[Differential approach to lymphadenectomy in patients with progressive fibrocavernous pulmonary tuberculosis].

The resection specimens from 31 patients with fibrocavernous tuberculosis (FCT) underwent a complex clinical andimmunological study, as well as a morphological one. It was ascertained that partial or extended lymphadenectomy did not always positively correlate with an adequate postoperative immune response and it depended on the morphological features of lymphatic apparatus lesion. The direct results of surgical treatment of patients with FCT suggest that in patients with specific lymphadenitis and cell-mediated immunodeficiency, the frequency of postoperative specific pleuropulmonary complications and their severity considerably exceed those if there is an adequate immune response. In patients with progressive FCT, baseline cell-mediated immunity deficiency is aggravated by surgery, increasing the risk of postoperative specific and nonspecific infectious pleuropulmonary complications.

[Parameters of acquired immunity and cation proteins of neutrophilic granulocytes in pulmonary tuberculosis]. / Pokazateli priobretennogo immuniteta i kationnye belki neitrofil'nykh granulotsitov pri tuberkuleze legkikh.

Clinical and immunological studies of 61 patients with pulmonary tuberculosis have indicated that the status of acquired and congenital (natural) immunity assessed by the intra- and extracellular levels of cation proteins of neutrophilic granulocytes is different in different clinical forms of pulmonary tuberculosis. The found correlations suggest that there is a relationship between the factors of acquired and congenital immunity and that cytokines are involved in the regulation of specific inflammation. More active degranulation of azurophilic granules of neutrophils occurs due to myeloperoxidase. Unlike other forms, fibrocavernous pulmonary tuberculosis shows a negative correlation between intra- and extracellular content of cation proteins. The findings make it possible to use the parameters of congenital immunity for more detailed characterization of an immune response in tuberculosis, which may be essential in developing new pathogenetic therapy regimens.

[Cytokine production-adenosine deaminase activity relationship in pulmonary tuberculosis]. / Vzaimosviaz' produktsii tsitokinov i aktivnosti adenozindezaminazy pri tuberkuleze legkikh.

The serum activity of the enzyme adenosine desaminase (ADA) was studied in patients with infiltrative tuberculosis in relation to IL-1 beta, TNF-alpha, IL-2 productions, the magnitude of a lymphocytic proliferative response to PPD and PGA. There was an association of high ADA levels with the severity of a tuberculous process, with the least IL-2 production together with drastically increased IL1 beta and significant disorders in the TNF-alpha system. Moderate ADA increases reflect the regularly enhanced activity of immunocompetent cells in response to an infectious agent. The findings indicate that a simple biochemical test may be used for rapid preliminary evaluation of the severity of disease and immune performance.

[Production of cytokines in different forms of pulmonary tuberculosis]. / Produktsiia tsitokinov pri razlichnykh formakh tuberkuleza legkikh.

The relationship of the production of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) to the pattern and etiology was studied in patients with pulmonary tuberculosis (n = 74) and nontuberculous lung diseases (n = 28). There was an inverse correlation between the production of the proinflammatory cytokines IL-1 beta and TNF-alpha and the main T-cellular immunity IL-2. An exacerbation of a tuberculous process is accompanied by an increase in IL-1 beta and TNF-alpha productions and by a decrease in inducted IL-2 synthesis. With favourable changes, there was, on the contrary, a reduction in the levels of IL-1 beta and TNF-alpha and a rise in IL-2. There were differences in the rate of cytokine synthesis in pulmonary tuberculosis, lung cancer, and pneumonia. Patients with cancer are most typified by the spontaneous mononuclear production of serum TNF-alpha and by the low level of IL-2 when PGA is stimulated. On the contrary, the least TNF-alpha synthesis and pronounced IL-2 production in pneumonia. A combination of the high production of PPD-induced IL-1 beta and PGA-stimulated IL-2 is more specific to patients with infiltrative pulmonary tuberculosis.

[Immune status characteristics as the basis for the prognosis of lung diseases]. / Osobennosti immunnogo statusa kak osnova dlia prognoza zabolevanii legkikh.

272 patients with pulmonary tuberculosis, 101 patients with pneumonia and 76 patients with cancer varying in severity have undergone a comprehensive immunological examination. Irrespective of the disease etiology, extension of the lesion in all the patients correlated with suppression of cellular immunity and activated IgA production. Increasing production of antituberculous antibodies in patients with disseminated tuberculosis and pulmonary cancer suggests unfavorable outcome of the disease. Genetic markers seem to relate with characteristics of pathological process in the lungs.

[Production of tumor necrosis factor-alpha and interleukin-1 beta in patients with pulmonary tuberculosis in relation to the course of a process and immunological features]. / Produktsiia faktora nekroza opukholei alpha i interleikina-1beta u bol'nykh tuberkulezom legkikh v zavisimosti ot techeniia protsessa i osobennostei immuniteta.

The production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) by peripheral mononuclears induced by prodigiosane, tuberculin, phytohemagglutinin and unduced and the serum levels of the above cytokines were studied. There was an relationship between the production of TNF-alpha in the patients' peripheral blood and the type and pattern of a tuberculosis process. The similar tendencies were found in the production of IL-1 beta. It was found that the production of IL-1 beta was higher in patients with a more predominant humoral immune response and that of TNF-alpha was greater in those with a more cellular response. There were the most marked relationships of cytokine synthesis to the degree of clinical parameters in prodigiosan cell induction of cells and to immunological parameters in tuberculin-induced cell stimulation.

[Significance of immunologic testing of patients in surgery of pulmonary tuberculosis]. / Znachenie immunologicheskogo testirovaniia bol'nykh v khirurgii tuberkuleza legkikh.

Immunological testing of surgical patients with specific pulmonary tuberculosis revealed specific immunodeficiency in 68% of cases which appeared at higher risk of postoperative complications. A scheme of a simple immunological testing by 2 reactions is provided.

[Evaluation of clinical significance of tuberculin sensitization in patients with lung cancer]. / Otsenka klinicheskoi znachimosti tuberkulinovoi sensibilizatsii u bol'nykh rakom legkogo.

Immunological and morphological findings were compared for 85 patients with lung cancer. Tuberculin sensitization was found to reflect the activity of antitumor immunity. The proportion humoral to cellular response to tuberculin and the intensity of these responses in lung cancer patients provide significant information on tumor histology and stage.

[Tuberculin sensitization in patients with lung cancer]. / Tuberkulinovaia sensibilizatsiia u bol'nykh rakom lëgkogo.

The data on immunological and morphological examinations of 85 lung cancer patients have been compared. Tuberculin sensitization indexes were shown to indicate the strength of antitumor immunity. Relationships between indexes of humoral and cellular immunologic response to tuberculin, on the one hand, and their actual levels in lung cancer patients, on the other, serve as fairly reliable indications of histological pattern of tumor and its extension.

[Immunological criteria in the differential diagnosis of lung diseases]. / Immunologicheskie kriterii differentsialnoi diagnostiki zabolevanii lëgkikh.

Immunological examination performed in 292 patients with pulmonary diseases which presented difficulties for differential diagnosis has shown essential differences in immunological status of tuberculous, pneumonia and cancer patients. The fact that immunological abnormalities were related to X-ray characteristics of the lesion made it possible to develop each X-ray syndrome-specific criteria of distinguishing tuberculosis from other pulmonary lesions. The advance of the disease caused unidirectional changes in immunograms for various pulmonary lesions. There is evidence of enhanced cell response to tuberculin in patients suffering from nontuberculous pulmonary lesions.

[Current principles of diagnosis of cavitary formations in the lungs]. / Sovremennye printsipy diagnostiki polostnykh obrazovanii v legkikh.

Tuberculosis, cancer or abscessed pneumonia were diagnosed in 141 (84%) of the 168 patients who had solitary cavities in the lungs in the absence of M. tuberculosis or cancer cells isolation. The most informative diagnostic signs in these cases are provided by sex, age, special features of the onset and course of the disease in the period between diagnosis establishment and patients' hospitalization, data obtained when fluorograms taken from archives were compared with the X-ray picture at the moment of disease detection as well as by the results of serological reactions such as tuberculous antigen detection and Mantoux test, and blood level fibrinogen determination. On the second stage of examination the supplementary signs were obtained in bronchoscopy, cytologic examination of the bronchial contents after prescription of irritating inhalations and prednisolone test and immunologic study. Correct diagnosis can be established in 99% of the cases in the presence of simultaneously five and more significant signs.

[Possibilities of computerized immunodiagnosis of tuberculosis and related lung diseases]. / Vozmozhnosti komp'iuternoi immunodiagnostiki pri tuberkuleze i slozhnykh s nim zabolevaniiakh legkikh.

The results of a computer analysis of immunograms for the differential diagnosis of tuberculosis, cancer, pneumonia and sarcoidosis are presented. The findings indicate that computer immunodiagnosis may be used as a supplementary tool that increases the effectiveness of diagnosis in difficult cases. The advantage of the elaborated system is to rapidly apply a systemic approach to the assessment of the patient's immune status and to objective diagnosis by using computer algorithms.

[Value of different combinations of immunological signs for differential diagnosis of lung diseases]. / Znachenie razlichnykh sochatanii immunologicheskikh priznakov dlia differentsial'noi diagnostiki zabolevanii legkikh.

Stemming from the results of a complex immunologic examination of 653 patients with lung diseases, 4 immunologic reactions of highly diagnostic value were identified, i. e. specific antibody formation, blast transformation with PPD and PHA and spontaneous rosette formation. The most valuable combinations of these reactions were defined for each type of the pathology. For tuberculosis, 16 such combinations were found, including 5 without specific antibody formation; 5 in cancer; 3 in nonspecific inflammation; and 1 in sarcoidosis. Diagnostically important combinations of the above immunologic reactions are summarized in the Table whose use in differential diagnosis of doubtful cases of tuberculosis, cancer, nonspecific pneumonia and sarcoidosis can increase their diagnostic probability up to 0.95-0.99 in 30 per cent of the patients without employing invasive methods.

[Informative value of diagnostic tables for detection of tuberculosis and related lung diseases]. / Informativnost' diagnosticheskikh tablits dlia raspoznavaniia tuberkuleza i skhodnykh s nim zabolevanii legkikh.

Different models of algorithms for the immunologic diagnosis of pulmonary tuberculosis, cancer, nonspecific inflammation and sarcoidosis were developed. A comparative assessment of the effectiveness of 3 versions of Diagnostic Tables was made. A significant advantage of these Diagnostic Tables based on the analysis of immunologic indices characterizing groups of patients with different forms of the process was defined, as they are seen in the X-ray pictures (3d version). A differential diagnosis of tuberculosis and nonspecific lung diseases made by the 3d version of the tables showed that correct and incorrect answers made up 87.6 and 6.8%, respectively. The developed method of immunodiagnosis can be of great help in the differential diagnosis of lung diseases.