[Differential diagnosis of tuberculosis of respiratory organs and pulmonary eosinophilia].

The reasons for misdiagnosis of tuberculosis in patients with pulmonary eosinophilia were analyzed, by using 6 clinical cases as an example. In most cases, the reasons for diagnostic errors are underestimation of elevated eosinophil levels and late afterexamination to verify the diagnosis. With general practitioners' increasing alertness, the inefficiency of antibiotics in patients with initially presumed pneumonia is frequently interpreted as an argument in favor of tuberculosis. Examining the cellular composition of bronchoalveolar lavage permits verification of the diagnosis of pulmonary eosinophilia in questionable cases. It is advisable to use a short course of test therapy with small-dose glucocorticosteroids for differential diagnosis of tuberculosis and pulmonary eosinophilias.

[Effect of surfactant-BL on ventilation and gas exchange function in patients with destructive pulmonary tuberculosis].

The fact that the treatment of pulmonary tuberculosis is a topical problem is beyond question. At present, it is well known that there is dissociation between the time of a negative sputum reaction and later cavernous healing, resolution of inflammatory changes. Therefore, search for new possibilities of pathogenetic action on the course of a tuberculous process, healing of destructive changes, and the maximum recovery of functional disorders are one of the ways of enhancing the efficiency of treatment in patients with destructive pulmonary tuberculosis. Over 70 years' history of the discovery and studies of the pulmonary surfactant system has made it possible to formulate a current concept of surfactant as a multicomponent system of cellular and non-cellular elements that ensure the antiatelectatic, antiedematous, protective, and other functions of the lung. The effects of surfactant preparations as an agent of pathogenetic therapy are being investigated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. The present paper presents the results of changes in external respiratory function and gas exchange before and after surfactant therapy in 64 patients with established drug-resistant infiltrative pulmonary tuberculosis. Along with the performed antituberculous therapy, the natural agent Surfactant-BL made in Russia was used by taking into account individual sensitivity. The agent was inhalationally administered in a daily dose of 25 mg by the schedule for 8 weeks.

[Potentialities of preoperative chest computed tomography in patients with pulmonary tuberculosis].

The data on 120 patients prepared for surgery for pulmonary tuberculosis were analyzed. Based on the results obtained after computed tomography (CT), the authors received additional information in 86 (71.7%) patients, resulting in changes in surgical tactics in 41 (34.2%) patients, delay of surgery in 33 (27.5%), and its cancellation in 12 (10%). It should be concluded that it is necessary to use chest CT in patients with pulmonary tuberculosis at the preoperative stage.

[Specific features of the macrophage formula of bronchoalveolar lavage in patients with destructive pulmonary tuberculosis]. / Osobennosti makrofagal'noi formuly bronkhoal'veoliarnogo smyva u bol'nykh destruktivnym tuberkulezom legkikh.

The macrophageal elements (ME) of bronchoalveolar lavage were cytologically and electron microscopically studied in 11 patients with active pulmonary tuberculosis who took antituberculous drugs during 3-6 months, which did not yield a significant clinical effect (Group 1) and in 24 patients with the disease who received inhaled C-BL during chemotherapy (Group 2). The drug was administered in a dose of 20 mg by a nebulizer every second day during 4-9 weeks. In Group 1, the high levels of young biosynthesizing (32.08 +/- 0.10) and mature secreting (11.50 +/- 0.70) ME were combined with the lower counts of phagocytizing macrophages (11.50 +/- 0.90). In Group 2, the specific features depended on the duration of C-BL use and after 20-28 inhalations their composition tended to normalize: biosynthesizing (18.30 +/- 1.05), secreting (5.80 +/- 0.95), and phagocytizing (47.20 +/- 1.05). In 19 patients from Group 2, the therapeutic effect was clinically regarded as positive.

[Morphology of the lungs and cellular composition of bronchoalveolar lavage in tuberculomas]. / Morfologiia legkikh i kletochnyi sostav bronkhoal'veoliarnogo smyva pri tuberkulemakh.

Morphology of the lungs and bronchoalveolar lavage (BAL) were studied in 27 patients with tuberculomas. The investigators also determined lymphocytic, macrophagal or neutrophil BAL composition regarding lymphocyte, macrophage or neutrophil dominating infiltration of pulmonary tissue outside the sites of specific inflammation. As a result, the activity of the process was assessed by subpopulation composition of lymphocytes in BAL, by morphology of alveolar macrophages in pulmonary tissue; the pattern of inflammatory reaction in the lesion focus was specified.

[Endoscopic diagnosis of tuberculosis and other granulomatous diseases of respiratory organs: advances and prospects]. / Dostizheniia i perspektivy razvitiia endoskopicheskoi diagnostiki tuberkuleza i drugikh granulematoznykh zabolevanii organov dykhaniia.

The paper presents data on the use of various bioptic methods in phthisiatry and pulmonology. Particular attention is given to granulomatous diseases of the lung whose misdiagnosis may be during clinical examinations in 50-70% of cases. Making the methods of transbronchial biopsies, including those of the lung and bronchoalveolar lavage, better, putting them into practice widely, and developing new studies (microbiological, electron microscopic, immunological, morphological) for biopsy specimens may improve the diagnosis of lung diseases.

[Evaluation of the functional activity of alveolar macrophages based on the results of a study of blood cells]. / Otsenka funktsional'naia aktivnosti al'veoliarnykh makrofagov po rezul'tatam issledovaniia kletok krovi.

NBT test basal values and those after cell stimulation with killed BCG culture were measured by spectrophotometry in alveolar macrophages isolated from bronchoalveolar lavage fluid, in peripheral blood neutrophils and monocytes of 49 patients with newly detected pulmonary tuberculosis. Stimulation coefficient was estimated as the ratio of induced to spontaneous NBT-test values. The findings evidence that spontaneous NBT-test values are regularly growing in all three cell types, and the stimulation coefficients lowers as the process grows in severity at the expense of pulmonary tissue disintegration and bronchial obstruction; these parameters adequately reflect the status of the body specific reactivity. Significant correlations were revealed between spontaneous NBT-test parameters in all 3 cell types and their stimulation coefficients. This permits a conclusion that spontaneous and induced NBT-test of the peripheral blood cells may help assess alveolar macrophage function.

[The instrumental diagnosis of disseminated lesions of the lungs]. / Instrumental'naia diagnostika disseminirovannykh porazhenii legkikh.

A study is presented of 52 patients with disseminated pulmonary lesions. Among them: histiocytosis X--17, alveolar microlithiasis--5, pulmonary phospholipoproteinosis--7, idiopathic hemosiderosis--14, primary pulmonary amyloidosis--1, primary diffuse lung tumours--8. All patients were subjected to complex bronchological examination including use of different biopsy transbronchial methods as well as open biopsy of the lung. The diagnostic value of the employed bronchial biopsies is discussed. A diagnostic algorithm of rarely met pulmonary disseminations has been developed. Recommendations on the use of different instrumental methods are formulated.