Use of different methods of ultraviolet irradiation of autoblood in patients with surgical forms of pulmonary tuberculosis

The dissertation is devoted to a comparative study of different methods of ultraviolet irradiation of autoblood in patients with surgical forms of pulmonary tuberculosis. The author compares the efficacy of separate UV irradiation of autoblood components, conventional UV irradiation of autoblood, and standard therapy, evaluating the influence of each method on the clinical course of the disease, radiological dynamics, general blood analysis, and laboratory markers of endogenous intoxication (paramecium test, level of medium-weight molecular peptides, leukocyte intoxication index). The work examines the time to cessation of bacterial excretion and the immediate and long-term outcomes of treatment, including mortality, the frequency of sputum conversion and closure of cavities of disintegration, and substantiates the feasibility of using separate UV irradiation of autoblood components in the combined therapy of this category of patients.

For the first time in clinical practice, the study examined the effect of separate UV irradiation of autoblood components combined with conventional treatment on blood parameters and the level of endogenous intoxication in patients with surgical forms of pulmonary tuberculosis. A comparative assessment was made of the efficacy of separate UV irradiation of autoblood components combined with conventional treatment, conventional UV irradiation of autoblood combined with conventional treatment, and conventional treatment alone. Certain indicators of the level of endogenous intoxication were studied (the paramecium test, the level of medium-weight molecular proteins, and the leukocyte intoxication index), which had previously been practically unused in surgical forms of pulmonary tuberculosis. Based on an analysis of changes in endogenous intoxication indices (according to the paramecium test, the level of medium-weight molecular proteins, and the leukocyte intoxication index), as well as general blood analysis and radiological data, the more effective action of separate UV irradiation of autoblood components combined with conventional treatment was demonstrated compared with conventional UV irradiation of autoblood combined with conventional treatment and with conventional treatment alone.

Practical significance. The identified blood disorders in patients with pulmonary tuberculosis under modern conditions differ markedly from similar indicators reported in the literature of previous years, and these changes require correction, which is of important practical value. The more pronounced corrective effect of separate UV irradiation of autoblood components on indicators of endogenous intoxication and blood parameters, as well as the absence of development of mycobacterial resistance to this treatment method, indicate that it can be used more widely in the practice of treating patients with surgical forms of pulmonary tuberculosis. Studies of endogenous intoxication indices (LII, paramecium test, level of medium-weight molecular peptides) and certain blood parameters showed that they objectively reflect the condition of patients and the dynamics of the process, and therefore their use in the practice of treating patients with surgical forms of pulmonary tuberculosis may be continued.

Implementation into practice. The results of the dissertation work have been implemented in the practical activities of the thoracic surgery department of the State Healthcare Institution «Ulyanovsk Regional Anti-Tuberculosis Dispensary» and the surgical department of the Municipal Healthcare Institution «Zvenigorod Central City Hospital».

Statements submitted for defense:

1. Surgical forms of pulmonary tuberculosis in patients under modern socio-economic conditions are characterized by markedly more pronounced blood disorders (a decrease in the number of lymphocytes and blood monocytes, anemia, and an increase in ESR) than was the case according to the literature in previous years.

2. The use of separate UV irradiation of autoblood components in surgical forms of pulmonary tuberculosis is accompanied by a significant improvement in general blood analysis parameters (an increase in the absolute and relative number of monocytes, an increase in the absolute and relative number of lymphocytes, a decrease in the number of leukocytes), a decrease in the level of endogenous intoxication, an improvement in the clinical course of the disease, and an improvement in immediate and long-term treatment outcomes (reduction of mortality, faster transfer of patients to outpatient treatment, an increase in the number of patients with sputum conversion, closure of cavities of disintegration, and sanation and obliteration of pleural empyemas).

3. Indicators of endogenous intoxication (LII, paramecium test, level of medium-weight molecular peptides) and certain blood parameters (lymphocytes) are objective both in terms of assessing the severity of the patients' condition and in terms of evaluating the effectiveness of their treatment with different methods.

Approval of the work. The materials of the dissertation were reported at:

– the 39th scientific and practical interregional conference of physicians (Ulyanovsk, 2004);

– the 40th scientific and practical interregional conference of physicians (Ulyanovsk, 2005);

– the All-Army International Conference dedicated to the 200th anniversary of the state institution «432 Order of the Red Star Main Military Hospital of the Armed Forces of the Republic of Belarus» (Minsk, 2005);

– the 41st scientific and practical interregional conference of physicians (Ulyanovsk, 2006).

Structure and scope of the work. The dissertation consists of an introduction, three chapters, a conclusion, findings, practical recommendations, and a bibliography; it is presented on 145 pages of typewritten text, contains 22 tables and 15 figures. The bibliography includes 259 domestic and 48 foreign literary sources. The studies were conducted at the Department of General and Operative Surgery, Topographic Anatomy with a course in dentistry of the Institute of Medicine, Ecology and Physical Culture of Ulyanovsk State University in 2002–2006 on the basis of the thoracic phthisiosurgery department of the State Healthcare Institution Ulyanovsk Regional Anti-Tuberculosis Dispensary.