[Clinical features of female genital tuberculosis in the period of 1980 to 2005].

Comparative analysis of two groups of patients with female genital tuberculosis treated at the Saint Petersburg Research Institute of Phthiosiopulmonology in 1980 to 2005 has shown that patients of younger age have recently fallen ill with this disease. The genital tuberculous process is commonly preceded or attended by other forms of tuberculosis of various organs and systems, such as the lung, lymph nodes, and kidney. The pain syndrome and impaired menstrual cycle are observed in half the patients; infertility is present in 60%; profound anatomic changes are less frequently seen in the fallopian tubes. Improvement of bacteriological methods promoted the timely diagnosis of the disease.

[Clinical picture of genital tuberculosis in different forms of its pathogen]. / Klinicheskaia kartina genital'nogo tuberkuleza pri razlichnykh formakh vozbuditelia.

Improvement of bacteriological diagnosis is of great value for the clinical picture of genital tuberculosis. The purpose of the study is to reveal the clinical features of genital tuberculosis in L-forms of Mycobacterium tuberculosis (MBT) versus traditional bacteriological methods and polymerase chain reaction (PCR) test with MBT DNA. A hundred and fourteen patients with verified active genital tuberculosis were examined. They were divided into 3 groups: 1) 36 patients with L-forms of MBT in the endometrial scrapes; 2) 32 with bacteriologically verified GT; 3) 46 with positive PCR test. A control group (Group 4) comprised 120 patients with NGD. Among the patients with L-forms there were prevalent females aged 21-40 years (83.4%). These patients had a history of spontaneous abortions more frequently than patients from other groups, in a third was found to have MBT with their L-variants. Signs of intoxication were observed in 47.2%. Oviductal obliteration and specific changes typical of tuberculosis were revealed on a hysterogram in 63.9%, other forms of prior and current extragenital tuberculosis were detected in a half of cases, traces of prior pulmonary tuberculosis were observed in 15%, 63.9% of the patients with L-forms and in 87% of those with positive PCR test were found to have pathological changes in the endometrium, which is indirectly indicative of its lesion. Thus, detection of L-forms of MBT in the endometrial scrapes leads to the conclusion that this is an active sluggish hematogenic tuberculous process, which is evidenced by a complex clinical and laboratory study.

[Features of hysterosalpingogram in verified genital tuberculosis]. / Osobennosti gisterosal'pingogramm pri verifitsirovannom tuberkuleze genitalii.

Two hundred and fifty one women were examined. Of them, 93 patients with active tuberculosis made up Group 1, 38 with inactive tuberculosis Group 2, and 120 with nonspecific gynecological diseases Group 3. In All tuberculosis was verified by morphological and bacteriological studies. Analyzing the X-ray pattern demonstrated that their leading X-ray signs were rigidity and clavity deformity of the uterine tubes and contrast shadows in the projection of uterine adnexa, and obliteration of the uterus. These signs were observed in 63.2% of the patients with inactive or long-lasting tuberculosis. At the same time young women with active tuberculosis firstly detected had no pronounced anatomic changes, which makes it possible to be initiate treatment timely and preserve reproductive function.

[Features of surgery on female genital tuberculosis]. / Osobennosti khirurgii tuberkuleza zhenskikh genitalii.

The paper gives the outcomes of treatment in 4983 patients treated at the Gynecology Clinic of the Saint Petersburg Research Institute of Phthisiopulmonology in 1977 to 1999. Surgical interventions different in their scope were made in 949 (19%) females. Analyzing 526 females of them indicated that organ-saving operations were performed in most cases (80.2%). Indications for surgery and the time of preoperative etiotropic therapy were defined. Emphasis is laid on that the introduction of laparoscopy into practical phthiosiologic gynecology will solve many problems associated not only with a surgical appliance, but also with the diagnosis of genital tuberculosis.

[Laparoscopy in the complex diagnosis abdominal and genital tuberculosis]. / Laparoskopiia v kompleksnoi diagnostike abdominal'nogo i genital'nogo tuberkuleza.

Laparoscopy may detect pathognomonic signs of rashes on the visceral peritoneum, enlarged mesenteric lymph nodes, a profound commissural process in the small pelvis and Douglas space to identify abdominal and genital tuberculosis. The examinees were also found to have a prior tuberculosis of other sites or a contact with bacillary patients. Laparoscopy shows a 19.7% increases in the diagnostic potentialities by morphologically verifying the diagnosis based on biopsy specimens.

[Clinico-morphological manifestations of genital tuberculosis in women]. / Kliniko-morfologicheskie proiavleniia tuberkuleza genitalii u zhenshchin.

Surgical material from 35 female patients with genital tuberculosis is analyzed. 57.1% of patients with clear-cut clinical symptoms showed tubercles and caseous foci. In other patients no specific pathology was found histologically. This condition can be called as a non-active tuberculosis if clinicoepidemyologic data and laboratory studies support diagnosis of tuberculosis. Natural evolution of the specific inflammation and its trend to fibrosis facilitate the development of secondary infection. In this respect tuberculosis of female genitalia resembles pulmonary tuberculosis.

[Clinical aspects of genital tuberculosis in young women]. / Klinicheskie osobennosti genital'nogo tuberkuleza u zhenshchin molodovogo vozrasta.

The review of 108 case histories of active genital tuberculosis (GT) in young women provided the following information: the symptoms emerged acutely in 30%, GT ran under the mask of nonspecific salpingo-oophoritis in 44%, GT was associated with pain, general toxicity, blood picture changes in 50, 30 and 66% of patients, respectively. In 70.7% of young women tuberculosis affected uterine tubes only, whereas in women over 30 years old the infection more frequently occurred in the uterus. 63% of GT females were treated surgically.

[Use of microsurgical technics in the treatment of tubal infertility of tuberculous etiology]. / Ispol'zovanie mikrokhirurgicheskoi tekhniki v lechenii trubnogo besplodiia tuberkuleznoi étiologii.

The data on the results of surgical treatment of tubal infertility in 104 patients are presented. In 52 of these cases the operations were conducted according to a developed method with the use of microsurgical techniques. A modified plastic surgery of the ampullar-fimbrial part of the uterine tube made it possible to achieve a 13% increase in restoring the patency of the uterine tubes as well as a 9% improvement of childbearing function. The experiments on rabbit does led to a conclusion that with the ampullar-fimbrial part of the uterine tube cut off, the pregnancy was still possible, but to a lesser degree.

[A new method of B-cell rosette-forming reaction]. / Novyi sposob postanovki reaktsii B-rozetkoobrazovaniia.

To increase the effectiveness of diagnosing tuberculosis, a new procedure of defining B-rosette forming lymphocytes is proposed. A commercially available product, i.e. dry erythrocytic tuberculous phosphatidic diagnosticum produced by the Leningrad Vaccine and Serum Research Institute and meant for serologic examinations and antiphosphatidic antibody detection, was used in the above reaction for the first time. The following groups were selected for the examination: 51 patients with female genital, locomotor and ocular tuberculosis; 33 persons with nonspecific diseases of the same sites; and 19 donors. A significant drop in the absolute percentage of B-rosette forming lymphocytes (EAC-RFC-ph) in patients with active tuberculosis of all sites was found out. High diagnostic informativeness of the procedure is demonstrated. There was an inverse correlation between the level of antiphosphatidic antibodies and the content of B-rosette forming lymphocytes in tuberculosis patients and the examined controls.