[Indication for the surgery in patients with pulmonary tuberculosis].
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Biomedical subjects
Publications and source records attributed to V P Strel'tsov.
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UNLABELLED: 58 patients with asthenia were observed during postoperative period after surgery treatment of tuberculosis. All of the patients were divided into two groups: 34 patients taking anti tuberculosis drugs and Stimol, and 24 patients taking only anti tuberculosis drugs. Following method where used to appreciate states of the patients: scales of Symptoms Check List--90, acid-base and gas state of blood, EKG, ECHOKG, KIG, Contactles Spirometry. RESULTS: Treatment with using of Stimol leads to quicker regress of asthenia to improvement in both cardiovascular and respiratory systems and normalization of gas state of blood. Effect of this medicine can be connected with positive influence on cardiac and respiratory functions of the body due to normalization vegetative prevision and improvement of metabolism in cells of drain and cardiomyocyties.
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Telethoracoscopy (TT) was performed in 76 patients with exudative pleurisy of unclear etiology. A correct diagnosis was made in all (100%) cases. Tuberculosis was detected in 41 (54%) patients. In this group of patients, the results were analyzed by taking into account the duration of disease, the nature of an operation, and morphological findings. In tuberculous pleurisy, TT may be conducted at any time; however, it is most effective when an acute period subsides and an exudate begins forming. At this time (2-3 months after the onset of the disease), surgery is not diagnostic, but also remedial as sanitation of the pleural cavity with partial pleurectomy.
The study covered 105 patients with chronic tuberculous pleurisy and empyema who had undergone surgery. Reparative pleurectomies with lung decortication were made in all the patients. Four groups of patients operated on in different periods were analyzed. The paper presents clinical, morphological, and instrumental evidence for indications for surgery. The best outcomes were achieved in patients with a 3-4-month history (100% efficiency with recovered ventilation function). The total efficiency of pleurectomy and decortication was 92.4% without fatal outcomes.
The outcomes of surgical treatment were analyzed in 264 new cases of restrictive pulmonary tuberculosis subjected to pulmonectomy without pretreatment with drugs in the preoperative period. Sixty one patients who had refused to have surgery or operated on after treatment were as a control. Indications for such policy were defined. These included limited tuberculomas and cavernous tuberculosis without local seeding, perifocal infiltration, exacerbations and preserved cellular and humoral immunity and non-specific protection factors. The outcomes of surgical interventions in the experimental group were slightly better. They had fewer complications, rapid recovery of working capacity, low per cent of disability than patients operated on after preoperative chemotherapy. There was no increase in the incidence of relapses.
If exudative pleurisy developed unfavourably with the formation of encystment, the development of massive pleural impositions, the deterioration of cardiorespiratory functional parameters, reparative operations, such as pleurectomy with decortication, were performed at month 3-4 of the onset of the disease with the minimum number of intra- and postoperative complications, with the more rapid and proper anatomic and functional recovery. Postoperative complications occurred in 75% of patients at months 1-2 of the disease, in 25-30% at months 5-12.
External respiratory function (ERF) was studied in 129 patients with restrictive pulmonary processes (tuberculomas, infiltrative and cavernous tuberculosis) before and after surgery. All the patients underwent saving lung resections. Changes in ERF were examined by conventional and the new method telespirography. This technique detects general and individual pulmonary ventilation disorders, which underlie criteria for assessing whether patients with pulmonary tuberculosis can be operated on. The authors show that the outcomes of surgical treatment are determined by the baseline status of the respiratory apparatus generally and each lung specifically. Distinctive features of complicated and uncomplicated postoperative periods are identified. The benefits of the new method are demonstrated.
Prior to and following surgery, 70 patients were examined for pulmonary tuberculosis who were divided into 2 groups: 1) 27 patients with limited processes (tuberculomas, infiltrating, cavernous tuberculosis in 1-2 segments) and 2) 43 patients with disseminated tuberculosis in 4 lobes or more. A comprehensive examination including studies of pulmonary circulation by radiotracer techniques (scanning, scintigraphy) and an original contactless study of pulmonary circulation (CSPC). There was a correlation between the results obtained by the two methods. The findings indicate a high validity of CSPC6 which makes it possible to recommend it as a screening technique for detection of pulmonary circulatory disorders.
Radiation of the neodymium YAG laser in the noncontact and contact regimens with a sapphire tips was employed for maximally sparing removal of different pathological formations from the lung. The laser was used for dissection and coagulation of lung tissue to obtain reliable air- and hemostasis of the wound surface of the lung. A total of 29 patients were operated on. A noncontact photocoagulation regimen produces a strong coagulation layer that sustains the intrapulmonary pressure up to 40 cm H2O. Preliminary ligation of large bronchial branches in the resection zone is obligatory. The postoperative period showed a rapid restoration of lung tissue structure at the site of intervention.
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