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.

An observation from practice is given – surgical treatment of mediastinal pulmonary hernia in a patient after pneumonectomy using the method of anterior mediastinal plastic surgery with a mesh implant with demonstration of long-term results.The patient I. 31 years old was ill with pulmonary tuberculosis for 3 years, treatment was carried out, against which the stenosis of the left main bronchus progressed. The patient underwent endoscopic operations: argonoplasmic destruction of the left main bronchus, balloon dilation of the left main bronchus, with a temporary effect. Due to recurrent stenosis of the left main bronchus, a pneumonectomy was performed on the left. After 7 months, she complained of severe shortness of breath at rest. Computed tomography revealed a displacement of the mediastinal organs to the left, an upper-anterior pulmonary mediastinal hernia of the right lung to the left midclavicular line at the level of the anterior I-IV intercostals on the left. The patient underwent plastic surgery of the anterior mediastinum on the right using a polymer mesh implant. As a result of treatment, after 3 years, radiologically stable restoration of the position of the only right lung in its hemithorax. The patient is functionally compensated, shortness of breath is not observed. The patient has completely returned to her usual lifestyle.

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.