[Clinico-morphological characteristics of pulmonary mycobacteriosis].

According to the criteria of the American Thoracal Societypulmonary mycobacteriosis has been diagnosed at 40patients without clinically important immunosupression (MAC--35%, Mkansasii--25%, M. xenopi--20%, M. fortuitum--12.5% and M. chelonae--7.5%). 95% patients have had clinically important symptomatology with polymorphic radiologic development such as a deformation of a lung pattern and focal dissemination (75%), locus and infiltration (52.5%), cavities (42.5%), marked pneumosclerosis (60%) and bronchiectasis (17.5%). 75% patients have had some changes of the bronhial tree. As opposed to tuberculosis the morphology of mycobacteriosis is more homogeneous and includes inflammation with epithelioid giant-cell granuloma and fibrosis, pneumogenic and bronchogenic cavernous cavities, mycobacterial endobronchitis. The polymorphism of clinic-radiologic developments, a similarity of lung diseases morphology caused by nontuberculous mycobacteria makes difficulties to diagnose theirs.

[Use of molecular-biological microchip TB-BIOCHIP-2 for detecting of Mycobacterium tuberculosis with multidrug resistance to fluoroquinolones in patients with new detected and chronic tuberculosis].

At present the left-handed "respiratory" quinolones such as moxifloxacin and levofloxacin are the most promising drugs for therapy of multidrug resistant tuberculosis (MDR). Fast and specific diagnostics of sensitivity of M. tuberculosis (MBT) with MDR to this group of drugs is required for timely prescription of adequate chemotherapy and its correction in case of MBT resistance to fluoroquinolones. A new generation of biological microchips - TB-BIOCHIP-2 makes possible to detect 9 mutation types in quinolones resistant determination region (QRDR) of gene. About 800 samples from 169 patients in Antituberculosis center were studied. In patients with new detected tuberculosis 23.5% MBT resistant to isoniazid and rifampicin (MDR) and sensitive to fluoroquinolones were revealed. In patients with chronic tuberculosis 65.5% MBT-MDR were revealed. Our results were confirmed with detecting ofloxacin resistance on Lowenstein - Jensen. In addition efficiency of TB-BIOCHIP-2 to control drug testing sensitivity of MBT-MDR on fluoroquinolones was confirmed.

[Types of skin lesions in pulmonary sarcoidosis and their prognostic value].

When sarcoidosis is suspected, a patient should be meticulously examined for dermal changes, the favorite sites of which are the skin of the face, ears, upper and lower extremities, and trunk. Elements may vary in number from solitary to multiple. When dermal changes are suspected of sarcoidosis, a dermatologist should examine the patient and, if there are some doubts about the nature of dermal elements, biopsy and histological study should be made since the morphological verification of the diagnosis primarily requires the use of extrapulmonary sites of the process, namely superficial peripheral lymph nodes, as well as the skin. The findings suggest that skin sarcoidosis characterized by the long-term chronic or progressive course is encountered at different (X-ray) stages of sarcoidosis of respiratory organs and is of poor prognostic value. The severity of dermal manifestations is no less and, in individual cases, more significant than pulmonary symptoms. Great or ugly skin lesions require prednisolone treatment. In some cases, long-term therapy cannot yield a result. Delagil treatment of dermal manifestations remains to be effective.

[Side effects of corticosteroidal therapy in patients with chronic forms of sarcoidosis].

The biological activity of glucocorticosteroids (GCS) is that there is always a risk of complications during repeated long courses of therapy in patients with recurrent sarcoidosis even if treatment is correctly organized. The clinical side effects of GCS were studied in 99 patients identified in 1995 to 2002, who had a chronic process and had been continuously treated with GCS for 2 years or more. The altered adrenal function by tile type of hypercorticism was observed in 73 (73.7%) patients, subsequent hypocorticism developed in 60 (60.6%). Impairments in electrolyte balance and protein, carbohydrate, and fat metabolism were seen in 74 (74.6%) patients; impaired functional disintegration of the hypothalamic-pituitary system in 26 (26.2%), allergic reactions in 12 (12.1%), complications of mixed genesis (gastritis and erosions of the stomach and intestine) in 20 (20.2%). A teratogenic effect was not observed. The most effective treatment of sarcoidosis--oral GCS--frequently leads to the occurrence of a great deal of side effects and drastically changes the quality and style of life in a patient with sarcoidosis. The correct and timely use of GCS in sarcoidosis requires a complete understanding of the pharmacological properties and features of their action, consideration of undesirable effects of treatment and the heath status of a patient with underlying diseases.

[A role of social and occupational factors in the development of chronic forms of respiratory sarcoidoisis and its relapses].

The social status and the presence of occupational and household hazards were analyzed in 134 patients with torpid chronic and undulating course of sarcoidosis lasting 3 years or more to estimate the significance of the above factors when the course of sarcoidosis was poor. The fact that 162 cases of hazards (metals, building materials, wood, textile, and paper dust, smoking, chemical substances, contact with patients with tuberculosis) occurred in 113 patients and 49 of the 134 patients with chronic forms of the disease were exposed to psychoemotional factors suggests that dust substances and chemical elements of different kinds, frequent stressful situations, and the X-ray signs of fibrosis of sarcoidosis-induced changes due to the absence of timely examinations should be regarded as a risk factors of the torpid chronic course of respiratory sarcoidosis (just at the stage of its primary detection).