- •Lecture topic:
- •The goal of treatment of patients with tuberculosis is elimination of clinical signs
- •CRITERIA FOR THE EFFECTIVENESS OF TREATMENT OF TUBERCULOSIS PATIENTS:
- •THE MAIN COMPONENTS OF TREATMENT OF
- •CHEMIOTHERAPY – etiotropic (specific) treatment of patients aimed at destroying the mycobacterial population
- •PRINCIPLES OF CHEMOTHERAPY:
- •FACTORS INFLUENCING THE CLINICAL
- •4 POPULATION OF MYCOBACTERIUM TUBERCULOSIS IN THE FOCUS OF ACTIVE SPECIFIC INFLAMMATION:
- •TWO PHASES OF CHEMOTHERAPY:
- •2.The CONTINUING PHASE of treatment is aimed at the remaining, slowly multiplying mycobacterial
- •REGIMENS FOR TAKING ANTI-TB
- •WAYS OF ADMINISTERING
- •CLASSIFICATION OF ANTI-TB DRUGS (WORLD HEALTH ORGANIZATION, 1998):
- •2ND LINE DRUGS (RESERVE DRUGS):
- •3RD LINE DRUGS:
- •CHEMOTHERAPY REGIME
- ••drug resistance of MBT;
- •TYPES OF CHEMOTHERAPY REGIMENS:
- •I STANDARD CHEMOTHERAPY
- •IIa STANDARD chemotherapy regimen
- •IIb STANDARD MODE OF
- •III STANDARD CHEMOTHERAPY
- •VI STANDARD CHEMOTHERAPY
- •CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:
- •CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:
- •CHEMOTHERAPY REGIMENS (ACCORDING TO ORDER NO. 109 OF THE MINISTRY OF HEALTH OF
- ••Chemotherapy Mode IIA is prescribed to patients with relapsed pulmonary tuberculosis and patients
- •3.CHEMIOTHERAPY MODE IIB is used in patients with high risk of drug resistance
- •4.CHEMIOTHERAPY MODE III is administered to patients with newly diagnosed small forms of
- •From the clinical point of view, V.Y. Mishin's classification is the most justified,
- •Multidrug-resistant tuberculosis (as defined by the WHO) includes pathogens resistant to at least
- •COLLAPSOTHERAPY treatment by creating an artificial pneumothorax or artificial pneumoperitoneum.
- •VARIANTS OF THE FORMED ARTIFICIAL PNEUMOTHORAX:
- •BASIC INDICATIONS:
- •CONTRAINDICATIONS TO APPLICATION OF ARTIFICIAL PNEUMOTHORAX:
- •PARTICULAR (determine clinical form of the disease, prevalence or localization of the process,
- •COMPLICATIONS ASSOCIATED WITH THE APPLICATION OF AN ARTIFICIAL PNEUMOTHORAX:
- •COMPLICATIONS ARISING DURING MAINTENANCE OF ARTIFICIAL PNEUMOTHORAX:
- •ARTIFICIAL PNEUMOPERITONEUM
- •MECHANISMS OF CURATIVE ACTION OF ARTIFICIAL PNEUMOPERITONEUM:
- •Main indications for the use of artificial pneumoperitoneum (according to I.A.
- •GENERAL
- •SPECIAL
- •COMPLICATIONS OF ARTIFICIAL
- •SURGICAL TREATMENTS.
- •3.Life-threatening complications and sequelae of tuberculosis have clinical manifestations and can lead to
- •POSSIBLE INDICATIONS
- •CONTRAINDICATIONS:
- •TYPES OF OPERATIONS:
- •8.Bronchial surgeries (occlusion, resection and plasty, stump reamputation).
- •PATHOGENETIC THERAPY –
- •Б. Hyaluronidase.
- •THANK YOU
Main indications for the use of artificial pneumoperitoneum (according to I.A.
Shaklein):
1.Infiltrative pulmonary tuberculosis with localization of the lesion below the clavicle.
2.Disseminated subacute tuberculosis.
3.Pneumonic phase of primary pulmonary tuberculosis.
4.Fibrotic cavernous tuberculosis with subcorneal localization of the caverns.
5.Pulmonary hemorrhage.
GENERAL
CONTRAINDICATIONS:
1.Extreme exhaustion (weakness of the anterior abdominal wall, presence of hernias).
2.Concomitant diseases of the abdominal cavity organs.
3.Diseases on the organs of the abdominal cavity.
4.Severe comorbidities.
5.Respiratory failure II - III degree.
SPECIAL
CONTRAINDICATIONS:
1.Disseminated forms of fibrotic cavernous pulmonary tuberculosis.
2.Subpleural localization of caverns above the level of III rib.
3.Caseous pneumonia
COMPLICATIONS OF ARTIFICIAL
PNEUMOPERITONEUM:
1.Damage to the intestinal wall (up to 1%).
2.Subcutaneous or mediastinal emphysema (3 - 5%).
3.Development of adhesions in the abdominal cavity (30 - 40%).
4.Pneumoperitonitis (2 - 8%).
5.Air embolism (up to 0.01%).
SURGICAL TREATMENTS.
INDICATIONS:
1.Ineffectiveness of chemotherapy, especially in cases of multidrug-resistant MBT.
2.Irreversible morphological changes in lungs, bronchi, pleura, lymph nodes, caused by tuberculosis process.
3.Life-threatening complications and sequelae of tuberculosis have clinical manifestations and can lead to undesirable consequences:
•pulmonary hemorrhage;
•spontaneous pneumothorax and pyopneumothorax;
•nodulobronchial fistula;
•cicatricial stenosis of the main or lobe bronchus;
•bronchiectasis with suppuration;
•bronchiolitis (bronchial stone);
•pneumofibrosis with hemoptysis;
•pancreatic pleurisy or pericarditis with impaired respiratory and circulatory function.
POSSIBLE INDICATIONS
URGENT OPERATIONS:
1.Progression of tuberculosis process against the background of intensive chemotherapy.
2.Repeated pulmonary bleeding.
EMERGENCY
OPERATIONS:
1.Profuse pulmonary hemorrhage.
2.Tension pneumothorax.
CONTRAINDICATIONS:
1.Prevalence of the process.
2.Age over 60 years.
3.Respiratory, circulatory, hepatic, and renal disorders.
TYPES OF OPERATIONS:
1.Lung resection, pneumonectomy.
2.Thoracoplasty.
3.Extrapleural filling.
4.Cavernous surgery (drainage, cavernotomy, cavernoplasty).
5.Videothoracoscopic sanation of the pleural cavity.
6.Pleurectomy, lung decortication; thoracostomy.
8.Bronchial surgeries (occlusion, resection and plasty, stump reamputation).
9.Removal of intrathoracic lymph nodes.
10.Destruction of pleural adhesions for correction of artificial pneumothorax.
11.Endoscopic removal of granulations or bronchiolitis during bronchoscopy.
12.X-ray endovascular occlusion of bronchial arteries for pulmonary bleeding.