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Measurement the arterial oxygen saturation (SaO2) by pulse oximetry (SpO2), using a fingertip sensor is commonly used in the management of patients with pulmonary diseases. The aim of study was to compare SaO2 results obtained from earlobe and SpO2 results obtained from fingertip in patients with pulmonary tuberculosis (PT). Methods: In 150 patients with PT (84 male and 66 female; aged 47.7±16.1; FEV1 74.4±28.1 % predicted) the paired samples were compared. In addition to SaO2, other parameters (pH, PaCO2, PaO2) were analyzed in the samples obtained from the earlobe. The Bland and Altman method, regression, and ROC-analysis were used. Results: The mean difference between SaO2 (94.4±3.6%) and SpO2 (94.9±3.7%) was minus 0.6 percentage point (pp). Limits of agreement were 4.0 pp and -5.1 pp. The value of the difference depended on PaO2 (correlation coefficient (R) was minus 0.49; coefficient of determination (R2) was 0.22; p According ROC curve analysis to determine value of SpO2 for the difference between SaO2 and SpO2 more 3 pp, when We did not find the influence of age, FEV1, pH, PaCO2 on the value of the difference between SaO2 and SpO2. Conclusion: Oxygen saturation results determined of different ways are often not identical. The difference between SaO2 and SpO2 are often more 3 pp when SpO2 results obtained from fingertip less than 94%.

Introduction: In recent years, the identification of non-tuberculous mycobacteria has become more frequent in the lung resection material of patients operated on for tuberculosis. Aim: To study the morphological features of non-tuberculous mycobacteriosis in the lung resection material of patients operated on for respiratory tuberculosis. Methods: Investigated the lung resection material of 68 patients. All patients were operated on for pulmonary tuberculosis. In the resection material for molecular genetic methods, various strains of non-tuberculous mycobacteria have been identified. A morphological study of the tuberculosis process was performed. Changes in lung tissue characteristic of non-tuberculous mycobacteriosis were highlighted. Results: In the lung resection material of patients, predominantly slowly growing non-tuberculous mycobacteria were identified: M. avium, M. intracellulare, M. kansasii, M. gordonae, M. xenopi. A hysthological study showed the presence of extensive areas of loose histiocytic macrophage granulomas without necrosis. Granulomas merged into conglomerates and underwent diffuse fibrotization. In these zones, a high concentration of acid-resistant mycobacteria was noted. Characteristic changes were observed with all forms of the pathological process in the lungs: disseminated, focal, fibrous-cavernous. Conclusion: The results obtained indicate the activation of lung tissue sclerosis in patients with a simultaneous combination of tuberculosis and non-tuberculous mycobacteriosis.

Introduction: An important role in treatment of fibro-cavernous XDR tuberculosis is played by the surgical methods. Aim: The study of the effects of the intravenous laser blood irradiation (IV LBI) on the efficiency of preoperative preparation and surgical treatment of patients with XDR TB. Methods: We studied 147 patients with fibro-cavernous pulmonary XDR TB. 1 group – 68 patients, who underwent a course of treatment with IV LBI (630 nm). 2 group – 80 patients, who were not treated with IV LBI. Results: All patients were operated. The patients treated with using IV LBI more often noted resorption of infiltration (17%) and сlosure of the cavities was more frequent (8%). In 1 group the increase of blood circulation around the cavity more often by 32%. Histological examination after surgery showed that in 2 group tuberculosis process has characteristic signs of pronounced progression with predominance of caseous-necrotic and exudative components. In group 1 small pockets of compacted caseous surrounded by a thin layer of granulation tissue and well-formed fibrous capsule. Large caverns have a wide fibrous wall, often with focal infiltration of lymphoid and macrophage elements, the presence of different areas of compacted caseosis, sometimes with calcification. On the periphery of the thick fibrous capsule can be seen glandular structures formed cubic epithelium without signs of atypia and reflecting the regeneration of alveolar tissue in this area. Fresh foci of dissemination and epithelial cell granulomas are not determined or isolated. Conclusion: The use of VLBI in preoperative preparation promotes healing processes and leads to effective surgical treatment.

Background: Recently despite decreasing TB incidence we observe increasing numbers of drug resistant TB cases, among them those with immunosuppression including diabetes mellitus cases. Surgery greatly contributes to treatment of patients with drug resistant pulmonary TB and diabetes mellitus. Pre-operational procedures, surgical tactics and post-operation management of pulmonary TB patients with diabetes mellitus remains discussable. Aim: To increase effectiveness of lung surgery in drug resistant TB patients with diabetes mellitus by improving pre-operational procedures and optimizing surgical tactics. Methods: We studied 70 pulmonary TB patients with diabetes mellitus, aged 14-66. Out of them 26 had fibrocavitary TB, 2 – cavitary TB, 2 – TB empyema, one – cirrhotic TB, 39 –tuberculoma. 28 patients had type 1 diabetes mellitus, 42 patients had type 2 diabetes mellitus. Results: 1. 70 patients underwent surgery. No post-operative complications or relapses were observed. 2. Considering presence of micro- and macroangiopathy and poor tolerance of antibacterial therapy, pre-operational procedures included plasmapheresis, intravenous laser irradiation of blood, detoxication therapy. Conclusion: Currently diabetes mellitus is not a contraindication to surgical treatment of drug resistant pulmonary TB patients; it is rather an additional argument for radical surgery.

Introduction: Recently we observe increasing numbers of patients with drug resistant bilateral pulmonary TB, whose only chance for cure is surgical intervention with pneumonectomy on the most affected side. Objectives: To demonstrate clinical, functional and cosmetic advantages of extrapleural pneumolysis with silicone filling versus resection of the only lung or thoracoplasty of the remaining lung. Materials and methods: We performed stage-by-stage surgical treatment of 8 patients with bilateral pulmonary TB, which had one “destroyed” lung and the other lung with fibrotic cavities. All the patients had reduced functional reserves; resection of the only lung was risky. As filling we used a breast silicone implant designed for life placement in the human organism. 5 patients underwent extrapleural plombage at the first stage and pleuropneumonectomy at the second stage of treatment, which allowed gradual adaptation to functional losses during 2-3 months. In 3 cases silicone plombage on the only lung at the second stage was performed under developing hemorrhage from the “destroyed” lung. Results: X-ray scanning revealed compression of cavities in the collapse zone of the only lung in all the patients; they all showed satisfactory condition, adaptation of the respiratory function and absence of the chest deformation otherwise unavoidable in thoracoplasty. Conclusions: The proposed method of stage-by-stage surgical treatment for disseminated pulmonary TB involving extrapleural pneumolysis with silicone plombage on the side of the least affection and pleuropneumonectomy on the most affected side is most functional and cosmetically acceptable.

Background: Effectiveness of surgical treatment of pulmonary TB patients depends on stabilization of TB process, which can be reached during preoperative care. Objective: To study influence of intravenous laser blood irradiation (IV LBI) on preoperative care and surgery outcomes in destructive pulmonary TB patients. Methods: We studied 100 patients aged 20-53 with diagnosed fibrocavitary pulmonary TB. The main group included 50 patients, who received IV LBI with gallium arsenide. The comparison group included 50 patients, who did not receive IV LBI. Results: 1. The patients, who received IV LBI, normalized hemostasis within three weeks. The patients of the comparison group remained hypercoagulative. 2. In the patients, who received IV LBI, we observed more rapid resolution of pericavitary infiltration and foci versus the controls confirmed by X-ray and CT scan. 3. 43 patients of the main group (86%) underwent surgery; cavity closure was observed in 7 patients (in 3 – spontaneously, in 4 – after installation of the endobronchial valve). 47 patients of the control group (96%) underwent surgery; cavity closure was observed in 2 patients (in one – spontaneously, in one – after installation of the endobronchial valve). No relapse was observed in either group. Conclusion: IV LBI led to earlier improvement of X-ray patterns and rheological properties of blood. More rapid stabilization of TB process was reached, which allowed reducing time of preoperative care and performing effective surgical treatment.