Estimation of Reserves for Improving the Results of Patients with Multipresistant Pulmonary Tuberculosis in the Application of Surgical Methods Based on Analysis of the Efficiency of Conservative Treatment of a Specified Cohort

In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done.In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention.Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start.According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients.Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment

ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT

In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done. In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention. Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start. According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients. Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment

THE ADVANTAGES OF DIFFERENTIATED TACTICS OF VIDEOTHORACOSCOPY IN PATIENTS WITH PLEURAL EFFUSION SYNDROME

The standard procedure of videothorascopic intervention has a series of disadvantages, connected with intubation narcosis, that limit the contingent of patients, who can undergo it.   Aim of the work is to raise the efficacy of diagnostic videothoracoscopy at pleural effusion syndrome on the base of its differentiated tactics.   Materials and methods. Differentiated tactics of the choice of method of diagnostic videothoracoscopy in patients with pleural effusion syndrome was introduced in the work of thoracic surgery department. Its essence is in fact that before operation after evacuation of effusion from the pleural cavity there was created an artificial pneumothorax, the state of hemithorax was radiologically assessed. According to the results of radiological examination, the patients, who underwent videothoracoscopy in simplified way, were selected. As opposite to the standard method, at simplified way the intravenous sedation was used instead of endotracheal, muscle rexalants were not used, the additional surgical manipulations were not carried out. For assessment of the efficacy of this tactics 124 cases of diagnostics and treatment of pleural effusion syndrome using videothoracoscopy we analyzed. Results. In the result of introduction of differentiated tactics of videothorascopic diagnostic in patients with pleural effusion syndrome the number of postanesthetic side effects was reduced by 65,9 %, the frequency of anesthesia by narcotic analgetics – from 2,8 to 1,4 times/day, the term of recovery of independent stool – from 72,0 to 34,3 hours, the term of activation after surgery (independent movement) – from 23,8 to 10,3 hours, the duration of staying in the intensive care department was reduced from 24,8 to 9,7 hours, duration of postsurgical treatment was reduced from 16,0 to 10,1 days. Results. The main advantages of introduction of differentiated tactics of videothorascopic diagnostics were: the reliable acceleration of activation after surgery, recovery of adequate peristalsis and independent stool, decrease of duration of staying in the intensive care department, decrease of the necessity in anesthesia with narcotic analgetics, reduction of the number of postanesthetic side effects and mean duration of postsurgical treatment. The received result is connected with the fact that two thirds of patients did not undergo the effect of preparations for intubation narcosis

ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT

In order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done.In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention.Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start.According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients.Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment