� Results of pneumonectomies in 30 patients (22 men and 8 women at the age varying from 20 to 56 years old) with fibrous cavernous pulmonary tuberculosis with multiple or extensive drug resistance� Group 1 included 17 patients who had pneumonectomy with anterior mediastinal plastics, of them 10 (58�8%) had no mediastinal hernia and 7 (41�2%) patients had a minor one� Group 2 included 13 patients who had pneumonectomy without anterior mediastinal plastics� Results. When pneumonectomy was performed, no mediastinal hernia developed in 82�4% (95% CI 59�0-93�8%) of patients who had anterior mediastinal plastics and in 7�7% (95% CI 1�4-33�3%) of patients with no plastics, p < 0�01� Anterior mediastinal plastics performed during pneumonectomy repaired a minor mediastinal hernia in 71�4% (95% CI 35�9-91�8%) of patients� After pneumonectomy with anterior mediastinal plastics due to fibrous cavernous tuberculosis, the risk of mediastinal hernia made 10�0% (95% CI 1�8-40�4%) in the patients who had no hernia before surgery, while in the patie...

The spread of drug-resistant forms of TB dictates the need for surgical treatment in the complex of anti-tuberculosis measures in Russia. Most often, surgical intervention is performed in the case of pulmonary tuberculoma or fibrotic cavitary tuberculosis (FCT). This study is devoted to the search for biomarkers that characterize the course of disease in surgical TB patients. It is assumed that such biomarkers will help the surgeon decide on the timing of the planned operation. A number of serum microRNAs, potential regulators of inflammation and fibrosis in TB, selected on the basis of PCR-Array analysis, were considered as biomarkers. Quantitative real time polymerase chain reaction and receiver operating curves (ROC) were used to verify Array data and to estimate the ability of microRNAs (miRNAs) to discriminate between healthy controls, tuberculoma patients, and FCT patients. The study showed that miR-155, miR-191 and miR-223 were differentially expressed in serum of tuberculoma with “decay” and tuberculoma without “decay” patients. Another combination (miR-26a, miR-191, miR-222 and miR-320) forms a set to differentiate between tuberculoma with “decay” and FCT. Patients with tuberculoma without “decay” diagnosis differ from those with FCT in serum expression of miR-26a, miR-155, miR-191, miR-222 and miR-223. Further investigations are required to evaluate these sets on a larger population so as to set cut-off values that could be applied in laboratory diagnosis.

An observation from practice is given – surgical treatment of a patient with advanced tuberculosis of a single lung and a pronounced lung displacement. Patient A., 47 years old, after 3 months from the left pneumonectomy for fibrocavernous tuberculosis complained of dyspnea at rest, and dysphagia, underwent CT scan, which showed a pronounced displace ment of a single right lung with tuberculoma to the left. At the first stage of the surgery, the overstretched section of a single lung with tuberculoma was resected, the displaced lung was put back and a hernial orifice was strengthened with a mesh implant. At the second stage, the extrapleural thoracoplasty was made with resection of I–IV ribs from the side of pneumonectomy to reduce the volume of the left hemithorax and prevent relapse of mediastinal hernia. As a result, the patient stopped dyspnea and dysphagia, radiographically a single right lung was visualized in the right hemithorax.

The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.

The objective of the study: to analyze the efficacy of extrapleural plombage with silicone plug (EPSP) in those suffering from destructive pulmonary tuberculosis with multiple/extensive drug resistance (M/XDR) and to assess EPSP impact on pulmonary functions and blood gases. Subjects and methods. 34 patients with chronic persistent destructive pulmonary tuberculosis who underwent EPSP were enrolled in the study. 23 were men and 11 were women at the age from 18 to 54 years old (the median age made 36.29± 10.2 years). MDR was diagnosed in 31/34 (91.2%) patients, and of them, 22/31 (70.0%) had XDR. A high profile life long breast implants with texturized coating causing no rejection by the host were used for extrapleural plombage. Results. 18 patients who underwent EPSP as a single surgery had their cavities healed in the operated lung in 100% of cases (95% CI 96.3-100%). There were no lethal outcomes. 1/18 (5.6%) patient suffered from a late complication (empyema) related to EPSP. Postponed outcomes of tuberculosis treatment (effective course of treatment after EPSP) were favorable in 13/16 (81.3%; 95% CI 57.0-93.4%) patients. In 11 patients with disseminated destructive tuberculosis who had EPSP combined with resection or collapse surgery, 12/12 (100%; 95% CI 75.8-100%) had their cavities healed in the operated lung; 2/12 patients needed additional bronchial valve block. Surgeries for EPSP resulted in no lethal outcomes or complications. In 5 patients with destructive tuberculosis relapse in the only lung, EPSP was used to stop the progress of the disease due to poor efficacy of chemotherapy. The impact on cavities healing in the operated lung was achieved in 4/5 (80.0%; 95% CI (37.6-96.3%) patients. The complication after EPSP was observed in у 1/5 (20.0%) patient and resulted in the lethal outcome. 3/5 patients had favorable postponed outcomes. After EPSP, ventilation and gas exchange functions deteriorated in 32% of patients, while in 28% of patients, they improved. The intensity of change was moderate or significant. The most dynamic and informative indicators were the vital capacity of the lungs and the partial tension of oxygen in oxygenated blood (PaO2).