RESUMEN
We present this clinical case as a demonstration of difficulties in differential diagnosis of pulmonary coccidioidomycosis. Differential diagnostics of peripheral pulmonary lesion performed using bronchoscopy with BAL and TBCB and video-assisted thoracic surgery (VATS) biopsy. Diagnostic specimens were tested using microbiological (luminescent microscopy, culture for M. tuberculosis (BACTEC MGIT960 and Lowenstein-Jensen Medium), RT-PCR, cytological and morphological (hematoxylin-eosin, Ziehl-Neelsen, PAS, Grocott methenamine silver (GMS) stainings) examinations. A diagnosis was verified correctly In Russia the country is not endemic for coccidioidomycosis and patient was treated accordingly. Diagnostics of peripheral pulmonary lesions requires of multidisciplinary approaches. Morphological examination, based on detection of only granulomatous inflammation in lung biopsy cannot be used for finally DS and requires microbiological confirmation for TB or other infections, and dynamic monitoring of the patient with concordance their anamnesis vitae and morbi.
Asunto(s)
Broncoscopía , Coccidioidomicosis , Enfermedades Pulmonares Fúngicas , Humanos , Diagnóstico Diferencial , Coccidioidomicosis/diagnóstico , Masculino , Broncoscopía/métodos , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/microbiología , Pulmón/patología , Pulmón/microbiología , Cirugía Torácica Asistida por Video/métodos , Biopsia/métodos , Coccidioides/aislamiento & purificación , Persona de Mediana Edad , Resultado del Tratamiento , Antifúngicos/uso terapéuticoRESUMEN
One of the reasons of dramatic situation with tuberculosis in Russia is untimely diagnostics of tuberculosis. The aim of the study was to identify the causes of diagnostic mistakes when we deal with disseminated pulmonary tuberculosis at current stage and to modernize the diagnostic process. The analysis of the diagnostic activity of the consultative diagnostic center of Central Tuberculosis Research Institute of Russian Academy Medical Sciences for 2011 was performed with special attention on the results of the survey of 505 patients with pulmonary dissemination. The frequency of discrepancies of disseminated pulmonary tuberculosis diagnostics was 96.1%. Based on the studies carried out the main causes diagnostic mistakes in patients with disseminated pulmonary tuberculosis were determined. New directions of improving of tuberculosis diagnostics were developed: overall high-technology examination of patient, adherence to the diagnostic procedure, developed by consultative diagnostic center of Central Tuberculosis Research Institute (CTRI), timely performing fiber-optic bronchoscopy with complex biopsy and diagnostic surgery procedures, further training of primary health care doctors. Implementation of proposed activities will significantly (by 3-5 times) reduce the time for diagnostics of respiratory system disease.
Asunto(s)
Diagnóstico por Imagen/normas , Tuberculosis Pulmonar/diagnóstico , Adolescente , Adulto , Anciano , Biopsia , Broncoscopía , Diagnóstico Diferencial , Diagnóstico por Imagen/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
The paper pools some experience with 6 videothoracoscopic and 505 video-assisted thoracoscopic (VATS) resections of the lung and 105 VATS pneumonectomies. The bulk of the operations [451 (73.2%)] was made for pulmonary tuberculosis in patients aged 7 to 77 years. 81% operations by separately treating root elements, including all pneumonectomies and major lung resections, were performed. A new SOMI-80 suturing apparatus designed for mini-invasive surgery was employed to suture lung tissue in most cases. Intraoperative and postoperative complications occurred in 5 and 8 cases, respectively. The efficiency of operations for tuberculosis was 98.6%.
Asunto(s)
Neumonectomía/métodos , Cirugía Torácica Asistida por Video/instrumentación , Tuberculosis Pulmonar/cirugía , Adolescente , Adulto , Anciano , Niño , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The authors have improved a procedure for preoperatively preparing patients with progressive drug-resistant fibrocavernous tuberculosis. This has been achieved by using ultraviolet laser irradiation (wavelength 248 nm) of the cavity walls in the multimodality treatment of this disease. Endocavitary laser irradiation increases preoperative preparation and surgical treatment and reduces the number of postoperative complications.
Asunto(s)
Terapia por Láser , Tuberculosis Pulmonar/radioterapia , Terapia Ultravioleta/métodos , Adulto , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Procedimientos Quirúrgicos Torácicos , Resultado del Tratamiento , Tuberculosis Pulmonar/patología , Tuberculosis Pulmonar/cirugíaRESUMEN
Ultraviolet laser radiation (a wavelength of 248 nm) was examined in vitro for its bacteriostatic and bactericidal actions on M. tuberculosis H37Rv. Sterilization was achieved when a dose of 10 m/J/cm2 was applied. This indicates that this type of radiation suppresses both the formation of colonies upon exposure of free Mycobacteria in the suspension and the incorporation of 3H-uracil by the mycobacteria phagocytized with peritoneal macrophages.
Asunto(s)
Terapia por Láser , Mycobacterium tuberculosis/efectos de la radiación , Terapia Ultravioleta , Desinfección , Técnicas In Vitro , Mycobacterium tuberculosis/crecimiento & desarrollo , Fagocitos/fisiología , Fagocitos/efectos de la radiaciónRESUMEN
Low-energy lasers were used in the combined preoperative treatment and therapy of 548 patients with chronic fibrocavernous tuberculosis. Indications for some types of exposure were defined, namely, transcutaneous exposure of the tuberculous involvement zone, combination of transcutaneous laser exposure and laser puncture, intravenous and endocavitary laser exposure. Low-energy lasers, as a many-factor pathogenetic exposure, are conducive to a more rapid and effective stabilization of tuberculosis progress, which helps sooner prepare the patients to surgical interventions and in some patients even do without them, reduce the number of postoperative complications, and improve the efficacy of surgical treatment of grave patients.
Asunto(s)
Terapia por Láser , Tuberculosis Pulmonar/terapia , Terapia Combinada , Humanos , Cuidados Preoperatorios/instrumentaciónRESUMEN
The efficiency of various types of lasers used in the surgical treatment of patients with tuberculosis and other diseases of the lungs and pleura was evaluated. Surgical (CO2 and YAG) and therapeutic lasers (helium-neon, ultra-violet and semiconductive) were used. The findings demonstrated that use of various lasers in lung surgery enables one to improve preoperative management, reduce the volume and traumatism of surgical interventions, decrease the number of postoperative complications and increase the effectiveness of surgical treatment of patients with tuberculosis and other diseases of the lungs and pleura.