[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.

[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.

[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.

[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.

[Significance of scintigraphic studies in the complex diagnosis of disseminated pulmonary tuberculosis]. / Znachenie stsintigraficheskikh issledovanii v kompleksnoi diagnostike disseminirovannogo tuberkuleza legkikh.

The aim of the work was to study the role of a scintigraphic examination in the complex diagnosis of disseminated pulmonary tuberculosis. Study was carried out by a computer-assisted gamma-camera with 99mTc pharmaceutical preparation. Combined examination included 55 patients among whom most patients (26 or 65.5%) had a disseminated lung process and 19 (34.5%) had changes circumscribed by 2-3 bilateral segments. The method was proved to be of high informative value. The microcirculatory changes in 47 (85.5%) patients with obvious signs of active pulmonary tuberculosis were more pronounced than those detected by X-ray. Dynamic scintigraphy in 8 (14q.5%) patients with a dubious process activity proved to be an advantageous supplementary method of study.

[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.