[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.

[Artificial pneumoperitoneum in the complex treatment of pulmonary tuberculosis patients isolating drug-resistant mycobacterium tuberculosis].

The pretreated patients who isolated drug-resistant Mycobacterium tuberculosis (MBT) were randomly divided into 2 groups. A multidrug-resistant MBT strain was isolated from 77 and 62.2% of patients in the study and control groups, respectively. Artificial pneumoperitoneum (PP) was applied to the study group patients (n = 95) during adequate chemotherapy. In the control group (n = 43), only chemotherapy was performed in accordance with the data of a MBT drug sensitivity test. The results were assessed by the trend in bacterial isolation cessation and decay cavity closure. In the group of patients treated with PP and chemotherapy, sputum inoculation abacillarity occurred in 72.6 and 95.8% by months 4 and 6, respectively; in the control group, this did in 48.8 and 65.1% in the same periods. Moreover, decay cavity closure was noted in 95.1% in the study group and in 63.7% in the control group following 6 months of treatment.

[Therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis].

Therapeutic plasmapheresis was performed in 159 patients with pulmonary tuberculosis treated in the clinic in 2000 to 2005. Four hundred and seventy-seven manipulations were made. Among its clinical forms, there was prevalent fibrocavernous tuberculosis (in 136 patients); 9 had infiltrative tuberculosis; caseous pneumonia was present in 5 patients; 4 had tuberculoma; 3 and 2 patients had focal and disseminated tuberculosis, respectively. Out of the 159 patients, 42 (26.4%) underwent therapeutic plasmapheresis at the stages of surgical treatment. Plasmapheresis was made in 61.9% (26/42) before surgery and in 38.1% (n = 16). The study defined indications for and contraindications to therapeutic plasmapheresis in patients with destructive pulmonary tuberculosis, including adolescents and patients at the stages of surgical treatment. A procedure has been developed for discrete and membranous plasmapheresis for this category of patients. In patients with destructive patients, therapeutic plasmapheresis was shown: 1) to level the symptoms of antituberculous chemotherapy intolerance; 2) to correct homeostatic disorders; 3) to enhance the efficiency of basic drug therapy and to promote timely preparation of patients for surgery; 4) to improve the quality of life.

[Comparative analysis of the semiotics of disseminated pulmonary tuberculosis and exogenous allergic alveolitis in accordance with the data of computed tomography].

OBJECTIVE: to improve the differential diagnosis of disseminated pulmonary tuberculosis (DPT) and exogenous allergic alveolitis (EAA) via comparative investigation of their computed tomography (CT) semiotics and identification of the most informative diagnostic criteria. MATERIAL AND METHODS: 70 patients, including 40 patients with DPT in a phase of infiltration and 30 patients with acute EAA, were studied using a Somatom Emotion 16 multi-slice spiral CT scanner (Siemens). All the patients underwent spiral scanning from the upper chest aperture to the costodiaphragmatic recesses with a high CT algorithm at 0.8-mm slice thickness and a 1.5-mm step. RESULTS: Analysis of the spread of dissemination foci established that pathological changes were peribronchovascularly located in both nosological entities and characterized by a preponderance of septal and intrabronchial locations in DPT and by a centrilobular distribution in EAA. Centrilobular foci were more commonly poorly defined in EAA and mixed foci were observed in DPT. In the latter, peribronchovascular, centrilobular foci were revealed at a distance from the visceral pleura (the boundary of the deep and superficial lymphatic network, respectively) in 38% and more than half of the cases (62%) with the involvement of the visceral and parietal pleura; in EAA, the centrilobular foci were more often combined with the involvement of the visceral pleura in more than 92% of cases. The tree-in-bud sign was significantly more common in DPT. The latter was mostly characterized by apicocaudal regression of dissemination. In EAA, the foci were more frequently located asymmetrically. Monomorphic foci with destruction, as well as their polymorphism were seen in DPT; those without destruction were predominantly observed in EAA. CT ground glass and mosaic perfusion syndromes were significantly more often in EAA. In DPT, the visceral and parietal pleuras were involved in the process in 62% of cases and changes were also more common in the extrapleural fat. CONCLUSION: In addition to the peribronchovascular location of foci, the characteristic CT signs for DPT are a preponderance of intrabronchial and septal locations of foci, their apicocaudal regression, the presence of the CT tree-in-bud sign, and thickened extrapleural fat. EAA showed a prevalence of asymmetrical foci with centrilobular location with the involvement of the visceral pleura into the process, with the presence of CT ground glass and mosaic perfusion syndromes, as well as the bronchial lumen visualized in the peripheral segments of the lung.

[Effects of millimetric electromagnetic waves on regional blood flow and effectiveness of multimodal therapy of patients with pulmonary tuberculosis]. / Vliianie élektromagnitnykh voln millimetrovogo diapazona na regionarnyi krovotok i éffektivnost' kompleksnoi terapii bol'nykh tuberkulezom legkikh.

The impact of millimetric electromagnetic radiation (MER) on the natural history of the disease was studied in 54 patients with various types of pulmonary tuberculosis. The patients were treated using wavelengths of 6.4 and 7.1 mm on a YAVOR device. Following 10 sessions of MER therapy used in combination with specific drugs, caverns were found to close in 50% of patients at months 2-3 of therapy and in the controls at months 5-6. Infiltrative changes at the site of lesion resolved at weeks 2-3 of MER exposure, but in the controls at months 1-2 of drug therapy. In 5 (10%) out of 54 patients, regional blood flow parameters became normal, 27 (50%) patients were ascertained to have a partial improvement and 22 (40%) had no changes. No changes were seen in the controls as long as 2 weeks either.

[Role of radionuclide studies in the evaluation of the activity of a pathological process in the lymph nodes and lung of patients with tuberculosis]. / Rol' radionuklidnykh issledovanii v otsenke aktivnosti patologicheskogo protsessa v limfaticheskikh uzlakh i legkikh u bol'nykh tuberkulezom.

The authors studied the activity of a pathological process in the lymph nodes of the mediastinum, by using 67Ga citrate and 99mTc, and pulmonary circulation with MAA-99mTc. Radionuclide studies have established that in new cases of respiratory tuberculosis, the function of lymph nodes recovers by 1.5 times higher than that in pretreated patients. In patients with destructive tuberculosis, pulmonary circulation restores insignificantly and slowly, particularly in a group of pretreated patients. This is explained by the fact that the lung fibrous changes available prior to therapy defy an evolutionary process.

[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.

[Difficulties in the radiodiagnosis of lung injuries in phthisiatric practice].

The paper describes clinical cases of concomitant lung and intrathoracic lymph node involvements as evidenced by conventional radiography and computed tomography (CT). It shows difficulties in the differential diagnosis of different nosological entities in pulmonary tuberculosis. The x-ray semiotics of concomitant lung injuries is also depicted.

[Pulmonary scintigraphy in evaluating the efficiency of surfactant therapy in the complex treatment of patients with destructive pulmonary tuberculosis].

Functional impairments of the mucociliary system (MCS) are known to develop in destructive tuberculous inflammation in the lung tissue. The effect of surfactant agents and their production stimulants is to recover the ventilation and gas exchange functions of the lung. The radioaerosol technique that adequately characterizes the deposition of an inhaled agent in the bronchial tree and records the state of mucociliary clearance (MCC) and MCS in different portions of the lung by the rate of tracer washout is of the greatest information value for the evaluation of MCC in vivo. Its normal values are in rather wide ranges so the absolute values are of low informative value. By taking into account the variability in the tracer washout range in health, the authors used only the time course of relative changes in this parameter--before and after surfactant therapy. The capacities of pulmonary scintigraphy were employed to monitor the efficiency of treatment for tuberculosis. The percentage of the activities in the areas of the right and left lung individually and in combination was estimated, by constructing the tracer washout curve. The percentage of 60-minute tracer washout was borne in mind to determine the rate of MCC.

[A comparison of clinico-scintigraphic studies with the morphological changes in the lungs in destructive tuberculosis]. / Sopostavlenie kliniko-stsintigraficheskikh issledovanii s morfologicheskimi izmeneniiami legkikh pri destruktivnom tuberkuleze.

Radionuclide findings were compared with morphological changes in resected lung tissue in 78 patients with destructive tuberculosis. In the preoperative period, 30 (38.5%) of 78 patients were found to have significant and much significant changes in regional blood flow while 48 (61.5%) patients had restrictive changes. This provides evidence that 76% of the first diagnosed patients with destructive pulmonary tuberculosis had chiefly inflammatory changes, i.e. the specific process was reversible and only 24% had sclerotic changes. In patients with chronic destructive tuberculosis, sclerotic pulmonary and inflammatory changes were prevalent in 73.6 and 26.4%, respectively. Scintigraphic studies are of great clinical and diagnostic value of characterizing the extent and site of a pathological process in patients with pulmonary tuberculosis, revealing regional circulatory disorders both at the site of a specific process and in the intact areas of the lung, as evidenced by morphological studies.

[Significance of radionuclide study in early diagnosis of chronic pleural empyemas]. / Znachenie radionuklidnogo metoda issledovaniia v rannei diagnostike khronicheskikh émpiem plevry.

Forty-five patients aged 17 to 70 years with exudative pleurisy were examined. Among them there were 31 patients with exudative pleurisy of tuberculous etiology, 7 with parapneumonic pleurisy and 7 with malignant pleurisy. In addition to clinical and X-ray examination, all the patients were studied for the functional status of the parietal pleura by using the radionuclide technique. The study indicated that the peripheral blood levels of radio pharmaceuticals (RP) ranged in relation to the duration of the disease: 0.33%, 0.31, 0.29, and 0.26% with a duration of 1-3, 4-6, 7-9, and over 10 months, respectively. With the least changes in the parietal pleura, the peripheral blood content of RP was highest and in pleural cirrhosis it was the lowest. The study showed that 66% were diagnosed as having early pleural empyema and 13 underwent pleurectomy.

[Evaluation of the functional state of the alveoli and capillary network of the lungs in patients with fibrosing alveolitis]. / Otsenka funktsional'nogo sostoianiia al'veol i kapilliarnoi seti legkikh u bol'nykh fibroziruiushchimi al'veolitami.

Regional blood flow and ventilation of the lungs in 48 patients with fibrosing alveolitis, including 19 with idiopathic fibrosing one and 29 with extrinsic allergic one, were investigated. A comprehensive radionuclide evaluation supplemented by a clinicoroentgenologic and functional studies mutually enhances the diagnostic potentialities for fibrosing alveolitis of different genes.