[Role of lung biopsy in diagnosis of pulmonary pathology at the prehospital level].

The aim of the work was to assess the value of biopsy techniques for fibrobronchoscopy under local anesthesia in patients with pulmonary pathology at the prehospital level. It included 706 subjects with lobular, segmental or diffuse lesions in the lungs of specific (tuberculosis), non-specific (pneumonia, exogenous alveolitis), and other origin. All known methods of endobronchial biopsy were employed (bronchoalveolar lavage or liquid lung biopsy, tissue biopsy, transbronchial biopsy, brush biopsy, puncture and aspiration biopsy) with subsequent cytomorphological and bacteriological studies of bioptates. Diagnostic efficiency of direct biopsy was estimated at 97%, transbronchial biopsy at 5-90% depending on nosological form of lung disease, brush and puncture biopsy 20-50 and 6% respectively. Reversible complications occurred in 1.4% and were resolved by therapeutic methods. Cost effectiveness of prehospital instrumental examination of patients with pulmonary pathology is 10 times the intrahospital one.

[Differential diagnosis of systemic vasculitis and tuberculosis].

Microbiology, X-ray study, and bronchoscopy, including the examination of bronchoalveolar lavage and histology of thransbronchial lung biopsy specimens have proven to be of the greatest informative value in the differential diagnosis of different forms of systemic vasculitis and tuberculosis in 52 patients. Focal pulmonary tuberculosis was detected in the phase of S(II) infiltration on the right in a patient with rheumatic arthritis; Mycobacterium tuberculosis was bacterioscopically detected. The patient underwent specific antituberculous therapy that provided beneficial effects.

[Biochemical characteristics of fluid and cells of bronchoalveolar washings in patients with extrinsic allergic alveolitis]. / Biokhimicheskie kharakteristiki zhidkosti i kletok bronkhoal'veoliarnykh smyvov u bol'nykh ékzogennym allergicheskim al'veolitom.

In 43 patients with exogenous allergic alveolitis (EAA), including 30 and 13 in its acute and chronic disease, bronchoalveolar lavage was performed, bronchoalveolar washing fluid (BAWF), isolated alveolar macrophages (AM) and unfractionated cellular sediment (NFCS) were separately studied. The BAWF showed high rates of lipid peroxidation (LPO), decreased antiproteolytic defense, and activated local synthesis of haptoglobin (Hp), fibronectin (FN), platelet activation factor (PAF), and enzymes of antioxidative defense (AOD). There was a rise in FN and PAF concentrations in the acute phase of the disease and higher PLO rates and elevated Hp levels in chronic EAA. The rate of oxidative metabolism in AMs was much higher in acute EAA than that in chronic EAA and accompanied by imbalance in the PLO-AOD system. AM levels of PAF was high in patients in both groups. The rate of LPO was higher in NFCS than in AM and was also followed by simultaneous AOD mobilization with preserved imbalance. A particularly significant AOD insufficiency in the NFCS was noted in chronic EAA, which was accompanied by decreased PAF. Thus, local pathochemical processes are of significance in developing the pattern of the process in EAA.

[Levels of mucin-antigen 3EG5 in the blood and bronchoalveolar swabs in patients with tuberculosis, sarcoidosis and fibrosing alveolitis]. / Soderzhanie mutsin-antigena 3EG5 v krovi i bronkhoal'veoliarnykh smyvakh u bol'nykh tuberkulezom, sarkoidozom i firbroziruiushchimi al'veolitami.

The levels of the antigen mucin 3EG5, a marker of the activity of interstitial lung diseases, were studied in the sera and bronchoalveolar swabs of patients with active tuberculosis, sarcoidosis of the respiratory organs, and idiopathic and exogenous allergic alveolitis. Its higher blood levels were detectable in patients with alveolitis (exogenous allergic ones to a greater extent) and absent in active tuberculosis and sarcoidosis. There was a correlation of the levels of the antigen mucin 3EG5 in the blood and bronchoalveolar swabs with the degree of lymphocytosis in the endopulmonal cytogram. The fact that there is a high variability of the blood levels of the antigen mucin 3EG5 in the range of nosological entities calls the differential diagnostic informative value of this parameter to question.

[Use of monoclonal antibodies for immunodiagnosis of lung cancer]. / Ispl'zovanie monoklonal'nykh antitel dlia immunodiagnostiki raka legkikh.

Fifty-three patients with lung cancer of different histological types and 72 with other lung diseases were examined by employing the panel containing 5 monoclonal antibodies (MAb) in the indirect immunofluorescence test (IFT). with tissue biopsy specimens, lung cancer could be revealed in 100% of patients with glandular carcinomas and adenocarcinoma of the lung, in 89% of those with small-cell carcinoma, and in 61% with squamous-cell carcinoma. With this, MAb reacted with cancer cellular membranes, by causing their fluorescence and failed to react and to cause the luminescence of inflammation cell membranes, the altered and intact bronchoalveolar epithelium in patients cancer and nontumoral diseases of the lung. IFT with MAb to lung cancerous surface antigens with the cells of tissue biopsy specimens may be a supplementation to cytological studies.

[Endoscopic diagnosis of tuberculosis and other granulomatous diseases of respiratory organs: advances and prospects]. / Dostizheniia i perspektivy razvitiia endoskopicheskoi diagnostiki tuberkuleza i drugikh granulematoznykh zabolevanii organov dykhaniia.

The paper presents data on the use of various bioptic methods in phthisiatry and pulmonology. Particular attention is given to granulomatous diseases of the lung whose misdiagnosis may be during clinical examinations in 50-70% of cases. Making the methods of transbronchial biopsies, including those of the lung and bronchoalveolar lavage, better, putting them into practice widely, and developing new studies (microbiological, electron microscopic, immunological, morphological) for biopsy specimens may improve the diagnosis of lung diseases.

[Lung microangiopathy in diabetics with lung tuberculosis]. / Legochnaia mikroangiopatiia pri tuberkuleze legkikh, razvivshemsia u bol'nykh sakharnym diabetom.

Histological and electron-microscopic studies of intact lung specimens were carried out in 30 patients with pulmonary tuberculosis developing in the presence of type I (insulin-dependent) diabetes mellitus. Material for investigation was obtained by intrapulmonary biopsy carried out during diagnostic bronchoscopy. Signs of adenopathy were detected in lung areas distant from tuberculous in foci all the cases. The diabetic origin of this condition was confirmed by expressed correlation with changes in the retinal and renal vessels and absence of correlation with the duration of tuberculous process. The degree of pulmonary adenopathy has a negative impact on the course of tuberculosis and efficacy of its therapy.

[Use of bronchovaxom in the treatment of patients with chronic obstructive bronchitis and bronchial asthma]. / Primenenie bronkhovaksoma v lechenii bol'nykh j khronicheskim obstruktivnym bronkhitom i bronkhial'noi astmoi.

Polyvalent vaccine bronchovaxom (BV) was studied for efficacy against chronic obstructive bronchitis and bronchial asthma exacerbation. Good results were reported: reduction of disability duration, number of recurrences, cough intensity, discharged sputum. Laboratory tests discovered that BV brought about IgE decrease, IgA, T3, T4/T8 increase in bronchoalveolar lavage.

[Effectiveness of the use of high-energy lasers in bronchology]. / Effektivnost' primeneniia vysokoénergeticheskikh lazerov v bronkhologii.

Bronchoscopy by laser radiation was performed in 141 patients. CO2 laser was used in 89 patients: 25 had pulmonary tuberculosis, 6 tumours, 35 stump inflammation, and 23 other diseases. YAG laser was used in 52 patients: 15 of them had tumours, 21 bronchial tuberculosis, 6 osteochondropathy and 10 other diseases. A good therapeutic result was obtained in most patients but in certain cases (malignant tumours) it was palliative. Special features and technical difficulties encountered during work with different types of lasers in fibroscopy under anesthesia and in fibrobronchoscopy under local narcosis are discussed. No complications were registered. Formation of the so-called "white thrombus" at the site of laser photodestruction was described which required removal during control bronchoscopy.

[The status of mucociliary clearance in patients with pulmonary tuberculosis]. / Sostoianie mukotsiliarnogo klirensa u bol'nykh tuberkulezom legkikh.

The authors present the findings of mucociliary clearance (MCC) in 64 patients, including 45 with different forms of pulmonary tuberculosis and 19 with chronic nonspecific pulmonary diseases. MCC was determined with the radioaerosol method with the use of TCK-5 kit human albumin suspension and 99mTc radioisotope. Fibrobronchoscopy was performed in all the patients and a brush bronchial mucosa biopsy in 34 of them. MCC indices in patients with different pulmonary diseases were analysed. The obtained data were compared with the status of the bronchial epithelium from cytologic study of bronchial biopsy specimens. A relationship of MCC drop in case of pathology in the bronchial villous apparatus was revealed.

[The instrumental diagnosis of disseminated lesions of the lungs]. / Instrumental'naia diagnostika disseminirovannykh porazhenii legkikh.

A study is presented of 52 patients with disseminated pulmonary lesions. Among them: histiocytosis X--17, alveolar microlithiasis--5, pulmonary phospholipoproteinosis--7, idiopathic hemosiderosis--14, primary pulmonary amyloidosis--1, primary diffuse lung tumours--8. All patients were subjected to complex bronchological examination including use of different biopsy transbronchial methods as well as open biopsy of the lung. The diagnostic value of the employed bronchial biopsies is discussed. A diagnostic algorithm of rarely met pulmonary disseminations has been developed. Recommendations on the use of different instrumental methods are formulated.

[Use of the CO2 laser in endobronchial pathology]. / Ispol'zovanie CO2-lazera pri éndobronkhial'noi patologii.

Endoscopic therapy by CO2-laser of the "Skalpel-1" type through the Friedel breathing bronchoscope is analyzed. The treatment was performed in 40 patients with various endobronchial affections such as tumors, fistulas due to tuberculosis of the intrathoracic lymph nodes, specific and nonspecific stump inflammation, mycotic lesions of the stump mucosa, foreign bodies, cicatricial stenosis of the bronchi, scleroma of the trachea and bronchi, hemorrhage. High efficiency of endoscopic laser bronchoscopy was shown.

[The etiologic significance of ultrafine forms of the causative agent of tuberculosis in the development of sarcoidosis of the respiratory organs]. / Etiologicheskoe znachenie ul'tramelkikh form vozbuditelia tuberkuleza v razvitii sarkoidoza organov dykhaniia.

Pathological material, i. e. bronchoalveolar lavage fluid (BALF) and blood plasma from patients with various pathological processes in the lungs was studied. Eighty seven patients with sarcoidosis of the respiratory organs were subjected to complex microbiological investigation and ultrasmall forms of tubercle bacilli were detected in BALF of 67 (77 per cent) of them. Histological examination revealed alveolitis and granulomas of lymphoid-macrophagal nature in the lungs of the experimental animals exposed to the material from the sarcoidosis patients.

[Use of carbon dioxide laser in the treatment of tuberculosis of the bronchi and trachea in children and adolescents]. / Primenenie uglekislotnogo lazera v lechenii tuberkuleza bronkhov i trakhei u detei i podrostkov.

The first experience with using carbon laser in treatment of specific bronchial affections in children and adolescents was studied. Persisting lymphobronchial fistulas and granulations in 4 children and adolescents were considered as indications to the treatment. The 2-3 exposures, to laser during bronchoscopy with burning out the granulations and caseous led to rapid healing of the fistulas and epithelization of the bronchial surface with formation of small cicatrices. No complications were observed.