Характеристика осложнений после операций по поводу туберкулеза легких у больных ВИЧ-инфекцией с разным уровнем CD4+-лимфоцитов и вирусной нагрузки

The objective: to study postoperative complications in pulmonary tuberculosis HIV positive patients with the relevance to CD4+ count and viral load before surgery.Subjects and methods. The results of planned lung resections of various extent for tuberculosis in 139 HIV positive patients were analyzed.Results. There was no statistically significant correlation between baseline CD4+ count and viral load and the development of postoperative complications in the investigated cases.Цель исследования: изучение послеоперационных осложнений при туберкулезе легких у больных с ВИЧ-инфекцией в зависимости от уровня CD4+-лимфоцитов и вирусной нагрузки перед операцией.Материалы и методы. Проанализированы результаты плановых резекций легких различного объема по поводу туберкулеза у 139 ВИЧ-позитивных пациентов.Результаты. Не выявлено статистически значимой взаимосвязи между исходным уровнем CD4+-лимфоцитов и вирусной нагрузкой с развитием послеоперационных осложнений у пациентов

Результаты торакальных операций у больных ВИЧ-инфекцией

The objective: substantiation of the possibility of surgical treatment of various lung diseases in HIV-infected patients.Subjects and Methods. Comorbidities, medical history, bad habits, ongoing antiretroviral therapy (ARVT), viral load and CD4+count before and after lung surgery were assessed. Blood loss during the operation, intra- and postoperative complications was analyzed. Causes of postoperative lethality were analyzed.Results. According to results of the study, planned surgical treatment for chronic abscess, tuberculosis, cancer, mycotic pulmonary lesions and cicatricial stenosis of the trachea in HIV-infected patients is justified, and should be performed based on indications common for these diseases. This is confirmed by the level of postoperative complications in HIV-negative patients. The vast majority of complications were temporary, not severe, and were resolved by conservative treatment. Achievment of the best results is facilitated by ongoing ART.Цель исследования: обоснование возможности хирургического лечения различных заболеваний легких у больных ВИЧ-инфекцией.Материалы и методы. Изучены коморбидный фон, анамнез заболевания, вредные привычки, проводимая антиретровирусная терапия (АРВТ), вирусная нагрузка и CD4+ лимфоциты до и после операции на легких. Проведен анализ кровопотери по ходу операции, интра- и послеоперационных осложнений. Проанализированы причины послеоперационной летальности.Результаты. Проведенное исследование свидетельствует, что плановое хирургическое лечение по поводу хронического абсцесса, туберкулеза, рака, микотических поражений легких и рубцового стеноза трахеи у больных ВИЧ-инфекцией оправдано и должно проводиться по общим для этих заболеваний показаниям. Это подтверждается уровнем послеоперационных осложнений у пациентов без ВИЧ. Подавляющее большинство осложнений носили временный, не тяжелый характер и устранены консервативно. Достижению наилучших результатов способствует проводимая АРВТ

The pulmonary outcome of long-term survivors after congenital diaphragmatic hernia repair

BACKGROUND: Congenital diaphragmatic hernia (CDH) represents a chronic condition with significant pulmonary and non-pulmonary complications. The main aim of the present study was to determine the pulmonary outcome in a group of long-term survivors of CDH. METHODS: Clinical records of 46 patients with CDH admitted to the University Children's Hospital Zurich between 1991 and 2001 were reviewed retrospectively. Survivors underwent clinical examination, lung function tests and measurements of exhaled nitric oxide. RESULTS: 30 of 46 (65%) patients survived after repair of CDH and 19 children participated in a follow-up study at the mean age of 7.9 (2.8) years. At least one wheezy episode requiring inhaled bronchodilators was reported by 9/19 (47%) children and 4/19 (21%) children complained of recurrent wheezy episodes. Nine children showed lung function impairment in spirometry as well as in oscillatory resistance. Neither duration of assisted ventilation nor the length of hospitalisation appeared to correlate with lung function. Exhaled nitric oxide was within normal range in our group of CDH survivors. Measurement of respiratory system resistance using a forced oscillation technique detected those CDH survivors, who showed abnormal pattern in spirometry. However, no correlation between oscillatory resistance and specific airway resistance measured by whole body plethysmography was found. CONCLUSIONS: Despite the presence of rather insignificant symptoms, we found mild to moderate pulmonary functional impairment in children surviving CDH repair

IMMUNE INDEXES IN PATIENTS WITH PROGRESSIVE FIBROUS-CAVERNOUS TUBERCULOSIS DEPENDENT ON SEVERITY OF DESTRUCTIVE CHANGES IN THE LUNGS

Abstract. We have studied cellular immune state in patients with progressive fibrous cavernous tuberculosis (FCT) with varying severity of lung destructive changes. It was found that increasing number of specific cytotoxic lymphocytes, NK-, NKT-, CD95-cells and activated T-lymphocytes, accompanied by a significant decrease of T-helper cells, B cells, CD25-cells, is a sign of destruction, along with inhibition of antigen-specific cellular response and functional insufficiency of T-helper and cytotoxic lymphocytes. Increased severity of the disease is consistent with activation of B cell compartment and weaker phagocytic function of neutrophils.Significant differences were revealed in spontaneous and induced production of IFNγ, IL-2 and IL-8 between various groups of patients with FCT. The alterations of immune and cytokine status in a certain clinical subgroup with progressing FCT were indicative for depletion of immune system potential. As based on these data, we have established some criteria in order to assess severity of immune pathology in the patients with progressing FCT which may be of predictive value for evaluating trends in development of the specific process and feasibility of immune correction therapy

FEATURES OF SPECIFIC IMMUNE RESPONSE IN THE PATIENTS WITH FIBROUS/CAVERNOUS TUBERCULOSIS OF LUNGS

Abstract. The aim of the present study was to determine the different profiles of the immune responsiveness of the patients with fibro-cavernous pulmonary tuberculosis to PPD from M.tuberculosis in comparison with their response to standart mitogen and IFNγ. A pronounced specific Th1 response was found, evidenced by the enhanced proliferation and IL-2 and IFNγ production after contact of their peripheral blood mononuclear cells (PBMCs) with PPD. At the same time a high frequency of PPD-anergy was shown: сonsiderable proportion of TB patients was characterized by low proliferative response to PPD coupled with the low levels of IL-2 and IFNγ. Most of the patients revealed failure of monocyte/macrophage oxidative burst in response to PPD. Additionally a positive correlation was found between the levels of their PBMC’s oxidative burst and IL-4 production

Frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients

The objective of this work was to study the frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients.Material and methods. Retrospective and prospective analysis of complications after lung resections for tuberculosis in 80 HIV-infected and 117 HIV-negative patients was carried out. Developed complications are divided into nonspecific and specific complications, according to the modified Russian classification of postoperative complications on the basis of Accordion classification.Results. It was noted that among the operated HIV-infected patients, XDR-TB (extensive drug-resistant tuberculosis) and clinically significant concomitant diseases were more common. Differences in the frequency of intraoperative complications in groups have not been established. Postoperative complications were mostly disposable, the frequency of deaths in the main group did not differ from that in the comparison group.Conclusion. Surgical treatment of pulmonary tuberculosis in HIV-infected patients is reasonable and justified, in general for patients with pulmonary tuberculosis, with adequate antituberculous chemotherapy and antiretroviral therapy