[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.

[Comparison of radionuclide studies with pleural morphological changes in patients with tuberculosis pleurisy].

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

[Clinicomorphological rationale for mediastinal lymphadenectomy in the surgical treatment of disseminated destructive pulmonary tuberculosis].

The paper analyzes morphological changes and results of surgical treatment in 515 patients with destructive pulmonary tuberculosis. Two hundred and seventy-four patients underwent mediastinal lymphadenectomy and in 241 patients lung resections or pneumonectomies were not followed by lymphadenectomy or solitary caseous molten lymph nodes were removed during an operation. In disseminated destructive pulmonary tuberculosis, active tuberculosis of intrathoracic lymph nodes (ILN) was found in 97%. The latter's significant signs are an enlarged lymph node of more than 2.0 cm, consolidation, periadenitis, and fluctuation. The incidence, extent, and pattern of ILN lesion varied in a lung tuberculous process depending on its site, form, and inflammation phase.

[The scientific path of a laboratory of pathomorphology and electron microscopy].

The paper shows the research directions of the staff of the laboratory of pathomorphology and electron microscopy, which cover the period from 1924 to the present time, which can be conventionally divided into 4 stages associated with the leading role of the laboratory's heads: Prof. V.G. Shtefko (1924-1945), Prof. V.I. Puzik (1945-1974), Prof. O.A. Uvarova (1974-1980), and Prof. V.V. Yerokhin (1980 up to the present time). The laboratory's researches are the productive path of phthisiomorphology. The tasks of the laboratory have been associated with the problems to be solved by the institute. This applies the morphology, pathogenesis, classification of tuberculosis, and changes in inflammatory reactions in response to the altered Mycobacterium tuberculosis and to specific and pathogenetic actions on tuberculosis. New living conditions give the laboratory's researchers new tasks that require their solution at a new technological level.

[Pathomorphological features of pulmonary tuberculosis at different stages of HIV infection: autopsy data].

The case histories, autopsy protocols, and histological specimens from 11 patients who had died from HIV-associated tuberculosis and 15 patients died from progressive disseminated tuberculosis and caseous pneumonia in the absence of HIV infection (a control group). In all the study patients, the morphology of the lung and peripheral and intrathoracic lymph nodes was examined at the early (2B) and late (4B-5) stages of HV infection (Groups 1 and 2, respectively). Group 1 patients had died from caseous pneumonia. Their morphology of tuberculosis differed little from that in the control group. Group 2 was marked by a predominance of disseminated tuberculosis with extensive exudative necrotic lesions in the lung, lymph nodes, and other organs in the presence of reduced lymphoid tissue and in the absence of a limited epitheloid cell reaction.

[On the morphological diagnosis of drug-resistant pulmonary tuberculosis].

The intraoperative samples taken from 15 patients with acutely progressive drug-resistant fibrocavernous pulmonary tuberculosis were studied. There were typical signs of granulomatosis inflammation, a predominance of an exudative tissue reaction, and an extensive vascular bed lesion. Two types of perifocal cellular infiltrates were identified. Mononuclear infiltrates with epithelioid cellular transformation along the periphery were defined as specified. Nonspecific infiltrates were composed of foam macrophages-lipophages and they reflected lipid metabolic disturbances. In addition, the severity of the process was determined by an extensive specific bronchial lesion of all generations. A morphological study of the samples could reveal the tissue and cellular features of respiratory organs in drug-resistant tuberculosis and identify the diagnostically significant signs of specific and nonspecific inflammation.

[Impact of phthisiosurgery on the development of morphological studies of the lung].

The paper describes the most important developmental stages of phthisiomorphology in chronological order, by using as an example the work of the Pathomorphology Laboratory, Central Tuberculosis Research Institute, since its organization. It also shows the stages of phthisiosurgery with the inestimable scientific and practical contribution of the works by L. K. Bogush and his followers from the formation of lung surgery to today's achievements. The authors give examples of the long-term working partnership of surgeons and morphologists in the development of these two disciplines, which was fruitful in deciding many issues of phthisiology.

[Morphological characteristics of reparative process in tuberculous inflammation]. / Morfologicheskaia kharakteristika reparativnogo protsessa pri tuberkuleznom vospalenii.

The morphological analysis of the reparative process in the involvement foci and adjacent pulmonary tissue in patients with pulmonary tuberculosis and experimental animals during intensive focal resolution has revealed a change in the cellular composition: epithelioid cells are replaced by macrophages, T-lymphocytes SD8 (suppressors) by those CD4 (helpers); actively synthesizing fibroblasts and vascular endothelium appear in the area of specific inflammation instead of the cells that have a decreased collagen-forming function. The employment of various methods for stimulation of cellular reactions (lasers, electromagnetic irradiation of the mm range - MM waves, the complex of cytokines) leukinferon enables one to alter the qualitative and quantitative cellular composition of granulomas, the rate of metabolic processes and the differentiation of cells, as well as to examine the regularities of reparative reactions more effectively and more purposefully. The perfocally adjacent pulmonary tissue wherein the diseased parenchyma and stroma recover has been ascertained to be also involved into the reparative process.

[Method of double embedding of tissue in paraplast-piccolyte]. / Metod dvoinoi zalivki tkani v paraplast-pikkalit.

A histological method of double embedding of the tissue in paraplast-piccolyte used for light microscopy is described. The method requires no special equipment, is simple and suitable for all methods of staining of sections obtained upon paraffin embedding, including immunofluorescent and immunoperoxidase procedures.

[Morphofunctional status of the lungs in extrinsic allergic alveolitis]. / Morfofunktsional'noe sostoianie legkikh pri ékzogennom allergicheskom al'veolite.

Morphological changes in the lungs of 57 patients suffering from exogenous allergic alveolitis (EAA) are described, the majority of patients had a contact with birds. Interstitial edema, microcirculation disturbances and abundant lymphoid infiltration were observed at an acute initial stage of the disease in 5 patients. Sarcoid-like granulomas in the lung interstitium and bronchiolar wall were found at a subacute stage of the disease in 10 patients along with edema, microcirculatory disturbances and lymphoid infiltration. Predomination of fibrosis with a deformation of all lung structures were observed in 42 patients with a chronic course of the disease.

[Comparative characteristics of the activity of proteolytic enzymes and their inhibitors in the lung tissue of guinea pigs during development of generalized and destructive tuberculosis]. / Sravnitel'naia kharakteristika aktivnosti proteoliticheskikh fermentov i ikh ingibitorov v legochnoi tkani morskikh svinok pri razvitii generalizovannogo i destruktivnogo tuberkuleza.

Two series of experiments were carried out using 66 guinea pigs infected with tuberculosis. In the first experiment generalized tuberculosis was stimulated by means of subcutaneous administration of Mycobacterium tuberculosis H37RV strain at a dose of 0.0001 mg. In the second experiment destructive form of tuberculosis was developed after intrapulmonary administration of the bacteria (1 mg) followed by VCG vaccination. In both experiments the animals were divided into groups with spontaneous form of the infection and the group of animals treated with rifamycin and isoniazid. Total protein, elastolytic activity, cathepsins B and D, free antitryptic activity were estimated in lung homogenates. Generalized and destructive forms of tuberculosis were shown to induce an increase in content of soluble protein as well as in cathepsin D, elastolytic and antitryptic activities in tissues. Destructive form of tuberculosis was characterized by more than 4-fold increase in elastolytic activity and by a distinct activation of cathepsin B. The antibacterial drugs used affected only slightly the biochemical patterns studied in lung tissue.

[The effect of antioxidants on the balance of proteinase-inhibitors system in the respiratory space of mice with pulmonary tuberculosis]. / Vliianie antioksidantov na balans sistemy proteinazy-ingibitory v respiratornom prostranstve myshei s tuberkuleznym porazheniem legkikh.

In three series of experiments generalized form of tuberculosis was simulated in 427 mice of CBA strain. After dissection of chest bronchoalveolar lavage was carried out and in the fluid obtained total content of protein, elastase-like and antitryptic activities were estimated. At the severe stage of the disease content of protein was increased 7-fold, antitryptic activity--5-fold and elastase-like activity--10-fold in the lavage. EDTA did not inhibit the elastase-like activity, i.e. the enzyme was derived only from neutrophils. All the patterns studied were unaltered after the animal treatment with alpha-tocopherol at a dose of 100 mg/kg (per os) within one or three weeks. In vitro incubation of preparations in presence of ascorbic acid at the final concentration of 0.01 M within 1 hr at 37 degrees caused a considerable (4-6-fold) activation of the antitryptic activity simultaneously with a distinct decrease in the elastase-like activity down to physiological values. The data obtained suggest that inactivation of the reactive centre of antiproteinases by means of products of free-radical oxidation appears to be mainly responsible for disbalance of proteinases-inhibitors in tuberculosis.

[The tissue and cellular reactions of the lung in drug-resistant tuberculosis]. / Tkanevye i kletochnye reaksii legkikh pri lekarstvenno-ustoichivom tuberkuleze.

The material obtained from 52 patients with drug-resistant fibrocavernous pulmonary tuberculosis was studied. Morphological studies established the progression of a process in 94.2% of the cases. There was a prevalence of an alternatively exudative tissue reaction, a generalization of the process with specific and non-specific changes in the lung, lesion to the vascular bed with a predominance of an exudative reaction, generalized nonspecific and specific bronchitis with impaired elimination of the intraalveolar contents and with the preserved extensive cellular infiltrates in the lung. Healing elements as the signs of the encapsulation of caseous necrosis, the proliferation of lymphoid elements, and a macrophageal response were simultaneously revealed, which provides evidence for that different modalities of pathogenetic therapy should be used.

[Leukinferon in combined therapy for acute pulmonary tuberculosis]. / Leikinferon v kompleksnoi terapii ostroprogressiruiushchego tuberkuleza legkikh.

Experiments on 140 CBA and C57BL/6 mice and studies of 163 patients with acute pulmonary tuberculosis have indicated that leukinferon has a immunomodulating effect on morphological reactions in the lung and on the clinical course of the disease. They have shown that leukinferon plays an important role in the activation of exudate macrophages and in the acceleration of their differentiation in experimental tuberculosis and that there is a rapid elimination of Mycobacterium tuberculosis from the involved organs without production of the L-forms of the causative agent when immunomodulation is used. At months 2-3, the patients with acute pulmonary tuberculosis showed the accelerated processes of detoxification, abacillation, infiltrate resolution, and decay cavity closure during hemo- and immunomodulation with the normalized production of cytokines (gamma-interferon and tumor necrosis factor-alpha). During 6-month therapy, a severe pulmonary process was arrested in 84% of cases and some patients were operated on (76% in the comparison group). The morphological effect of leukinferon was to increase mononuclear infiltration and to normalize a lung connective tissue response, by further decreasing the rate of inflammation.

[Mycobacteria in the development of periodontal foci of infection]. / Mikobakterii v razvitii okolozubnykh ochagov infektsii.

A total of 162 samples of material from the periodontal foci of infection were examined microbiologically and morphologically to detect mycobacteria and their biologically changed variants. The regularities of the pathologic process development in periodontal tissues of subjects without tuberculosis were found to fully conform to the current concept of a latent tuberculous infection. The periodontal foci of infection may be regarded as reservoirs of persistent mycobacteria, whose main form, L variant, was detected in 71.6% of cases. Clinical and morphologic manifestations of periodontitis depend on the stability of the persistent mycobacteria L forms.

[Functional morphology of the lungs in patients with tuberculosis and diabetes mellitus]. / Funktsional'na morfologiia legkikh u bol'nykh tuberkulezom i sakharnym diabetom.

The lungs of 20 patients (between the ages of 14 and 46 years) with tuberculosis and type I diabetes mellitus were subjected to a morphological examination with the help of a light and electron microscope. Thirteen patients were operated on for fibrous-cavernous tuberculosis and 7 for pulmonary tuberculoma. A duration of the concurrent diseases was 3 to 10 years (5.5 years, on average). All patients had a serious form of diabetes mellitus. The combined affection was characterized by a progressive course of tuberculosis with involvement of bronchi in the process. Specific features of tissue reactions pertinent to this combined pathology were revealed which comprised defective defense mechanisms (alveolar macrophages, type II alveolocytes and fibroblasts in the form of their dystrophy) generalized affection of pulmonary vessels, intensive fibre formation and disorganization of the forming connective tissue, which has a bearing on the development of the pathological process.