Individual treatment tactics for the pulmonary infiltrative tuberculosis

Abstract

Surgery is performed for treating the pulmonary tuberculosis only when long-term chemotherapy is ineffective. However this can be reconsidered for some patients with the infiltrative tuberculosis. The decision is grounded by the studied mechanism of the tuberculous inflammation development together with a common origin of a collagen and early pneumosclerosis around the caseous necrotic zones. This causes aggravation of the chemiospecimen penetration into tuberculous foci. At the same time bactericidal activity of alveolar macrophages reduces. Thus the process preserves activity but takes on flabby and torpid course. Its dynamics together with the pneumosclerosis origin are controlled by the examination of the sputum cytogram, the bactericidal activity of 4 alveolar macrophages as well as the contents of the malonic dialdehyde, histamine and serotonin. By the 4^th month of the treatment the high values of these indexes on the background of a corresponding X-ray picture can be considered an indication for a minor pneumonectomy. By December 1995 fifteen of the 72 examined patients had been successfully operated. The surgery at an early stage advances a more prompt and effective pulmonary tuberculosis treatment. Surgery can be a cure alternative to a long and continuos chemotherapy.