[Significance of tuberculosis of the large bronchi in the diagnosis and treatment of restrictive forms of pulmonary tuberculosis]. / Znachenie tuberkuleza krupnykh bronkhov v diagnostike i lechenii ogranichennykh form tuberkuleza legkikh.

A total of 1223 new cases of restrictive forms of pulmonary tuberculosis were examined. Of them 652 and 598 patients were followed up in the period of the good (1980-1984) and poor (1997-2001) tuberculosis epidemiological situation, respectively. A comparative analysis has indicated that there has been recently a rise in the incidence of tuberculosis of main bronchi from 10.5 to 18.0%, which most commonly complicates intrathoracic lymph nodal or infiltrative pulmonary tuberculosis. A more severe clinical course and a more frequent bacterial isolation have been ascertained mainly in infiltrative, ulcerative, and fistular forms of bronchial tuberculosis irrespective of the form of pulmonary tuberculosis. The comprehensive examination of patients with restrictive pulmonary tuberculosis is certain to include bronchial fibroscopy that may determine the form and phase of bronchial tuberculosis, the rate of a process in the lung, make and differentiate its diagnosis, use systematic and topical therapy (with hydrocortisone aerosols, GINK, streptomycin), and cure bronchial tuberculosis within 2-3 months.

[The body's adaptation and responsiveness and their impact on the outcome of exudative pleuritis]. / Adaptatsiia, reaktivnost' organizma i ikh vliianie na iskhod éksudativnogo plevrita.

The authors studied homeostasis in 182 patients, including 126 patients with exudative pleuritis of tuberculous etiology and 56 with parapneumonic pleuritis. They determined the adaptive reactions of the body by the leukograms and the types of its responsiveness, established their relationship with other homeostatic parameters. Impaired responsiveness in patients with exudative pleuritis substantially affected the efficiency of etiotropic treatment. At the end of the basic course of therapy, the rate of marked residual pleural changes was 84.6% in patients with tuberculous pleuritis (Subgroup 1). Activation pathogenetic therapy with methyluracil promoted a reduction in the number of patients with significant residual pleural changes (32.8% in Subgroup 2).

[Clinical and immunological characteristics and specific features of the treatment of patients with recurrent sarcoidosis of respiratory organs]. / Kliniko-immunologicheskaia kharakteristika i osobennosti lecheniia bol'nykh s retsidiviruiushchimi formami sarkoidoza organov dykhaniia.

In the past 35 years, the authors have followed up 5600 patients with sarcoidosis of respiratory organs (SRO), among whom 1.2 and 10.7% were found to have single and multiple recurrences. The clinical manifestations of recurrent sarcoidosis were moderate, by showing a drastic reduction in the count of T and T"a" lymphocytes, as well as helper lymphocytes, and an increase of circulating immune complexes and immunoglobulins G, A, and M. Poor adaptive responses (AR) defined by the blood leukocyte and lymphocyte counts that reflect the body's nonspecific responsiveness were concurrently diagnosed. In chronic recurrent SRO, poor AR as stress and superactivation amount to as much as 86.1%. To optimize treatment, the patients were given adaptogens (thymaline, levamisole, dibasole, etc.) that make AR better, by enhancing the efficiency of treatment, reducing its duration, and improving prognosis.

[Diagnostic features of focal pulmonary tuberculosis in new cases]. / Osobennosti diagnostiki ochagovogo tuberkuleza legkikh u vpervye vyiavlennykh bol'nykh.

The authors examined 120 new cases of focal pulmonary tuberculosis (FPT) during the good epidemic situation years (1982-1986) and 70 patients during the poor epidemic situation years (1995-1999). The latter years were marked by a worse social composition, more frequent contacts with those isolating bacteria, a more severe course with weight loss, prolonged subfebrile temperatures, anemia, an increasing tendency for lung tissue decay and even in large foci, a more frequent bacterial isolation along with progressive immunodeficiency. New diagnostic technologies, such as computed tomography, T-lymphocytic studies at the subpopulational level by using monoclonal narrow-specific antibodies, adaptive response tests that reflect the body's responsiveness, are of value in diagnosing FPT.

[Causes of fatal outcomes in patients with sarcoidosis]. / Prichiny letal'nykh iskhodov u bol'nykh sarkoidozom.

There have been 21 (7.4) fatal cases among 282 patients with diffuse sarcoidosis of the lung and other organs in the past 30 years. The study of the causes of death indicated that 5 patients had progressive sarcoidosis of the lung and intrathoracic lymph nodes with progressive cardiopulmonary failure. Ten other dead persons had generalized generalized sarcoidosis; sarcoidosis of the central nervous system, liver, spleen, and kidney with marked progressive failure of these organs were of the greatest contribution to death. Concomitant diseases, such as pyoinfection, bronchiectasis with pulmonary hemorrhage, essential hypertension, diabetes, and bronchial cancer, are causes of death in 5 more patients with pulmonary sarcoidosis.

[Assessment of homeostasis by body's adaptative responses in patients with tuberculous pleurisy]. / Otsenka gomeostaza po adaptatsionnym reaktsiiam organizma u bol'nykh tuberkuleznym plevritom.

The types of adaptative responses were defined, by analysing leukograms in 126 patients with tuberculous pleurisy. Assessing homeostasis by proteinograms, cellular and humoral immunity verified adaptative responses as an integral index of responsiveness. This identified 5 types of responsiveness. Abnormal (hyperactive, hyporeactive, paradoxical, and areactive) responsiveness was found in 78.6% of patients with tuberculous pleurisy. All outcomes with significant residual pleural changes were observed in patients with abnormal responsiveness. Adaptative responses may be used in the clinical setting not only for evaluation of homeostasis, but for prediction of prognosis and for organization of controlled pathogenetic therapy on an individual basis.

[Specific features of diagnosis and treatment of patients with pulmonary sarcoidosis and tuberculosis]. / Osobennosti diagnostiki i lecheniia bol'nykh sarkoidozom v sochetanii s tuberkulezom organov dykhaniia.

In the past 30 years, the authors examined and treated 6473 patients with pulmonary sarcoidosis, of them 105 (1.6%) had contacted with the individuals isolating Mycobacterium tuberculosis and 45 (0.7%) had a history of various forms of pulmonary tuberculosis; however, the patients with pulmonary sarcoidosis had neither exacerbations nor relapses. Of the 6473 patients, 41 (0.63%) was diagnosed as having active pulmonary tuberculosis, including 20 with focal pulmonary tuberculosis, 13 with disseminated pulmonary tuberculosis, 4 pulmonary tuberculosis with infiltrative, and other 4 with destructive pulmonary tuberculosis, disseminated and destructive pulmonary tuberculosis occurred in the progressive pulmonary sarcoidosis. The etiopathogenetic treatment of tuberculosis with at least 3-4 drugs (small-dose hormones, antioxidants, immunomodulators) was found to cure the two abnormalities in 95.2% and in 4.8% of cases, the pathological process became chronic when limited disseminated pulmonary tuberculosis was concurrent with disseminated pulmonary sarcoidosis.

[New aspects in pathogenesis of respiratory sarcoidosis]. / Novye aspekty patogeneza sarkoidoza organov dykhaniia.

A comprehensive examination was made of 101 patients with sarcoidosis of the intrathoracic lymph nodes (ITLN) (n = 33), with that of ITLN and lung (n = 47) or sarcoidosis of the lung (n = 21). Special studies were conducted to examine the pulmonary scintigraphic and X-ray pneumopolygraphic findings reflecting impaired microcirculation and biomechanics of respiration, the levels of medium-weight molecules, their fractions, and small-weight molecules in the sera and urine, which reflects the severity of endoxemia, as well as the electrophoretic motility of red blood cells which are involved in metabolism and the degree of tissue hypoxia. The findings have confirmed that there are respiratory, circulatory, and tissue hypoxias, and endogenous intoxication just in earliest respiratory sarcoidosis, which is of definite importance in the pathogenesis of the disease, allowing the use of pathogenetic agents as antihypoxants to be justified.

[The differential diagnostic characteristics of sarcoidosis of the intrathoracic lymph nodes and of cardiovascular diseases]. / Osobennosti differentsial'noi diagnostiki sarkoidoza vnutrigrudnykh limfaticheskikh uzlov i nekotorykh serdechno-sosudistykh zabolevanii.

One hundred and fifty-four (5.7%) of 2690 patients who had been admitted to a hospital for sarcoidosis of intrathoracic lymph nodes (ITLN) were diagnosed as having various cardiovascular diseases (hypertensive disease, congestive lung, congenital and acquired cardiac diseases, atherosclerosis, aortic aneurysms and myocarditis). Misinterpretation of the X-ray film of the lung root, no lateral X-ray films, inadequate scope of objective studies of the cardiovascular system are the most common errors at prehospital examination. The obligatory making of lateral X-ray films, tomograms, the use of computed tomography, ECG and phonocardiography, and thorough account of objective data are valuable additional methods in the differential diagnosis of ITLN sarcoidosis and cardiovascular diseases accompanied by the appearance of wide truncal large vessels of the root due to pulmonary hypertension.

[The diagnosis and treatment of neurosarcoidosis]. / Diagnostika i lechenie neirosarkoidoza.

In 14% of patients with respiratory tract sarcoidosis granulomatous lesions were found in the central nervous system. Clinical classification of neurosarcoidosis was developed which included specific granulomatous forms: CNS arachnoiditis and perivasculitis, sarcoid myositis, as well as nonspecific forms (vasoautonomic dystonic syndrome, angiotrophoneurosis). Diagnostic and therapeutic techniques are presented.

[Long-term follow-up of patients with sarcoidosis of respiratory organs]. / Otdalennye rezul'taty nabliudeniia za lechenymi bol'nymi sarkoidozom organov dykhaniia.

Long-term (3-25 years) responses to treatment are available for 1820 patients with respiratory sarcoidosis. 65.7% of them were females and 34.3% males primarily at the age of 21-50 (92.7%). Sarcoidosis of the intrathoracic lymph nodes (ITLN), sarcoidosis of the lungs and ITLN, diffuse forms of pulmonary sarcoidosis, generalized sarcoidosis were diagnosed in 64, 28.2, 4.6, 2.6% of patients, respectively. All the patients received combined pathogenetic treatment (hormones, antioxidants, antihypoxants, immunomodulators, angio- and hepatoprotectors) which proved highly long-acting in stage I-II (a complete response rate 84.3% and 82.7%, respectively, residual changes remained in 1/5 of the patients). Long-term recurrences occurred in 3.5% of patients who had marked residual changes in the lungs. The disease took a chronic course in 8.7%, progression was recorded in 9.3, lethal outcome in 0.7% of the cases.

[Diagnosis and treatment of generalized forms of sarcoidosis]. / Osobennosti diagnostiki i lecheniia generalizovannykh form sarkoidoza.

A total of 132 patients with generalized sarcoidosis (GS) who amounted to 2.8% out of 4700 examinees and followed-up patients with respiratory sarcoidosis were studied. The pathomorphological study of biopsy specimens, X-ray functional, and immunological studies are of great importance in the diagnosis of GS. The latter in the examinees was characterized by the most common lesions to the skin, subcutaneous fat, peripheral lymph nodes, liver, spleen, central and peripheral nervous systems and eyes. The combined pathogenetic therapy developed, which involves corticosteroidal hormones and anabolic drugs, immunomodulators, antioxidants and antihypoxants has been shown to be effective in 62% of the patients.

[Diagnosis and treatment of pleural lesions in sarcoidosis of the respiratory organs]. / Diagnostika i lechenie porazheniia plevry pri sarkoidoze organov dykhaniia.

Among the 2775 respiratory sarcoidosis patients who were examined over the last ten years 278 (10%) had pleural affections: thickening of interlobular pleura and pleural deposits (98.2%), exudative pleurisy (1.1%) and spontaneous pneumothorax (0.7%). The most common pleural affection was found in sarcoidosis of stages II and III (16.8 and 70.8%, respectively). The clinical manifestations in all forms of this pathology had poor symptoms. Complex therapy proved to be highly effective. It included use of corticosteroids, antioxidants and immunomodulators; massive exudative pleurisy was managed by pleural puncture and removal of exudate.

[Status of the peroxidation-anti-oxidation system in patients with sarcoidosis of the respiratory organs]. / Sostoianie perekisno-antioksidantnoi sistemy u bol'nykh sarkoidozom organov dykhaniia.

Parameters of lipid peroxidation (LPO) and of the antioxidant system (AOS) were analysed according to the level of diene conjugates (DC) and blood serum antiradical activity (ARA), respectively. Study included 115 patients with active respiratory sarcoidosis. The DC level was found to be significantly increased in 89-97% ot the examined patients. At the same time, the ARA changes had a differently directed pattern. The DC/ARA coefficient was estimated which was also increased in most patients providing evidence on the peroxide-antioxidant system imbalance in active sarcoidosis patients. It was found that the parameters were dependent on the process duration. They were studied in dynamics against the background of combined therapy in 2-4-6 months and in the remote periods (1-2 years). Dynamic changes in the biochemical parameters had the unidirectional pattern with manifestation of the clinical and X-ray process dynamics. There was a significant difference in the rate and degree of changes in the LPO-AOS parameters depending on the activity degree of sarcoidosis process and treatment effectiveness. It is believed that the antioxidant therapy is necessary in all sarcoidosis forms at the early stages of treatment and that its duration should be no less than 4 months in the acute process while the protracted course requires a longer period of time.

[Clinico-immunologic aspects of the differential diagnosis of disseminated processes in the lungs]. / Kliniko-immunologicheskie aspekty differentsial'noi diagnostiki disseminirovannykh protsessov v legkikh.

The results of examination of 224 patients with newly detected disseminated processes in the lungs who were admitted for differential diagnosis are presented. Immunologic studies which include determination of the natural killer activity, neutrophil phagocytosis, a total number of T- and B-lymphocytes and synthesis of antituberculosis antibodies in the indirect hemagglutination reaction with three basic M. tuberculosis antigens (phosphatide, polysaccharide and tuberculin) proved to be of high diagnostic value. Immunologic tests used along with clinical studies allowed timely diagnosis of disseminated pulmonary tuberculosis in 62 patients, the disseminated forms of lung sarcoidosis in 115 and nonspecific diseases (microfocal pneumonias of a protracted character, pneumoconioses carcinomatoses, etc.) in 57 patients.

[Natural killers in the blood of patients with limited forms of pulmonary tuberculosis]. / Estestvennye killery krovi u bol'nykh s ogranichennymi formami tuberkuleza legkikh.

Activity of natural killer cells in blood of 47 new cases of limited tuberculosis of the lung was studied during their complex examination. There was a significant decrease in the activity of the natural killer cells in tuberculous patients which could be used as an additional criterion of the specific process activity.

[Treatment methods and results in patients with sarcoidosis of the respiratory organs under hospital and outpatient conditions]. / Metody i rezul'taty lecheniia bol'nykh sarkoidozom organov dykhaniia v statsionarnykh i ambulatornykh usloviiakh.

The results of treating 1360 patients with sarcoidosis of the respiratory organs were studied. Sarcoidosis of stages I, II and III was diagnosed in 67.3, 26.2 and 6.5 per cent of the patients, respectively. Extrapulmonary localization of the process was detected in 17 per cent of the patients. The patients were subjected to complex treatment including the use of prednisolone or presocyl as the essential drugs, immunomodulators (delagil, plaquenyl, levamisole and ethimizol), antioxidants (alpha-tocopherol and sodium thiosulfate) and hydrocortizone aerosols. Recovery from the initial stages of sarcoidosis was observed in 86.5 per cent of the patients when prednisolone was used and in 84.5 per cent of the patients given presocyl. The results of the treatment in the in- and out-patients with sarcoidosis were the same.