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

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

Displasia fibrosa do osso temporal: relato de dois casos Fibrous dysplasia of the temporal bone: report of two cases

A displasia fibrosa do osso temporal é uma doença de etiologia ainda controversa, manifestando-se principalmente por estenose progressiva do conduto auditivo externo e pela perda condutiva da audição. Outras manifestações incluem abaulamento na região temporal ou retroauricular, otorréia, otalgia e disacusia sensório-neural. A incidência é maior no sexo masculino e acomete principalmente a raça branca. O exame radiológico característico demonstra um aspecto de "vidro-fosco" homogêneo envolvido por uma concha de tecido cortical denso, embora existam outros padrões radiológicos desta enfermidade. O exame microscópico demonstra um trabeculado ósseo semelhante aos caracteres chineses. Este estudo relata dois casos de displasia fibrosa do osso temporal que se destacam, pois ultrapassaram o osso temporal, acometendo a região zigomática, sendo que no segundo caso houve também comprometimento do osso esfenóide e o pterigóide. Os pacientes foram submetidos à mastoidectomia radical modificada e tiveram boa evolução.<br>Fibrous dysplasia of the temporal bone (FDTB) is a disorder which etiology is still controversial. Its main clinical feature is a progressive narrowing of the external auditory canal following by conductive hearing loss. Temporal or retroauricular enlargement, ear discharge, otalgia, and sensorineural hearing loss are additional findings. Women and Caucasians are more affected. The prominent finding is a homogeneous radiodense "grounded glass" like image shell surrounded by dense cortical tissue. However, other radiological patterns of this disease may be displayed. Microscopically, a trabecular of bone in "Chinese letter" configuration is found. The two cases of FDTB herein reported are particularly special for a far beyond temporal commitment reaching the zygomatic area in the first case and sphenoid and pterygoid bones in the second one. This infrequent clinical feature with unusual radiological findings made these two cases worth-reported