Some Aspects of the Surgical and Endoscopic Treatment of Tuberculosis in Russia

Abstract

26,000, while 85% of the operations were lung resections [6]. In the period 1986-1988, 17,000-18,000 operations for pulmonary Tb were performed in Russia yearly only in specialized tuberculosis hospitals [3]. In 2003, 10,479 surgeries were performed in Russia for respiratory Tb, which was deemed "extremely insufficient" [7]. In 2006, 12,286 operations were carried out for pulmonary Tb including 9300 (75.7%) lobectomies and other resections as well as 399 (3.2%) pneumonectomies [4]. According to another report, the forms of Tb most frequently treated by resections and pneumonectomies were cavitary Tb (52.2%) and tuberculoma (43.9%) [8].The abovenamed surgeries were performed and recommended also for patients with inactive post-tuberculous fibrosis including cases with sparse symptoms [9]. At the same time, surgeries were performed in the active phase of Tb. In some provinces (Kemerovo, Chelyabinsk, Mordovia), 25-40% of patients with destructive Tb were operated on [10]. At the time of initial Tb diagnosis, an operation was deemed reasonable in 15-20% of patients [3]. According to another paper by the same authors, indications for surgery were found in 20-30% of patients at the initial diagnosis and/or among cases of active Tb [11].In Yekaterinburg and surrounding province (2006)(2007)(2008), indications for surgery were determined in 1784 from 4402 (40.5%) patients with pulmonary Tb while 1079 (24.5%) were operated on. Among reasons of the comparatively "low" surgery rate were the patients' non-compliance and unavailability [12]. In the international literature, corresponding figures are generally lower e.g. <5% of pulmonary Tb patients were supposed to require surgery [13]. The same percentage is given in the reviews [14,15]. The topic of Tb surgery may become more relevant due to the multidrug resistance. According to a current estimate from Russia, the need for surgery has increased from 5% to 15% over the last twenty years [16]. However, the recent systematic review and metaanalysis concluded that, compared with chemotherapy alone, the survival benefit of pulmonary resection combined with chemotherapy is not significant, although the quality of data was deemed "relatively poor" [17]. According to another metaanalysis, partial lung resection, but not pneumonectomy, was associated with improved treatment success in multidrug-resistant Tb. It was not excluded, however, that "healthier" patients were preferentially chosen for surgery, leading to a bias. The confounding by indication, as patients most likely to benefit are selected for the treatment, has been a limitation in many

Magnesium Supplementation with Special Reference to Alcohol-Related Conditions: Experience from Russia

“…69,70 Suboptimal practices have been applied as per instructed and according to leading expert publications, and some examples have been discussed previously. 70,71 In brief, the overuse of Halsted and Patey mastectomy with excision of pectoral muscles, routine electrocoagulation of cervical ectropions without cyto-or histological examination for precancerous changes, extensive gastric resections for peptic ulcers, thoracic and abdominal surgery for bronchial asthma and diabetes mellitus, 70 overuse of surgery in tuberculosis (Tb), 71 mass bronchoscopy in conscripts with supposed pneumonia. 72,73 Some invasive methods with questionable indications were introduced or advocated by first generation military surgeons.…”

Magnesium Supplementation with Special Reference to the Treatment of Alcoholism

“…The surgical treatment of Tb was recommended to be implemented earlier i.e. after a shorter period of medical therapy [43,56,57]. Among others, vocal cord injuries were observed after repeated bronchoscopies sometimes performed in conditions of suboptimal procedural quality assurance.…”