[The course of a process and the efficiency of treatment of pulmonary tuberculosis patients excreting Mycobacterium tuberculosis with extensive drug resistance to antituberculous drugs].

Forty-one pulmonary tuberculosis patients (32 males and 9 females) excreting Mycobacterium tuberculosis (MBT) with extensive drug resistance to antituberculous drugs were examined. The process was first detected in 14.6% of the patients. At the previous stage of treatment, the vast majority of patients (85.4%) received antituberculous drugs. Fibrocavernous tuberculosis was a predominant form (73.1%). The acutely progressive course of the process was observed in 29.3% of patients. Lung destructive changes and bacterial excretion were revealed in all (100%) patients. Resistance to streptomycin, isoniazid, rifampicin, and fluoroquinolones was seen in all (100%) patients. The fact that in this cohort of patients the resistance of MBT to reserve drug, such as kanamycin, amikacin, and cycloserine, is observed at a rather high rate (from 58.5 to 73.1%) is concerned about. For evaluation of the efficiency of treatment, all the examinees were divided into 2 groups, which were equal in clinical and laboratory characteristics. Group 1 patients (n = 19) were given chemotherapy regimen 2b (in new cases of tuberculosis) and individual chemotherapy regimens. Collapse therapy was additionally used in the treatment of Group 2 patients (n = 22). After 3-month chemotherapy, negative sputum was established in 4 (9.8%) and 6 (14.6%) patients in Groups 1 and 2, respectively. Following 6-month therapy, MBT excretion ceased in 13 (31.7%) and 15 (36.6%) patients in Groups 1 and 2, respectively. After 3- and 6-month therapy, decay cavity closure occurred in 2 (4.8%) and 7 (17%) Group 1 patients and in 4 (9.8%) and 15 (36.6%) Group 2 patients, respectively (p < 0.05).

[New-onset pulmonary tuberculosis patients with schizophrenia: course and efficiency of treatment].

To investigate the specific features of the course and efficiency of treatment, the authors examined 72 patients with new-onset pulmonary tuberculosis and schizophrenia versus 68 new-onset pulmonary tuberculosis patients without mental diseases. Tuberculosis has been found to be identified in 66.7% of schizophrenics by lung fluorography made at a mental hospital or specialized dispensary. This mainly diagnoses the circumscribed forms of the disease with a low bacterial discharge, drug resistance, and cavitation while in nonschizophrenics, pulmonary tuberculosis is detected in 33.3% of cases in general health care network facilities. Following 9 months, complex treatment of pulmonary tuberculosis in schizophrenics succeeded in ceasing bacterial discharge, as shown by microscopy and sputum cultures, in 94.4 and 84.5% of cases, respectively. However, in schizophrenics receiving chemotherapy for tuberculosis, adverse reactions are revealed in 63.9% of cases, with this the incidence of these reactions depends not only on antituberculosis drugs, but also on drugs taken by patients for schizophrenia. Schizophrenic patients with pulmonary tuberculosis need an individual approach to treating the patient, longer treatment, intermittent use of antituberculosis agents, regular clinical and laboratory monitoring of the development of side effects, and complex pathogenetic treatment.

[The detection and diagnosis of pulmonary tuberculosis in an investigatory isolation ward].

The purpose of the study was to examine the implication of radiation and microbiological methods in the timely detection and diagnosis of pulmonary tuberculosis in untried prisoners in an investigatory isolation ward. Fluorographic films made in 12,298 convicts were analyzed. Abnormal fluorograms were revealed in 14 and 7.7% of the untried prisoners in 2005 and 2006, respectively; the changes were tuberculosis-associated in 70.2% of cases. Fluorescence microscopy and inoculation were used to carry out sputum tests for Mycobacterium tuberculosis in 41.1% of the convicts with abnormal fluorograms and complaints about productive cough. Early diagnosis of pulmonary tuberculosis was made by microscopy in 14.9% of the prisoners; the diagnosis of tuberculosis was verified by the inoculation test in 34.5% of negative microscopy patients. In the remaining patients, the diagnosis of tuberculosis was based on X-ray studies and the results of treatment.

[Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

[Scintigraphy in tuberculosis patients with concomitant nonspecific infection].

The data of clinical, X-ray, and radioisotopic pulmonary scintigraphic studies were analyzed in 119 patients with tuberculosis. In patients with pulmonary tuberculosis concurrent with nonspecific infection, impaired pulmonary capillary blood flow may occur in the area of lesion in 60.8% of cases. Concomitant chronic bronchitis observed in half of the patients of this group is an important pathogenetic point of this unfavorable tendency resulting in increased fibrosis in the lung. Less effective treatment of the underlying diseases is another factor contributing to a reduction in pulmonary capillaries during therapy.

[Infiltrative pulmonary tuberculosis: course and efficiency of treatment].

The purpose of the investigation was to study the course of and the efficiency of treatment for new-onset infiltrative pulmonary tuberculosis. Two hundred and two patients with this condition were examined. Among the 202 patients, 15 (7.4%), 49 (24.3%), and 46 (22.8%) patients had lobular, rounded, and cloud-like infiltrates, respectively. 31 (15.3%) patients had periscissuritis and 61 (30.2%) had lobitis. The extent of infiltrative pulmonary tuberculosis within 1 segment was encountered in 19.3% and more frequently in the presence of rounded and lobular infiltrates; the specific process in 2 segments was detected in 24.3% of cases and more frequently when rounded and cloud-like infiltrates were observed. In periscissuritis and lobitis, the process occupied 1 lobe in 87.1 and 44.3% of cases, respectively, and 2 lobes or more in 34 (55.7%) patients. Infiltrates were located in the upper lobe in 167 (82.7%) patients, in Segment IV in 21 (10.4%), Segment IX in 6 (3%), Segment X in 5 (2.5%). The signs of lung tissue decay were detected in 140 (69.3%) persons. Decay cavities of less than 2 cm, 2-4 cm, and more than 4 cm in diameter were found in 56 (40%), 62 (44.3%), and 22 (15.7%) patients, respectively. Mycobacterium tuberculosis (MTB) was detected in 13.3, 46.9, 54.4, 70.9, and 83.6% of the patients who had lobular, rounded, and cloud-like infiltrates, periscissuritis, and lobitis, respectively. The drug-sensitive MBT population was seen in 58.4% of the patients; the drug-resistant MBT population was detected in 18.1% of the patients: in 14.3% with a lobular infiltrate, in 10% with a rounded infiltrate, in 28.6% with a cloud-like one, in 21.4% with perscissuritis, and in 15.7% with lobitis. Multi-drug MBT resistance was ascertained in 3.5% of the patients. Bacterial isolation ceased in 100% of the patients with a lobular infiltrate after 1-month therapy, in 47.8 and 52.2% of those with a rounded infiltrate after 1- and 2-month therapy, respectively, in two thirds and one third of the patients with a cloud-like infiltrate after 1- and 2-month therapy, respectively, in 45.4 and 31.8% of those with periscissuritis after 1- and 2-month therapy, respectively, and in 45.1 and 11.8% of cases of lobitis after 1- and 4-month therapy, respectively.

[Diagnostic features of recurrent respiratory tuberculosis].

In 1998-2001, prophylactic examinations revealed recurrences of respiratory tuberculosis in 70.1-69.8% of cases; among the persons having pronounced posttuberculosis changes, the recurrences being, on the contrary, detected in 61-70% of cases on their visits to health care facilities for the symptoms of inflammatory bronchopulmonary disease. The recurrences of respiratory tuberculosis in the past years (1999-2001) are characterized by their predominant development in intact lung tissue and in the presence of minor residual tuberculosis-induced changes (64.8%) while those in the previous years (1991-1993) occurred in 64.9% in the presence of pronounced residual changes. In 14.6% of patients, recurrent pulmonary tuberculosis are identified by detecting Mycobacterium tuberculosis in the sputum in the absence of clinical, X-ray, and laboratory data on the activity of residual tuberculosis-induced changes. Thus, 18.7% and 19.6% of focal and infiltrative tuberculosis, respectively, and 66.7% of tuberculomas are detected. Common severe forms (disseminated, fibrocavernous, caseous pneumonia) are found in 66.7-100% of cases on referral to therapeutic institutions.

[Present-day aspects (diagnosis, clinical course and treatment) of acute progressive pulmonary tuberculosis]. / Sovremennye aspekty (diagnostika, klinika i lechenie) ostrogo progressiruiushchego tuberkuleza legkikh.

A total of 103 patients with acute progressive pulmonary tuberculosis whose age ranged from 18 to 60 years were examined. Caseous pneumonic, infiltrative-caseous, disseminated, and rapidly progressive fibrocavernous tuberculosis was found in 45.6, 17.5, 16.5, and 20.4% of cases, respectively. The clinical picture was characterized by its acute onset with significant intoxication syndrome. Moreover, all the patients had respiratory and immunological failure, varying disseminated intravascular coagulation syndrome, non-specific bronchopulmonary infection; some presented with pulmonary hemorrhage, spontaneous pneumothorax and pleural empyema. The sputum smear test was positive in all the patients. If there was no evidence for drug resistance, patients had a 4-month regimen using isoniazid, rifampicin, pyrazinamide, ethembutol, and kanamycin. In the subsequent 10-12 months, isoniazid, rifampicin, and ethambutol were given. The patients with multidrug resistant tuberculosis were administered protionamide, ofloxacin, amikacin, supplemented by pyrazinamide and ethambutol. The combined chemotherapy could stop bacterial isolation in more than 80% of patients, make the process stable, and prepare them for planned surgical treatment. When complications occurred and the disease was in steady progress, salvage operations were made, which was the only possible way of preventing the progression of disease at times and of saving life in the patient.

[Efficacy of ofloxacin (zanocin) in the treatment of multidrug resistant pulmonary tuberculosis]. / Effektivnost' ofloksatsina (zanotsina) pri lechenii polirezistentnogo tuberkuleza legkikh.

Data concerning chemotherapy of patients with multiresistant tuberculosis of the lungs by reserve antituberculous agents in combination with ofloxacin are presented. It was shown that the ofloxacin-including chemotherapy regimen applied to patients with multiresistant destructive tuberculosis of the lungs provided by the end of the 6-month treatment course elimination of multidrug resistant tubercle bacilli isolation at least in 80% of the patients and closure of the lung caverns after artificial pneumothorax and routine surgical interventions in more than half of the patients. For all this, side effects that could not be eliminated were stated merely in 8.5% of the patients.

[Role of lymphocytes and corticosteroids in the pathogenesis of caseous pneumonia]. / Rol' limfotsitov i kortikosteroidov v patogeneze kazeoznoi pnevmonii.

A complex of clinical, X-ray, cytochemical, immunological, and biochemical studies of total 11-OCS, its free forms and separation of free hydrocortisone and corticosterone in the fractions was performed in 52 patients with caseous pneumonia. The patients with caseous pneumonia were found to have the phenomena of dyscorticism, which were characterized by the predominance of the concentration of corticosterone over that of hydrocortisone in the peripheral blood. These changes were proportional by the decreases in the activity of major energy enzymes and in the functional activity of lymphocytes. Under these conditions, the predominance of peripheral blood corticosterone levels determines the increased inflammatory potential and neutralizes the biological effects of hydrocortisone. The detected dyshormonal metabolic and functional changes form the essence of the pathogenesis of caseous pneumonia and the extent of caseous lung tissue necrosis. Under the influence of chemotherapy, complex disintoxication treatment in combination with prednisolone, there is a marked trend of the peripheral blood concentration of hydrocortisone to increase, for metabolism and lymphocytic functional activity to become normal.

[Diagnosis and therapeutic punctures of abdominal organs under ultrasound control]. / Diagnosticheskie i lechebnye punktsii organov briushnoi polosti pod ul'trazvukovym kontrolem.

Data on 32 diagnostic punctures of the liver, pancreas and spleen under ultrasonographic US control are available. False diagnosis was registered in 1 case. 16 curative procedures under US control were carried out in patients with hepatic abscesses (7), suppurative pseudocysts of the pancreas (4), abscesses of the abdominal cavity (5); in 4 patients external drainage extrahepatic bile ducts was carried out. This method, being not much traumatic, produces good results in definite group of surgical patients.

[X-ray characteristics of disseminated pulmonary tuberculosis]. / Rentgenologicheskaia kharakteristika disseminirovannogo tuberkuleza legkikh.

The X-ray pattern of disseminated pulmonary tuberculosis is considered in terms of examination findings in 98 patients. Under the present-day conditions, the X-ray pattern of disseminated tuberculosis is more commonly characterized by a combination of focal shadows of varying diameters with a prevalence of foci of this or that size. Symmetrical areas of infiltration (14.3%) and relatively symmetrical systems of decay cavities (6%) were a major abnormal shadow. A total of 76% had a destructive process. There was a predominance of generalized processes with medium and large cavities.

[Efficacy of chemotherapy in patients with the newly detected complicated destructive pulmonary tuberculosis]. / Effektivnost' khimoterapii u bol'nykh s oslozhnennym techeniem vpervye vyiavlennogo destruktivnogo tuberkuleza legkikh vpervye vyiavlennogo destruktivnogo tuberkuleza legkikh.

A hundred and fifty-six patients with first detected destructive pulmonary tuberculosis were examined. 43.6% of the patients were found to have various complications: bronchial tuberculosis and exudative pleurisy were more common. All the patients received conventional chemotherapy. The studies have demonstrated that the efficiency of chemotherapy during the complicated course was less than in the uncomplicated one: closure of decay cavities was observed in 69.4% of the patients with specific lesion of the bronchial system, in 78.8% of those with a complication, such as exudative pleurisy (in 81.8% with uncomplicated course). In these groups of patients, cessation of bacterial isolation, as verified both bacterioscopically and culturally, was slower.

[Bacterial factors and decompensation of cor pulmonale in patients with pulmonary tuberculosis]. / Bakterial'nye faktory i dokompensatsiia legochnogo serdtsa u bol'nykh tuberkulezom legkikh.

Sputum from 88 patients with different forms of pulmonary tuberculosis complicated by chronic cor pulmonale (CCP) was tested for Mycobacterium tuberculosis (MBT) and nonspecific flora. The high occurrence of multidrug resistance of MBT and nonspecific causative agents are found in patients with signs of heart failure in the presence of decompensatory CCP in 20% of cases, the frequency of concomitant chronic bronchitis was 86%.

[Pneumonia in patients from a tuberculosis dispensary]. / Pnevmoniia u bol'nykh protivotuberkuleznogo dispansera.

In their everyday practice phthisiologists have to make a differential diagnosis and to treat patients with pneumonia who account for 2.7% of the patients treated at tuberculosis hospital. The main reason of diagnostic errors in patients with pneumonia in general hospitals is that the compulsory diagnostic minimum is not observed and the patients' sputum is not tested for acid-resistant Mycobacteria. The paper analyzes the results of treatment in 20 patients with pneumonia in the contagious isolation wards of the tuberculosis hospital, who were in-effectively treated in the outpatient setting. Multimodality treatment with broad-spectrum antibiotics, including rifampicin and streptomycin, aerosols, and physiotherapy may completely resolve infiltration and eliminate the clinical manifestations of the disease in 19 patients.

[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.

[Frequency, pattern, and diagnosis of adverse reactions in patients with pulmonary tuberculosis during chemotherapy with leading drugs]. / Chastota, kharakter i diagnostika pobochnykh reaktsii u bol'nykh tuberkulezom legkikh pri khimioterapii osnovnymi preparatami.

The frequency and pattern of adverse reactions to essential antituberculous agents were studied in 480 patients with first diagnosed and recurrent pulmonary tuberculosis. Adverse reactions were found to occur in 16.9% of cases and to be mainly associated with concomitant diseases of different organs and systems wherein they occurred 15.6 times more frequently, rather than with the number (3-4-5) of used drugs. Adverse reactions were generally caused by an individual drug and predominantly streptomycin. At the same time no significant difference was established in the frequency of toxic (45.5%) and allergic (37%) reactions, but with a rather low frequency of mixed reactions (17.3%). The firstly performed cytochemical and immunological studies of lymphocytes and eosinophils provided new evidence for the pathogenesis of different patterns of adverse reactions. Lymphocytes from patients with toxic reactions showed significant intracellular structural and metabolic disturbances that led to a higher apoptosis of these cells. In patients with lymphocytic allergic reactions, on the contrary, displayed activated processes of anaerobic oxidation and their cytotoxic activity. In both types of adverse reactions, eosinophils exhibited severe intracellular metabolic disturbances that result in destruction and increased apoptosis, which determined the allergic component in virtually all types of side effects. Rational pathogenetic therapy using hormonal, vitamin, and metabolic agents and plasmapheresis could show a 2-fold reduction in the number of patients with adverse reactions without changing the routine chemotherapy regimen and only in 5.6% of cases, the reactions were intractable, which made a specific drug be discontinued and therapy used on an individual basis.

[Effectiveness of artificial pneumothorax in the treatment of patients with pulmonary tuberculosis with multiple drug-resistant Mycobacteria]. / Effektivnost' iskusstvennogo pnevmotoraksa v lechenii bol'nykh tuberkulezom legkikh s mnozhestvennoi lekarstvennoi ustoichivost'iu mikobakterii.

The efficiency of treatment was compared in 2 groups of patients with destructive pulmonary tuberculosis and isolation of multidrug resistant Mycobacteria. In 43 patients of a study group, artificial pneumothorax (AP) was used during chemotherapy with reserve drugs while 43 patients of a control group received chemotherapy alone. AP was shown to be highly effective in treating patients with destructive pulmonary tuberculosis who isolated multidrug resistant Mycobacteria. Moreover, by the end of 12-month therapy, AP in combination with chemotherapy ensured cessation of bacterial isolation in 88.7% and cavernous closure in the lung in 86.8%, which was almost twice higher than that with therapy with reserve antituberculous drugs.