[Comparative analysis of a new modification of segmental tuberculin test with the routine Koch test]. / Sravnitel'nyi analiz novoi modofokatsii segmentarnykh tuberkulinovykh prob s traditsionnoi proboi Koch.

A focal reaction plays the leading role in the assessment of segmental tests (ST). The sensitivity of ST is 72.4% and that of the Koch test is 64.5%, their specificity is 94.1 and 80.0%, respectively. A 10% or more increase in adenosine deaminase during peritoneal fluid ST indicates to the exacerbation of genital tuberculosis. Analysis of the cellular composition of peritoneal fluid from the Douglas space is proposed as a criterion for a focal reaction. There are ultrasound symptoms which accompany the exacerbation of an inflammatory process in the genitals in response to ST and which are indicative of a positive focal reaction. The minimum tuberculin load and lack of contraindications allow ST to be introduced into the practical work of tuberculosis facilities.

[Clinical picture of genital tuberculosis in different forms of its pathogen]. / Klinicheskaia kartina genital'nogo tuberkuleza pri razlichnykh formakh vozbuditelia.

Improvement of bacteriological diagnosis is of great value for the clinical picture of genital tuberculosis. The purpose of the study is to reveal the clinical features of genital tuberculosis in L-forms of Mycobacterium tuberculosis (MBT) versus traditional bacteriological methods and polymerase chain reaction (PCR) test with MBT DNA. A hundred and fourteen patients with verified active genital tuberculosis were examined. They were divided into 3 groups: 1) 36 patients with L-forms of MBT in the endometrial scrapes; 2) 32 with bacteriologically verified GT; 3) 46 with positive PCR test. A control group (Group 4) comprised 120 patients with NGD. Among the patients with L-forms there were prevalent females aged 21-40 years (83.4%). These patients had a history of spontaneous abortions more frequently than patients from other groups, in a third was found to have MBT with their L-variants. Signs of intoxication were observed in 47.2%. Oviductal obliteration and specific changes typical of tuberculosis were revealed on a hysterogram in 63.9%, other forms of prior and current extragenital tuberculosis were detected in a half of cases, traces of prior pulmonary tuberculosis were observed in 15%, 63.9% of the patients with L-forms and in 87% of those with positive PCR test were found to have pathological changes in the endometrium, which is indirectly indicative of its lesion. Thus, detection of L-forms of MBT in the endometrial scrapes leads to the conclusion that this is an active sluggish hematogenic tuberculous process, which is evidenced by a complex clinical and laboratory study.

[Polymerase chain reaction and ligase chain reaction in the diagnosis of gynecological tuberculosis]. / Polimeraznaia i ligaznaia tsepnaia reaktsiia v diagnostike ginekologicheskogo tuberkuleza.

The polymerase chain reaction (PCR) and the ligase chain reaction (LCR) were evaluated and compared on 55 gynecological samples collected from women with active gynecological tuberculosis (Group 1), gynecological diseases other than tuberculosis (Group 2), and active tuberculosis elsewhere in the body without evidence for gynecological tuberculosis (Group 3). Acid fast staining and culture of Mycobacteria appeared to be ineffective in all specimens. The sensitivity of both amplification methods was 94.7% (one of the 19 patients with non-tuberculosis). The LCx method showed a very high inhibition by specimens (64.1% of negative samples versus 16.7% for PCR and LCx could be useful tools in the diagnosis of gynecological tuberculosis.

[Features of hysterosalpingogram in verified genital tuberculosis]. / Osobennosti gisterosal'pingogramm pri verifitsirovannom tuberkuleze genitalii.

Two hundred and fifty one women were examined. Of them, 93 patients with active tuberculosis made up Group 1, 38 with inactive tuberculosis Group 2, and 120 with nonspecific gynecological diseases Group 3. In All tuberculosis was verified by morphological and bacteriological studies. Analyzing the X-ray pattern demonstrated that their leading X-ray signs were rigidity and clavity deformity of the uterine tubes and contrast shadows in the projection of uterine adnexa, and obliteration of the uterus. These signs were observed in 63.2% of the patients with inactive or long-lasting tuberculosis. At the same time young women with active tuberculosis firstly detected had no pronounced anatomic changes, which makes it possible to be initiate treatment timely and preserve reproductive function.

[Features of surgery on female genital tuberculosis]. / Osobennosti khirurgii tuberkuleza zhenskikh genitalii.

The paper gives the outcomes of treatment in 4983 patients treated at the Gynecology Clinic of the Saint Petersburg Research Institute of Phthisiopulmonology in 1977 to 1999. Surgical interventions different in their scope were made in 949 (19%) females. Analyzing 526 females of them indicated that organ-saving operations were performed in most cases (80.2%). Indications for surgery and the time of preoperative etiotropic therapy were defined. Emphasis is laid on that the introduction of laparoscopy into practical phthiosiologic gynecology will solve many problems associated not only with a surgical appliance, but also with the diagnosis of genital tuberculosis.

[Laparoscopy in the complex diagnosis abdominal and genital tuberculosis]. / Laparoskopiia v kompleksnoi diagnostike abdominal'nogo i genital'nogo tuberkuleza.

Laparoscopy may detect pathognomonic signs of rashes on the visceral peritoneum, enlarged mesenteric lymph nodes, a profound commissural process in the small pelvis and Douglas space to identify abdominal and genital tuberculosis. The examinees were also found to have a prior tuberculosis of other sites or a contact with bacillary patients. Laparoscopy shows a 19.7% increases in the diagnostic potentialities by morphologically verifying the diagnosis based on biopsy specimens.

[Clinico-morphological manifestations of genital tuberculosis in women]. / Kliniko-morfologicheskie proiavleniia tuberkuleza genitalii u zhenshchin.

Surgical material from 35 female patients with genital tuberculosis is analyzed. 57.1% of patients with clear-cut clinical symptoms showed tubercles and caseous foci. In other patients no specific pathology was found histologically. This condition can be called as a non-active tuberculosis if clinicoepidemyologic data and laboratory studies support diagnosis of tuberculosis. Natural evolution of the specific inflammation and its trend to fibrosis facilitate the development of secondary infection. In this respect tuberculosis of female genitalia resembles pulmonary tuberculosis.

[Diagnostic values of polymerase chain reaction test in females with genital tuberculosis]. / Diagnosticheskie vozmozhnosti metoda tsepnoi reaktsii pri genital'nom tuberkuleze u zhenshchin.

The previously offered procedure for detecting. Mycobacterium tuberculosis, which is based on the polymerase chain reaction (PCR), has been tested for diagnosing genital tuberculosis in females. PCR was used to examine endometrial curettage specimens in 44 patients with different nosological entities, which showed a high sensitivity (80%) and a high specificity in the diagnosis of genital tuberculosis.

[Clinical aspects of genital tuberculosis in young women]. / Klinicheskie osobennosti genital'nogo tuberkuleza u zhenshchin molodovogo vozrasta.

The review of 108 case histories of active genital tuberculosis (GT) in young women provided the following information: the symptoms emerged acutely in 30%, GT ran under the mask of nonspecific salpingo-oophoritis in 44%, GT was associated with pain, general toxicity, blood picture changes in 50, 30 and 66% of patients, respectively. In 70.7% of young women tuberculosis affected uterine tubes only, whereas in women over 30 years old the infection more frequently occurred in the uterus. 63% of GT females were treated surgically.

[Value of the morphological characteristics of choriocarcinoma in the prognosis of the disease]. / Znachenie osobennostei morfologii khoriokartsinomy dlia prognoza zabolevaniia.

Morphologic studies of 59 choriocarcinomas identified 56 histologic patterns which are of prognostic value. According to information index of Koulback, 17 of them were the most valuable (cytologic pattern of tumor, degree of polymorphism of cyto- and syncytiotrophoblast, mitotic activity of cytotrophoblast, type of tumor growth, degree of blood vessel invasion, etc.). Individual prognosis can be established on the basis of said characteristics, using the Neuman-Pearson procedure. The reliability of individual prognosis made in the study reached 93%.

[Morphological characteristics of normal trophoblast and choriocarcinoma]. / Morfologicheskaia kharakteristika normal'nogo trofoblasta i khoriokartsinomy.

A certain ratio of cyto- and syntrophoblast cells in the chorion is known to exist during a certain third of pregnancy. It was shown that cell differentiation taking place in the placental epithelium can occur in the same order during malignant transformation of the trophoblast, too. The histological type of tumor was found to be in correlation with the pattern of pregnancy (normal or pathologic) preceding the disease as well as with the stage of pregnancy termination. A significant difference in syncytial choriocarcinoma incidence after normal pregnancy (88.7 +/- 8.8%) and pathological one (41.2 +/- 11.2%) (t = 3.2) was registered. These findings can be interpreted on the basis of morphological characteristics of the disease, which should be considered in planning therapy. The results should also be taken into account when making prognosis.

[The patient's age in different pathogenetic variants of choriocarcinoma in pregnancy and treatment results]. / Vozrast bol'nykh pri razlichnykh patogeneticheskikh variantakh khoriokartsinomy beremennosti i rezul'taty lecheniia.

Patients with choriocarcinoma of normal pregnancy survived longer (mean age 36.3 +/- 1.2 years) than those suffering pathologic pregnancy choriocarcinoma (31.7 +/- 1.1; t = 2.9). In the former group, better treatment results were obtained in older patients. However, those who died from choriocarcinoma were of similar age whatever pattern of tumor: 31.7 +/- 1.8 years--normal pregnancy and 31.9 +/- 5.9--pathologic one.

[Mitotic regime of benign and malignant tumors of the trophoblast]. / Mitoticheskii rezhim dobrokachestvennykh i zlokachestvennykh opukholei trofoblasta.

Mitotic regimen was studied in 52 choriocarcinomas and 45 hydatidiform moles. A clear-cut correlation between the rate of proliferation and degree of hyperplasia of the trophoblast was established for hydatidiform mole. Choriocarcinoma revealed higher values for mitotic index, incidence of pathologic mitoses and the profile of abnormal cell division patterns. Higher mitotic index and incidence of pathologic mitoses in cases of choriocarcinoma were associated with less favorable clinical course of the disease. The presence of villi ruled out the diagnosis of choriocarcinoma.

[Metastatic spread in various pathogenetic variants of choriocarcinoma]. / Metastazirovanie pri razlichnykh patogeneticheskikh variantakh khoriokartsinomy.

The analysis of data on 208 cases of choriocarcinoma of different pathogenetic types established certain regularities of tumor dissemination into various organs. Metastases were observed in 33.3 +/- 5.1% of cases of choriocarcinoma of pathologic pregnancy. Dissemination was twice more frequent in patients suffering choriocarcinoma of normal (full-term or interrupted) pregnancy (56.2 +/- 4.5%; t = 3.4).

[Role of hydatidiform mole in the pathogenesis of choriocarcinoma]. / Rol' puzyrnogo zanosa v patogeneze khoriokartsinomy.

Such pathogenetic patterns of choriocarcinoma (ChC) as development after normal and pathologic gestation are discussed. Clinically-based criteria of vesicular mole progression were established. It was found that 66.4 +/- 4.4% of cases did not need chemotherapy because removal of vesicular mole was invariably followed by cure. Therapy was indicated in 29.2 +/- 4.3% as symptoms continued to increase. Transition of untreated vesicular mole to ChC was recorded in 4.4 +/- 1.9% of cases. Timely adjuvant chemotherapy reduced relative risk of transformation to ChC 17.7 times.

[Immunological and hormono-metabolic indices in trophoblastic disease]. / Immunologicheskie i gormonal'no-metabolicheskie pokazateli pri trofoblasticheskoi bolezni.

Certain immunologic and hormono-metabolic indexes were studied in patients with hydatidiform mole and uterine choriocarcinoma. Changes in T- and B-lymphocyte ratio were observed: B-lymphocyte levels were abnormally high in hydatidiform mole while those of T-lymphocytes-low in choriocarcinoma. Blastogenic response of lymphocytes in trophoblastic disease matched the mean values in healthy females. No pronounced metabolic changes were registered in cases of trophoblastic disease (who are generally young). It was concluded that cellular immunity suppression is not associated with fat-carbohydrate metabolism disturbances in hydatidiform mole and choriocarcinoma of the uterus.

[Clinical study of several aspects of the pathogenesis of choriocarcinoma during pregnancy]. / Klinicheskoe izuchenie nekotorykh aspektov patogeneza khoriokartsinomyberemennosti.

It was shown that pathogenesis of choriocarcinoma depends on both the outcome of a preceding pregnancy and its nature (type). The latter, in turn, is determined whether pregnancy is normal (birth, abortion or miscarriage) or pathological (hydatidiform mole or ectopic choriocarcinoma). Different genetic and clinical patterns of pathogenesis of choriocarcinoma are identified--those of normal pregnancy and abnormal one.

[Risk factors in uterine choriocarcinoma patients and their effect on the treatment results]. / Faktory riska u bol'nykh khoriokartsinomoi matki i ikh vliianie na rezul'taty lecheniia.

Adverse factors of risk versus survival were studied in 208 cases of uterine choriocarcinoma. The said factors were not identified in some cases; in others, they ranged 1-4 and more in different combinations and were found to influence five-year results of treatment. In the absence of factors of risk, survival was 100.0%; in cases of one factor, it fell to 90.9, two-83.4, three-72.0 and four and more--to 12.8%. Significant differences in the degree of risk factor manifestation were established in survivors and victims of choriocarcinoma.

[Risk factors and choice of treatment method with uterine choriocarcinoma patients]. / Faktory riska i vybor metoda lecheniia bol'nykh khoriokartsinomoi matki.

An analysis of the results of uterine choriocarcinoma treatment versus the degree of risk is presented. Chemotherapy alone was found to be sufficient in 70.2% of cases free of risk, as compared with only 31.2% in case of four and more factors. Application of chemotherapy alone proved, on the whole, to be more beneficial than that of surgery plus chemotherapy modality, as evidenced by the death rates of 13.8 +/- 3.4 and 32.5 +/- 5.4% (t = 2.9), respectively. Polychemotherapy of cases with 1-4 factors of risk or more gave significantly better results than monochemotherapy, regardless of the former being a sole treatment or a component of combined therapy.