[Role of lung biopsy in diagnosis of pulmonary pathology at the prehospital level].

The aim of the work was to assess the value of biopsy techniques for fibrobronchoscopy under local anesthesia in patients with pulmonary pathology at the prehospital level. It included 706 subjects with lobular, segmental or diffuse lesions in the lungs of specific (tuberculosis), non-specific (pneumonia, exogenous alveolitis), and other origin. All known methods of endobronchial biopsy were employed (bronchoalveolar lavage or liquid lung biopsy, tissue biopsy, transbronchial biopsy, brush biopsy, puncture and aspiration biopsy) with subsequent cytomorphological and bacteriological studies of bioptates. Diagnostic efficiency of direct biopsy was estimated at 97%, transbronchial biopsy at 5-90% depending on nosological form of lung disease, brush and puncture biopsy 20-50 and 6% respectively. Reversible complications occurred in 1.4% and were resolved by therapeutic methods. Cost effectiveness of prehospital instrumental examination of patients with pulmonary pathology is 10 times the intrahospital one.

[Comparison of radionuclide studies with pleural morphological changes in patients with tuberculosis pleurisy].

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

[Clinicomorphological rationale for mediastinal lymphadenectomy in the surgical treatment of disseminated destructive pulmonary tuberculosis].

The paper analyzes morphological changes and results of surgical treatment in 515 patients with destructive pulmonary tuberculosis. Two hundred and seventy-four patients underwent mediastinal lymphadenectomy and in 241 patients lung resections or pneumonectomies were not followed by lymphadenectomy or solitary caseous molten lymph nodes were removed during an operation. In disseminated destructive pulmonary tuberculosis, active tuberculosis of intrathoracic lymph nodes (ILN) was found in 97%. The latter's significant signs are an enlarged lymph node of more than 2.0 cm, consolidation, periadenitis, and fluctuation. The incidence, extent, and pattern of ILN lesion varied in a lung tuberculous process depending on its site, form, and inflammation phase.

[The scientific path of a laboratory of pathomorphology and electron microscopy].

The paper shows the research directions of the staff of the laboratory of pathomorphology and electron microscopy, which cover the period from 1924 to the present time, which can be conventionally divided into 4 stages associated with the leading role of the laboratory's heads: Prof. V.G. Shtefko (1924-1945), Prof. V.I. Puzik (1945-1974), Prof. O.A. Uvarova (1974-1980), and Prof. V.V. Yerokhin (1980 up to the present time). The laboratory's researches are the productive path of phthisiomorphology. The tasks of the laboratory have been associated with the problems to be solved by the institute. This applies the morphology, pathogenesis, classification of tuberculosis, and changes in inflammatory reactions in response to the altered Mycobacterium tuberculosis and to specific and pathogenetic actions on tuberculosis. New living conditions give the laboratory's researchers new tasks that require their solution at a new technological level.

[Pathomorphological features of pulmonary tuberculosis at different stages of HIV infection: autopsy data].

The case histories, autopsy protocols, and histological specimens from 11 patients who had died from HIV-associated tuberculosis and 15 patients died from progressive disseminated tuberculosis and caseous pneumonia in the absence of HIV infection (a control group). In all the study patients, the morphology of the lung and peripheral and intrathoracic lymph nodes was examined at the early (2B) and late (4B-5) stages of HV infection (Groups 1 and 2, respectively). Group 1 patients had died from caseous pneumonia. Their morphology of tuberculosis differed little from that in the control group. Group 2 was marked by a predominance of disseminated tuberculosis with extensive exudative necrotic lesions in the lung, lymph nodes, and other organs in the presence of reduced lymphoid tissue and in the absence of a limited epitheloid cell reaction.

[On the morphological diagnosis of drug-resistant pulmonary tuberculosis].

The intraoperative samples taken from 15 patients with acutely progressive drug-resistant fibrocavernous pulmonary tuberculosis were studied. There were typical signs of granulomatosis inflammation, a predominance of an exudative tissue reaction, and an extensive vascular bed lesion. Two types of perifocal cellular infiltrates were identified. Mononuclear infiltrates with epithelioid cellular transformation along the periphery were defined as specified. Nonspecific infiltrates were composed of foam macrophages-lipophages and they reflected lipid metabolic disturbances. In addition, the severity of the process was determined by an extensive specific bronchial lesion of all generations. A morphological study of the samples could reveal the tissue and cellular features of respiratory organs in drug-resistant tuberculosis and identify the diagnostically significant signs of specific and nonspecific inflammation.

[Impact of phthisiosurgery on the development of morphological studies of the lung].

The paper describes the most important developmental stages of phthisiomorphology in chronological order, by using as an example the work of the Pathomorphology Laboratory, Central Tuberculosis Research Institute, since its organization. It also shows the stages of phthisiosurgery with the inestimable scientific and practical contribution of the works by L. K. Bogush and his followers from the formation of lung surgery to today's achievements. The authors give examples of the long-term working partnership of surgeons and morphologists in the development of these two disciplines, which was fruitful in deciding many issues of phthisiology.

[Leukinferon in combined therapy for acute pulmonary tuberculosis]. / Leikinferon v kompleksnoi terapii ostroprogressiruiushchego tuberkuleza legkikh.

Experiments on 140 CBA and C57BL/6 mice and studies of 163 patients with acute pulmonary tuberculosis have indicated that leukinferon has a immunomodulating effect on morphological reactions in the lung and on the clinical course of the disease. They have shown that leukinferon plays an important role in the activation of exudate macrophages and in the acceleration of their differentiation in experimental tuberculosis and that there is a rapid elimination of Mycobacterium tuberculosis from the involved organs without production of the L-forms of the causative agent when immunomodulation is used. At months 2-3, the patients with acute pulmonary tuberculosis showed the accelerated processes of detoxification, abacillation, infiltrate resolution, and decay cavity closure during hemo- and immunomodulation with the normalized production of cytokines (gamma-interferon and tumor necrosis factor-alpha). During 6-month therapy, a severe pulmonary process was arrested in 84% of cases and some patients were operated on (76% in the comparison group). The morphological effect of leukinferon was to increase mononuclear infiltration and to normalize a lung connective tissue response, by further decreasing the rate of inflammation.

[The tissue and cellular reactions of the lung in drug-resistant tuberculosis]. / Tkanevye i kletochnye reaksii legkikh pri lekarstvenno-ustoichivom tuberkuleze.

The material obtained from 52 patients with drug-resistant fibrocavernous pulmonary tuberculosis was studied. Morphological studies established the progression of a process in 94.2% of the cases. There was a prevalence of an alternatively exudative tissue reaction, a generalization of the process with specific and non-specific changes in the lung, lesion to the vascular bed with a predominance of an exudative reaction, generalized nonspecific and specific bronchitis with impaired elimination of the intraalveolar contents and with the preserved extensive cellular infiltrates in the lung. Healing elements as the signs of the encapsulation of caseous necrosis, the proliferation of lymphoid elements, and a macrophageal response were simultaneously revealed, which provides evidence for that different modalities of pathogenetic therapy should be used.

[Effects of immunomodulator leukinferon on the course of experimental tuberculosis]. / Vliianie immunomoduliatora leikinferona na techenie éksperimental'nogo tuberkuleza.

An experiment was conducted on 60 CBA mice intravenously inoculated with cultured Mycobacteria tuberculosis (MBT), Erdmann strain, in a dose of 0.025 mg. The specific features of tissue, cellular, and biochemical reactions were studied in the lung, liver, and spleen when leukinferon (LF) was included into tuberculosis treatment regimen. LF was shown to have a positive impact on the development of reparative reactions during tuberculous inflammation by reducing the time of abacillation and recovering the structure of diseased organs. By month 3 of follow-up, MBT were not detected in mice receiving antibacterial agents (ABA) and LF, while typical and changed forms of LF were identified in the cytoplasm of alveolar macrophages in mice treated with ABA alone. A specific feature of an inflammatory reaction as a significant proliferation of lymphocytes and macrophages with their ample infiltration of target organs was noted in animals receiving LF. This was followed by the activated production of alpha- and gamma-interferons and by the mobilization of an enzymatic link of anti-oxidant defense under chronic oxidative stress, which led to a reduction of resolution of inflammatory areas and to an increase in survival of animals which had not been given ABA, but treated with LF alone.

[Features of morphological reactions in caseous pneumonia]. / Osobennosti morfologicheskikh reaktsiipri kazeoznoi pnevmonii.

The morphological features of caseous pneumonia (CP) were studied in 90 patients aged 20-54 years by using specimens obtained at autopsy and surgery at the Central Research Institute of Therapy, Russian Academy of Medical Sciences and Moscow Clinical Tuberculosis Hospital No. 7. Thirty patients died from CP, 30 were operated on for CP. A matched group of 30 patients was operated on for fibrocavernous pulmonary tuberculosis (FCPT). Of the 30 patients operated on for CP, the process was classified as an individual nosological entity in 19 patients and as a complication due to FCPT in 11 patients. Out of the 30 deceased, CP was as an individual nosological entity in 17 patients and it complicated acute FCPT in 13 patients. Morphological (light and electron microscopy) and immunomorphological studies revealed the specific features of CP, which distinguished it from other forms of pulmonary tuberculosis. These included: the fulminant course and dissemination of lung tissue lesion, which is association with the appearance of intravascular blood coagulation and lung infarction; 2) development of immunodeficiency in the presence of autoallergy to the basilar membrane of lung vessels, macrophageal and lymphocytic dysfunctions; 3) extensive cell dystrophy of the air-blood barrier even in the intact portions of the lung; 4) hepatic dysfunction due to extensive dystrophy to the extent of hepatocytic micronecroses and dyscirculatory disorders.

[Clinical presentation, course and treatment of recurrent sarcoidosis: followup data]. / Klinika, techenie i lechenie retsidiva sarkoidoza po dannym dispansernogo nabliudeniia.

The paper presents the results of long-term follow-ups of 107 patients with recurrent sarcoidosis registered as having Group VII-IB. In the patients, there was the greatest dissemination of the process in the lung, intrathoracic lymph nodes and other organs and MF MB in the blood, sputum, BAC? Group VIIIB patients need the greatest attention of physicians, treatment involving extracorporeal and physiotherapeutical methods to prevent respiratory failure and disability.

[Oxidative metabolic changes, antioxidantion, and platelet activation rat phagocytes during development of experimental specific tuberculous changes]. / Izmeneniia okislitel'nogo metabolizma, sostoianie antioksidatnoi sistemy i uroven' factora aktivatsii trombotsitov v fagotsitakh krys pri razvitii éksperimental'nykh spetsificheskikh tuberkuleznykh izmenenii.

An experiment was made on 100 noninbred albino rats, of which 80 rats were intraperitoneally inoculated by Mycobacterium tuberculosis (MT) in a dose of 7.5 mg. Examinations were conducted 1 day, 1, 2, and 8 weeks after inoculation. Alveolar macrophages, nonfractionated cellular sediment of bronchoalveolar lavage, and leukocytes were the object of the studies. Spontaneous and BCG-stimulated HCT test, the activities of superoxide dismutase (SOD) and catalase, the content of malonic dialdehyde (MDA), and platelet activation factor (PAF) were determined in all cell populations. The course of the process was histologically controlled. Following a fortnight, specific foci developed in the organs, they began spontaneously resolving 6 weeks later. In all types of cells, an infectious process resulted in an increase in the rate of oxidative metabolism, which did not lead to their functional exhaustion. In early infection, the activity of SOD dropped, the level of MDA and the activity of catalase increased. During involution of specific changes, their normalization of MDA and catalase variables corresponded to the high values of SPD in the cells. The level of PAF moderately elevated during the formation of specific changes in the organs and fell below the control values in the involutional phase of the process.

[Features of oxidative metabolism and level of platelet activating factor in pulmonary and circulating phagocytes of tuberculosis-resistant animals at stages of experimental infection]. / Osobennosti okislitel'nogo metabolizma i uroven' faktora aktivatsii trombotsitov v legochnykh i tsirkuliruiushchikh fagotsitakh rezistentnykh k tuberkulezu zhivotnykh na étapakh éksperimental'noi infektsii.

An experiment was conducted on noninbred albino rats intraperitoneally inoculated with Mycobacteria tuberculosis (MBT) in a dose of 0.025 mg. Alveolar macrophages (AM), non fractionated cell sediments (NFCS) and circulating leukocytes were studied 1 day, 1, 2, and 6 weeks after inoculation. Spontaneous and killed BCG culture-stimulated killed HCT-test, the activity of superoxide dismutase (SOD) and catalase, the level of malonic dialdehyde (MDA) and platelet activation factor (PAF) were determined. Morphological changes were histologically controlled. The rats administered the MBT dose sufficient to initiate generalized tuberculosis in guinea pigs were found to develop nonspecific changes which became reversible by the end of the experiment. Throughout the process, there was no splash of basal oxidative metabolism in all phagocytic types and their functional decompensation did not develop. Following 1.5 months, all the types of phagocytes showed an increased oxygen burst during specific stimulation. The level of MDA did not exceed the control values in all periods. The activity of anti-oxidative enzymes changed heterodirectionally. At the final stage, the activity of catalase repeatedly increased with normal or reduced SOD values. In early infection, the concentration of PAF rose in the pulmonary phagocytes. When resistance was formed, in all cell types it fell below the control values.

[Platelet activating factor in biological fluids of animals with different species-specific resistance at the stage of infective process after inoculation with mycobacterium tuberculosis]. / Faktor aktivatsii trombotsitov v biologicheskikh sredakh zhivotnykh s raznoi vidovoi rezistentnost'iu na étapakh infektsionnogo protsessa posle zarazheniia mikobakteriiami tuberkuleza.

Following 24 hours, 1, 2, and 6 weeks of inoculation of guinea-pigs and albino rats by Mycobacterium tuberculosis (MT), the levels of platelet activation factor (PAF) were determined in the plasma, leukocytes, alveolar macrophages, nonfractionated cellular sediment and fluid of bronchoalveolar lavage (FBAL) by testing rabbit platelets. The guinea-pigs developed generalized tuberculosis, the rats receiving a small dose of MT developed nonspecific inflammation and those taking a large dose had specific foci. In both experiments, spontaneous regression of inflammatory changes began in rats after 6 weeks. In the guinea-pigs inoculated by MT, there was a steady increase in PAF synthesis in all cell populations, PAF levels dropped in fluids. In the rats receiving a small dose of MT, the cellular levels PAF levels periodically rose in early infection, but decreased below the control values during regression of inflammatory changes. Concurrently, the level of PAF became lower in plasma and FBAL. With high-dose inoculation, it drastically fell in the cells just after MT administration, then moderately increased during the development of specific changes and again dropped at the end of the experiment. In early infection the changes in PAF levels in the body's fluids were mirror as regards to the respective cells, but at regression of specific changes, the content of PAF was lower than the normal values in all the fluids under study.

Morphological reactions in the subcutaneous fat after lymphotropic administration of isoniazid: experimental study. / Morfologicheskie reaktsii v podkozhnoí kletchatke pri limfotropnom vvedenii izoniazida (éksperimental'nye issledovaniia).

Two experiments were conducted on 36 guinea-pigs. One of them examined the morphology of the distribution of the intravital stain trypan black with isoniazid 1, 3, 6, 24, and 48 hours after their administration into the subcutaneous fat of the neck and axilla. It demonstrated that the agents came from the subcutaneous fat largely to the intrathoracic lymph nodes and lungs via the lymphatics in a retrograde way. The other experiment on 16 healthy guinea-pigs indicated that 1, 2, and 3 months after lymphotropic administration (into the pretrachea and axilla), an infiltrate appeared and increased at the site of drug administration, which became larger after 3 months of lymphotropic injection, and after discontinuation it is completely resolved and the tissue structures of the subcutaneous fat recovered.

[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.