DIAGNOSTIC THORACOSCOPIC METHODS OF RESPIRATORY SYSTEM DISEASES IN PATIENTS WITH HIV INFECTION
https://doi.org/10.17238/issn2072-3180.2020.3.40-46
Abstract
Introduction. In the absence of non-invasive methods morphological verification is required to establish a diagnosis of diseases of pulmonary system. The most importance is the early diagnostic HIV-infected patients.
The aim of this work is to study the results and safety of surgical diagnostics of patients with undifferentiated pulmonary and intrapleural processes not diagnosed with traditional examination methods.
Materials and methods. In the period 2014—2019, 404 diagnostic thoracic interventions were performed at the Clinic 2 of Moscow Research and Clinical Center for Tuberculosis Control to verify the diagnosis, 111 of them were HIV-infected.
Results. Tuberous tumor-like rashes on parietal pleura were in 69.4% of patients with pleurisy during thoracoscopy. In 65% of cases of histological examination verified the formation of classical granulomas. Acid-fast bacilum were identified in 48%. DNA of tuberculosis mycobacteria in altered pleura was found in 84%. Resistance to rifampicin was found in 23.5% of patients. In six cases patients without HIV defined pleural mesothelioma. In the group of lung resection 40% of patients confirmed pulmonary tuberculosis, 15.7% of patients had benign lung tumors, 20.2% of patients had malignant lung tumors, 23.8% had rare and atypical pathological pulmonary processes.
Conclusion. Surgical diagnostic methods of pulmonary and pleura diseases is safe, effective and does not lead to a significant number of complications and mortality among patients with HIV infection, regardless of the initial immune status. The low detection of the pathogen in the exudate allows considering thoracoscopy biopsy to be the only reliable diagnostic method for pleurisy which also has a medical character. Using the T-SPOT®.TB test system of pleural fluid increases the clinical sensitivity to 91.3% compared with the analysis of peripheral blood (83.7%).
About the Authors
T. I. Abu Arkub
Moscow Research and Clinical Center for Tuberculosis Control of Moscow Health Department, Cliniс №2
Russian Federation
Russian Federation
Abu Arkub Tamila - Thoracic surgeon of surgery department
107014, Barbolin st, 3, Moscow
B. G. Barsky
Moscow Research and Clinical Center for Tuberculosis Control of Moscow Health Department, Cliniс №2
Russian Federation
Russian Federation
Barsky Boris - PhD, Chief of surgical department
107014, Barbolin st, 3, Moscow
M. V. Sinitsyn
Moscow Research and Clinical Center for Tuberculosis Control of Moscow Health Department, Cliniс №1
Russian Federation
Russian Federation
Sinitsyn Mikhail - MD, deputy director
107014, Strominka, 10, Moscow
References
1. Vasilyeva I.A, Belilosvkii E.M., Borisov S.E., Sterlikov S.A., Sinitsyn M.V. Tuberculez, sochetnij s Vich Infekcij v sttanach mira I Rossiiskoj Federacii [Tuberculosis combined with HIV infection in the countries of the world and the Russian Federation]. Tuberkulez I bolezni legkih., 2017, 9(25), pp. 8–18. (In Russ.)
2. Shevchenko Yu.L., Ablitsov Yu. A., Vetshev P. S., Kashevarov S. B., Vasilashko V. I., Ablitsov A. Yu., Orlov S. S., Travin N. O. Videotekhnologii v torakal’noj hirurgii [Video technologies in thoracic surgery]. Al’manah klinicheskoj mediciny, 2007, 16, pp. 214–216. (In Russ.)
3. Barchuk A.S., Lemekhov V.G., Klimenko V.N., Gorokhov L.V. Znachenie videotorakosokpii v diagnostike novoobrazovanij organov sredosteniya [The value of video thoracoscopy in the diagnosis of mediastinal neoplasms]. Voprosy onkologii, 1999, 3, pp. 298−301. (In Russ.)
4. Zharakhovich I.A. Biopsiya v diagnostike zabolevanij organov dyhaniya [Biopsy in the diagnosis of respiratory diseases]. Khirurgiya, 1974, 8, pp. 71−76. (In Russ.)
5. Luo Q., Han Q., Chen X., Xie J., Wu L., Chen R. The diagnosis efficacy and safety of video-assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: a retrospective study. J. Thorac. Dis., 2013, 5(3), pp. 283−288. http://doi.org/10.3978/j.is-sn.2072-1439.2013.04.12 (In Russ.)
6. Dmitrieva L.I., Shmelev E.I., Stepanyan I.E., Apaev A.T. Luchevaya diagnostika interstitsial’nyh zabolevanij legkih [Radiation diagnostics of in terstitial lung diseases]. Vestnik rentgenologii i radiologii, 2000, 2, pp. 9−17. (In Russ.)
7. Kotiv B.N., Chuprina A. P. Videotorakoskopiya v differencial’noj diagnostike i lechenii perifericheskih obrazovanij legkih [Video thoracoscopy in the differential diagnosis and treatment of peripheral lung formations]. Vestnik nacional’nogo mediko-khirurgicheskogo centra im. N. I. Pirogova. 2012, 7(2,), pp. 18–21. (In Russ.)
8. Bensard D.D., Mclntyre Jr. R.C., Waring B.J., Simon J.S. Comparison of videothoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease. Chest., 1993, 103, pp. 765−70.
9. Baughman RP. Pulmonary sarcoidosis. Clin. Chest. Med., 2004, Sep., 25(3), pp. 521−530.
10. Fibla J.J., Molins L., Blanco A. Video-assisted thoracoscopic lung biopsy in the diagnosis of interstitial lung disease: a prospective, multi-center in 224 patients. Archivos de Bronconeumologia, 201, 48, pp. 81−85.
11. Kornev B., Popova E., Kogan E. Porazhenie legkih pri sistemnykh zabolevaniyakh soedinitel’noj tkani [Lung damage in systemic connective tissue diseases] Vrach, 2000, 9, pp. 22−25. (In Russ.)
12. Zhestkov K.G., Voskresenskij O.V., Fursa E.V., Virskij N.Yu. Torakoskopiya i mini-invazivnaya khirurgiya tuberkuleza [Thoracoscopy and mini-invasive surgery of tuberculosis]. Tikhookeanskij medicinskij zhurnal, 2002, 2, pp. 13−15. (In Russ.)
13. Klimenko V.N., Barchuk A.S., Lemekhov V.G., Sherbakov A.M. Videotorakoskopiya v diagnostike i lechenii novoobrazovanij legkogo, sredosteniya i plevry [Videothoracoscopy in the diagnosis and treatment of neoplasms of the lung, mediastinum and pleura]. Voprosy onkologii, 2002, 3, pp. 371−376. (In Russ.)
Review
For citations:
Abu Arkub T.I., Barsky B.G., Sinitsyn M.V. DIAGNOSTIC THORACOSCOPIC METHODS OF RESPIRATORY SYSTEM DISEASES IN PATIENTS WITH HIV INFECTION. Moscow Surgical Journal. 2020;(3):40-46. (In Russ.) https://doi.org/10.17238/issn2072-3180.2020.3.40-46
Views:
493
Email this article 