Impact of Experimental Tuberculosis on Fertility of Female BALB/c Mice.

The study revealed no effects of pregnancy and childbirth on the course of tuberculosis in female BALB/c mice after aerosol infection with Mycobacterium tuberculosis. However, we demonstrated a negative effect of tuberculosis infection on the fertility of infected females, which manifested in a longer period from mating to pregnancy and in a smaller litter size. Impaired reproductive function in response to the effect of the systemic infectious process was accompanied by the development of immunosuppression confirmed by an immunological test (delayed-type hypersensitivity to tuberculin) and the formation of genital tract dysbiosis during pregnancy and postpartum period.

[Difficult case of differential diagnosis of partial lung atelectasis. Case report].

In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.

[Pulmonary function testing and prehabilitation in thoracic surgery]. / Funktsional'noe testirovanie i preabilitatsiya v torakal'noi khirurgii.

Preoperative assessment should include spirometry and analysis of the diffusing capacity for carbon monoxide. If necessary, exercise tests can be performed. High risk patients can be revealed considering these data. These patients need for prehabilitation, i.e. preoperative measures increasing functional capacity. This review is devoted to preoperative assessment, principles of prehabilitation and perioperative nutritional support.

[Physical activity and physical training as method of prevention of cardiovascular diseases].

A growing body of data demonstrates that exercise capacity is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, obesity, high cholesterol, and type 2 diabetes mellitus. Individuals who maintain a regular program of PA that is longer in duration, of greater intensity, or both are likely to derive greater benefit than those who engage in lesser amounts. In this review, the authors have shown the possibility of assessing physical activity and the main provisions of the appointment of physical training to improve and preserve the cardiorespiratory fitness.

[A difficult case of the differential diagnosis of focal infiltrative lung changes in phthisiatric practice].

Errors occur rather commonly in the differential diagnosis of respiratory diseases accompanied by X-ray lung tissue changes as foci and infiltration. Infiltrative and disseminated pulmonary tuberculosis, lung cancer, and pneumonia constitute a high proportion among the detected concurrent lung diseases. The rate of diagnostic discordance for these lung abnormalities accounts for more than 30%; and the diagnosis period for an infiltrative lung process lasts 2­3 weeks in 20% of cases and above 1­3 months in 80%. In particular, clinicians are faced with great difficulties in diagnosing aspiration pneumonia; this is due to that its X-ray manifestations are not purely specific and they are characterized by the parenchymal (alveolar) infiltration of lung tissue with a varying extent of lung inflammation. This paper describes a clinical case of a patient with salivary gland adenocarcinoma and focal infiltrative lung changes. Diagnostic difficulties have emerged in establishing the genesis of the changes in the lung.

[Optimisation of diagnostics and differential diagnostics disseminated pulmonary tuberculosis].

One of the reasons of dramatic situation with tuberculosis in Russia is untimely diagnostics of tuberculosis. The aim of the study was to identify the causes of diagnostic mistakes when we deal with disseminated pulmonary tuberculosis at current stage and to modernize the diagnostic process. The analysis of the diagnostic activity of the consultative diagnostic center of Central Tuberculosis Research Institute of Russian Academy Medical Sciences for 2011 was performed with special attention on the results of the survey of 505 patients with pulmonary dissemination. The frequency of discrepancies of disseminated pulmonary tuberculosis diagnostics was 96.1%. Based on the studies carried out the main causes diagnostic mistakes in patients with disseminated pulmonary tuberculosis were determined. New directions of improving of tuberculosis diagnostics were developed: overall high-technology examination of patient, adherence to the diagnostic procedure, developed by consultative diagnostic center of Central Tuberculosis Research Institute (CTRI), timely performing fiber-optic bronchoscopy with complex biopsy and diagnostic surgery procedures, further training of primary health care doctors. Implementation of proposed activities will significantly (by 3-5 times) reduce the time for diagnostics of respiratory system disease.

[Up-to-date technologies in preoperative preparation and postoperative period in patients with progressive destructive pulmonary tuberculosis].

The impact of complex pathogenetic treatment involving the latest advances of science and technology in the correction of pulmonary surfactant system (PSS) disorders, extracorporeal therapy and immunomodulation on the enhancement of efficiency of surgical treatment in patients with progressive destructive tuberculosis of the lung. The results of examinations and treatment were studied in 199 patients with progressive and complicated pulmonary tuberculosis. According to the used treatment, the patients were divided into 2 groups: a study group (n = 102) and a control one (n = 97). In the pre- and postoperative periods, the study group patients received complex pathogenetic therapy by the developed algorithm: for pharmacological activation of PSS, nebulizer aerosol therapy with lasolvan (ambroxol) was first used in various modifications by the developed algorithms. The efficiency of preoperative preparation in the study group patients in accordance with the applied methods of pathogenetic therapy indicated that the best results were achieved in the context of stabilization of a specific process, compensation of complications and comorbidity in the patients who underwent modified drug-induced PSS activation with small-volume plasmapheresis and leukinferon (LI) in 93.3% and drug-induced PSS activation with small-volume medical plasmapheresis (MI) in 81.4%. Overall, comprehensive preoperative preparation involving correction of homeostatic disorders by the developed algorithm proved to be 30.9% more effective (81.4%) than the conventional preoperative preparation in the controls (50.5%). Analysis of the results of surgical treatment depending on the methods of pathogenetic therapy used in the pre- and postoperative period showed that the efficiency of surgical treatment was observed in 25 (80%) patients receiving nebulizer aerosol therapy and MP, in 20 (86.9%) who had nebulizer aerosol therapy + MP and in only 8 (65%) treated with nebulizer aerosol therapy.

[Experience with small-volume plasmapheresis used in the correction of hemostatic disorders in patients with progressive destructive pulmonary tuberculosis].

Pulmonary tuberculosis may result from a complex of the phenomena predisposing to impaired blood coagulation. The purpose of the investigation was to study the efficiency of small-volume plasmapheresis in the correction of hemostatic disorders in patients with progressive destructive pulmonary tuberculosis. The results of examination and treatment were analyzed in 112 patients aged 18 to 65 years who had progressive destructive pulmonary tuberculosis treated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, in 1994 to 2004. The patients were divided into groups: Group 1 (basic)--43 subjects receiving the standard therapy supplemented by 4 small-volume plasmapheresis sessions every 2 days and comparison groups: 2A--36 patients receiving 2 plasmapheresis sessions at a week interval and 2B--33 patients being on the standard therapy alone. In the presence of endogenous intoxication, the patients with disseminated and complicated fibrocavernous tuberculosis were ascertained to develop blood coagulative disorders typical of grades 1-2 chronic disseminated intravascular coagulation (DIC). The use of small-volume plasmapheresis in combination with antiaggregatory and anticoagulant therapy in patients with disseminated and complicated fibrocavernous pulmonary tuberculosis had a beneficial effect on the blood aggregation controlling system positive impact, prevented DIC progression, promoted improvement of blood rheological properties. With the standard therapy (including double plasmapheresis at a week interval), positive hemostatic changes were absent throughout the preoperative period.

[Morphological signs of acute lung lesion in patients with caseous pneumonia].

The authors conducted light optical and electron microscopic studies of caseum-free resected lung parenchymal portions from 11 patients with caseous pneumonia. All cases were found to have severe vascular bed permeability impairments, developed extensive intraalveolar edema, destruction of both type 1 respiratory alveolocytes and surfactant-producing type 2 alveolocytes. Release of plasma proteins into the intraalveolar space and their interaction with extracellular phospholipoproteins gave rise to hyaline masses.