[Specific and nonspecific bronchial and regional lymph nodal lesions as a manifestation of synergism in the lymph epithelial system in pulmonary tuberculosis].

The lung and lymph nodes were examined in 130 patients aged 19-70 years, who had been operated on at the Department of Surgery, Saint Petersburg Research Institute of Phthisiology, for pulmonary tuberculosis. The immunopathological changes have close correlations in the bronchi and pulmonary respiratory parenchyma. This gives grounds to regard the lung and lymph nodes jointly as the organ of local immunity (sui generis) and to suggest that there is a synergism of immune reactions. Every gross organism prefers this or that line of development of an inflammatory process in the lung. This choice is predetermined genetically, on the one hand, and caused by other factors, on the other. The latter include the duration of disease, its inclination for the undulating course, and a rather steady-state high activity of inflammation along with concomitant bronchopulmonary pathology that in turn varying in manifestations, depending on the morphofunctional status of BALT. The development of specific bronchial damage in the presence of nonspecific bronchitis argues for the key impact of BALT.

[Ex juvantibus diagnosis in suspected skin tuberculosis].

The paper deals with the diagnosis of cutaneous tuberculous lesions, by performing expectancy antituberculous treatment (ex juvantibus and ex nocentibus). The urgency of this problem is confirmed by the analysis of 205 cases of cutaneous tuberculosis of different clinical forms, which demonstrates that the efficiency of antituberculous therapy proved to be significant in 18.5% of cases to make a definitive diagnosis. The optimum procedure for this therapy is discussed.

[Elastic materials in surgery for inflammatory diseases of the vertebral column].

When 17 patients were surgically treated for spinal tuberculosis and osteomyelitis, anterior spine fusion was performed by A. Ye. Garbuz's procedure that was based on the replacement of a spinal defect by a carbon-carbonic implant that had rifampicin containers in the frontal sections, as well as by autologous bone grafts. The carbon-carbonic implants reliably fix an operated spinal portion, prevent the progression of kyphotic deformity, and create good conditions for autologous bone grafts to knit. An osteocarbonic block forms in the late postoperative period.

[Recovery of the support capacity of the vertebral column in patients with tuberculous spondylitis].

The paper presents the results of anterior spine fusion in 250 patients with tuberculous spondylitis involving 2 to 8 vertebrae, by using free and non-free autologous bone grafts, carbonaceous implants, and revascularized transplants. Anterior spine fusion added to posterior spinal fixation with a CD-type metal construction. A tuberculous process in the spine was cured in 96.1% of cases; the spinal support capability recovery rate was 95.2% in the early postoperative period and in 93.5% in the late one.

[Experimental morphological analysis of perichondrial chondrogenesis].

Microscopic structure of perichondrium of rabbits of different age groups was studied under normal conditions and after its ortho- and heterotopic transplantation in several variants. The results obtained showed that after isolation from its normal environment and placement into unusual conditions of survival, perichondrium maintained its capacity for growth; its cells were found to divide and differentiate actively eventually forming regular hyaline cartilage in a manner similar to that taking place during normal ontogenesis. Perichondrial chondrogenesis occured in all cases of free perichondrial transplantation, provided the experimental conditions assured the optimal vascularization of transplant bed and there were no inerference with the realization of perichondrial histoblastic potential. The most intensive and full-scale chondrogenesis was obtained in the experiments that provided the expansive growth of transplant due to availability of a free space above it. Under these conditions, the proliferation of chondroblasts occured similar to that taking place in normal articular cartilage, outer surface of which faces the free space of articular cavity. These experimental data were supported by the clinical practice, where perichondrial transplantation is successfully used for the treatment of osteoarticular pathology.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Osseous-perichondral autoplasty in surgery for tuberculosis of the joints]. / Kostno-peikhondrial'naia autoplastika v khirurgii tuberkuleza sustavov.

The results of 68 reconstruction surgeries made in the hip and knee joints in tuberculosis and concomitant diseases were studied. Advantages of operations involving the component plasty of joint ends (osseous autoplasty, as well as auto-perichondral plasty and their variations), including under the conditions of revascularization of the osseous bed, were proven on the basis of the results of a comparative analysis of clinical-and-functional data and X-ray examinations. The use of the method ensuring additional sources for vascularizing the joint tissues improves the conditions of autograft assimilation; the application of perichondral grafting preserves or expands the joint split, which provides an increased mobility amplitude in a damaged joint. The use of perichondral plasty and of its combination with revascularization of the joint osseous joint tissues secured more favorable results as compared to the implementation of osseous-plasty interventions alone.

[An experimental evaluation of new plastic materials in the surgery of osseous tuberculosis]. / Eksperimental'naia otsenka novykh plasticheskikh materialov v khirurgii kostnogo tuberkuleza.

Experiments related with xenoplasty made in 108 rabbits are described. An original method of processing the spongy xenografts is suggested; it provides for both minimizing the immune response and for obtaining a new plastic material applicable for replacement of the postoperative osseous cavities. A complete healing of the operated bone and a close-to-norm recovery of osseous structures were ensured in experiments with animals. A similar result was obtained in experimental osseous tuberculosis after the removal of tuberculous foci. The study materials are passed over for testing in clinical practice.

[Efficiency of plastic surgery for osteoarticular tuberculosis by using revascularization of osseous tissue bed and graft]. / Effektivnost' plasticheskikh operatsii pri kostno-sustavnom tuberkuleze s primeneniem revaskuliarizatsii kostnoi tkani lozha i transplantanta.

The paper provides the results of using original procedures for revascularization of the osseous bed and free bony grafts by transplanting osteovascular complexes in patients with tuberculosis of the hip joint and spine. A total of 20 patients with tuberculous coxitis and 14 with spondylitis were operated on. These interventions were found to have advantages over plastic surgery with bony grafts and mobilizing operations without plasty in similar skeletal lesions, appeared as a great scope of movements in the operated joints is achieved, less time for grafts to adhere with the bed and bony block of vertebrae, and enhanced accumulation of a radioopaque agent in the area to be replaced.

[Type UUKM-4d carbonic carbon and porous titanium in plastic repair of bone defects: experimental studies]. / Uglerodistyi uglerod marki UUKM-4D i poristyi titan v plastike kostnykh defektov (éksperimental'nye issledovaniia).

The experimental laboratory of the Saint Petersburg Research Institute of Pharmacology studied the potentialities of replacing bony defects and cavities by type UUKM-4d high-porous carbonic carbon. It was found that in orthotopic implantation, the more intensively bony osseous tissue was grown into the pores of an implant made of carbonic carbon, the more prolonged a postsurgical interval was; just at month 1 after orthotopic implantation, carbonic carbon implant was tightly fixed in the bony bed. Porous titanium is also fixed in the osseous defect without producing negative reactions of a patient's osseous tissue.

[Experimental rationale and clinical evaluation of perichondroplasty used in surgery for tuberculosis and nonspecific joint diseases]. / Eksperimental'noe obosnovanie i klinicheskaia otsenka primeneniia perikhondroplastiki v khirurgii tuberkuleza i nespetsificheskikh zabolevanii sustavov.

Experiments on 77 rabbits studied the specific features of chondrogenesis during different grafting modifications for the perichondrium. The latter was found to have a high chondroplastic potential. The factors predisposing to cartilaginification and inhibiting this process were identified. Experimental positive results of perichondrial arthroplasty, in tuberculous arthritis as well, were achieved. By taking into account the experimental data, original methods for reparative operations used in patients with tuberculosis and nonspecific diseases of the joints were developed in the clinical setting. Their use in 12 patients yielded positive results, suggesting that the above methods are promising and their further study is advisable.

[Pathogenetic aspect of the diagnosis of tuberculous lymphadenitis]. / Patogeneticheskii aspekt diagnostiki tuberkuleznogo limfadenita.

Based on their own experimental (55 rabbits) and clinical (114 patients) findings, the authors propose a new immunopathogenetic approach to diagnosing tuberculous lymphadenitis under the present-day conditions by taking into account the environmental situation. They describe an original enzyme immunoassay for lymph nodal extracts, which has yielded positive results: 88% sensitivity, 92% specificity, and 90% diagnostic efficiency.

[Diagnosis of tuberculosis and other peripheral lymph node diseases]. / Diagnostika tuberkuleza i drugikh zabolevanii perifericheskikh limfaticheskikh uzlov.

Basing on the results of their studies, analysis of 894 patients with tuberculosis of the lymph nodes and nonspecific lymphadenopathy treated in 1983-1993, medical literature, the authors investigate the place of lymphadenopathies in medical practice: new data on the patients, pathogenesis and pathomorphosis of tuberculous and nonspecific lymphadenopathies, diagnostic techniques. Updated approaches to this disease led to a 17.8% decrease in the percentage of cases with unclear etiology.

[Immunological studies and the problems of the pathogenesis of osteoarticular tuberculosis (tuberculous spondylitis, tuberculous synovitis)]. / Immunologicheskie issledovaniia i voprosy patogeneza kostno-sustavnogo tuberkuleza (tuberkuleznyi spondilit, tuberkuleznyi sinovit).

Tests of levels 1-2 were employed to study immune status of 102 patients with tuberculous lesions of the spine and knee joint. Investigations of humoral local response in these patients provided evidence for comparison with systemic response, advanced diagnosis of tuberculous spondylitis and synovitis. It was found that high level of antituberculous antibodies in the synovial fluid is typical for specific allergic synovitis where synovial membrane represents the organ of immunogenesis. The appearance of even minimal number of antituberculous antibodies in the liquor indicates disorder of immune and hematoencephalic barriers of the brain in tuberculous spondylitis complicated with spinal meningitis.