[Levofloxacin (Tavanic) in complex therapy of tuberculosis].

Preclinical and clinical investigations of levofloxacin in complex with antituberculosis drugs of the main and reserve groups in 152 patients with newly diagnosticated drug resistant pulmonary tuberculosis demonstrated its efficacy and safety. The adverse events due to levofloxacin (8.6% of the cases) disappeared after discontinuation of the drug use without any affection of the patient's organs. Levofloxacin is applicable in antituberculosis therapy of patients with extended, acute progressing or polycavernous tuberculosis of the lungs. It provides significant clinical improvement and if necessary allows to prepare the patient in a short period for surgical operation.

[Sparfloxacin in combined therapy for pulmonary tuberculosis].

Efficacy and safety of the difluoroquinolone sparfloxacine used in combined therapy for drug-succeptible and drug-resistant pulmonary tuberculosis were studied. Clinical trials enrolled 60 patients with severe pulmonary tuberculosis. The most effective combinations of sparfloxacine and other antituberculous drugs were determined. Data on satisfactory tolerability of sparfloxacine used in various combinations of the main and reserve agents are presented.

[The effectiveness and safety of sparfloxacine in combined therapy for tuberculosis].

The effectiveness and safety of the difluoroquinolone sparflo (sparfloxacine) used in combined therapy for drug-sensitive and drug-resistant pulmonary tuberculosis were studied. Clinical trials were carried out in 60 patients with severe pulmonary tuberculosis. The more effective combinations of sparfo and other antituberculous drugs were determined. Data on the satisfactory tolerability of sparfo used in various combinations of first- and second-line agents are presented.

[Clinical and X-ray characteristics of first detected intrathoracic lymph node tuberculosis in children].

Sixty-two case histories of Moscow children aged 4-12 years, treated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, for first detected intrathoracic lymph node tuberculosis (ITLNT), were studied. Planned and prophylactic studies revealed the disease in 95.1% (including 66.1% after mass tuberculin diagnosis and 29% on examination for their contact). The disease was more commonly asymptomatic. Mild or moderate signs of the total disorder syndrome were prevalent in the clinical picture. In 56.5% of cases, a tuberculous process was detected in the phase of consolidation and calcinations. Among the patients with intrathoracic lymph nodal changes in the infiltration phase, the children with minor forms of ITLNT whose diagnosis was verified by computed tomography were 72.7%. The use of computed tomography in the diagnosis of ITLNT allowed one to make the fullest evaluation of changes in intrathoracic lymph nodes, including the groups of the anterior and posterior mediastinum.

[Comparative characterization of x-ray studies for diagnosing minor forms of tuberculosis of intrathoracic lymph nodes].

This paper deals with a follow-up of children referred for further studies with a presumptive diagnosis of minor tuberculosis of intrathoracic lymph nodes (ITLN). The authors compare the efficiency and implication of all used X-ray tomographic studies. In 2002 to 2005, a total of 187 children were examined by survey X-ray study, imaging, and computed tomography (CT). X-ray study applying the conventional procedure revealed enlarged ITLN in 64 (34.2%) children and deformity of the lung roots in 108 (57.6%); in 15 (8.0%) children having no changes on routine X-ray tomographic study, positive tuberculin tests suggesting the high activity of tuberculous infection served as the basis for further examination. Comprehensive clinical and X-ray studies employing CT confirmed the diagnosis of tuberculosis in 81 (43.3%) children. It has been ascertained that CT can visualize ITLN that is no longer observable by means of the conventional X-ray tomographic procedure. The use of CT excludes cases of hyperdiagnosis of minor forms of tuberculosis of ITLN, which are encountered when traditional X-ray tomography is applied.

[Surgical treatment for tuberculosis of intrathoracic lymph nodes in children and adolescents].

Ninety-four children and adolescents with tuberculosis of intrathoracic lymph nodes (TITLN) were operated on. Late diagnosis and long-term ineffective antituberculous therapy (chemotherapy lasted 2-3 years in 29.8% and 4-5 years in 19.1%) lead to the occurrence of complicated forms of TITLN in 34% of children. Computed tomography (CT) reliably determines the extent, site, and phase of a tuberculous process, assesses the time course of changes in the efficiency of antituberculous therapy. CT aids in defining the optimal time of surgical interventions. Bilateral consecutive one-stage removal of affected lymph nodes is possible in children with bilateral TITLN.

[Today's high-resolution digital X-ray study in the detection and diagnosis of pulmonary tuberculosis].

The radiation technique is the only method for timely identification of pulmonary tuberculosis, and there has been no alternative to it so far. The authors provide convincing evidence for this, by conducting 720 test trials on an AMTsR-1 small-dose high-resolution (3.2 to 5 pairs of lines per mm) digital X-ray apparatus made in Russia. For space resolution, the obtained digital X-ray images are equal to full-format film radiographs, which allows one not only to reveal, but also diagnose tuberculosis and other diseases of the lung. Such forms of tuberculosis, as focal (9%), infiltrative (15%), tuberculosis of intrathoracic lymph nodes in the phase of infiltration (7%), fibrocavernous tuberculosis (19%) could be detected and diagnosed at the state of digital X-ray study of the lung in 100% of cases without circumstantiating linear and computed tomography. Computed tomography is indispensable to the diagnosis of tuberculosis of intrathoracic lymph nodes, bronchus, the types of disseminated tuberculosis, and bronchopleural fistulas.

[Clinical, X-ray, and bacteriological features of drug-resistant tuberculosis].

The data on 1400 patients with first diagnosed drug-resistant tuberculosis, who were followed up in 2000-2005, have been used to analyze the causes of and factors predisposing to the development of clinical, X-ray, and bacteriological features of drug-resistant tuberculosis. The prevalence of its clinical forms with a rapid progression of the process, with complications, comorbidity, the high frequency of multidrug resistance, total resistance, and massiveness and duration of bacterial isolation, which are commonly observed in socially dysadapted patients in incompliance of appropriate treatment regimens, is shown to determine a great epidemic danger. These features should be taken into account on developing and implementing the appropriate measures in both tuberculosis facilities and general hospitals.

[Interstitial (lymphogenous) disseminated pulmonary tuberculosis: diagnostic capacities of computed tomography].

Computed tomography (CT) as a priority radiation diagnostic technique for interstitial lung diseases was used to examine 35 patients with disseminated interstitial lymphogenous tuberculosis (ILT). Individuals having ILT amounted to 29% of the total number of the patients with disseminated pulmonary tuberculosis. The major CT markers of ILT are interstitial diffuse bilateral lesion with the reticular or reticulonodular macrostructure. ILT is characterized by its lymphogenous origin with involvement of the superficial and peripheral lymphatic network, by a productive inflammatory reaction showing no tendency to consolidation and cavernization, by none or meager bacterial isolation, by a negative or insignificant tuberculin sensitivity, as well as by difficulties in the identification of a granulomatous component. In terms of the level of damage to the interstitial structures, ILT presented with predominant intralobular interstitial lesion as small reticularity in 16% of the patients, with predominant intralobular interstitial lesion as large reticularity in 59%, and with predominant peribronchovascular interstitial lesion in 25%. The identified CT types of ILT are noteworthy for a chemotherapeutic approach and its results and for the degree of development of interstitial fibrosis.

[Computed tomography in the diagnosis and classification of tuberculosis of intrathoracic lymph nodes].

Six hundred and seventy-six children suffering from tuberculosis and infected with Mycobacterium tuberculosis (MBT) were examined. The specific features of the involvement of intrathoracic lymph nodes (ITLN), their extent, site localization, size, structure, and secondary changes in the adjacent tissues were identified. A computed tomographic (CT) classification of ITLN was proposed. The types of ITLN were identified; these were severe adenopathy, mild adenopathy, and micropolyadenopathy. ITLN that were less than 5-mm, multiple, soft tissue, homogeneous in a child with Mycobacterium-infected tuberculosis were regarded an objective reflection of insidious tuberculosis infection. There is evidence for the necessity of making a CT study of children with tuberculosis and those infected with MBT as an absolutely indicated X-ray technique.

[Optimization of tuberculosis complex chemotherapy with the use of moxifloxacin]. / Optimizatsiia komleksnoi chimioterapii tuberkuleza pri ispol'zovanii moksifloksatsina.

It was shown in vitro that moxifloxacin by its activity against Mycobacterium tuberculosis (susceptible and resistant to the main antituberculosis agents) was highly superior to lomefloxacin (by 2 to 4 times by the MIC and by 4 times by the MBC). In murine lung tissue culture the highest effect was observed with the use of moxifloxacin in combination with isoniazid and pirazinamide. The efficacy of the regimens with the use of moxifloxacin was estimated in the treatment of 152 patients with pulmonary tuberculosis diagnosticated for the first time. The use of moxifloxacin was shown to be most advantageous in complex therapy of patients with extended and progressive tuberculosis due to polyresistant Mycobacterium tuberculosis strains or patients with concomitant nonspecific inflammatory diseases of the respiratory tracts due to a great variety of grampositive and gramnegative organisms, acid fact bacteria, atypical bacteria and a great variety of anaerobes. The tolerance of the treatment regimens with the use of moxifloxacin was mainly satisfactory.

[Computerized tomography of the lungs and mediastinum in children with tuberculosis risk]. / Kompiuternaia tomografiia legkikh i sredosteniia u detei s riskom zabolevaniia tuberkulezom.

Computed tomography (CT) was made in 75 children and adolescents infected with M. tuberculosis. As shown by x-ray, they had normal lungs and mediastinum. The children comprised a group of tuberculosis risk and had undergone regular check-ups for tuberculosis. CT has detected tuberculosis of the intrathoracic lymph nodes (ITLN) in 28(37.3%) children. Adenopathies were discovered in 8 anatomic groups, being more frequent in retrocaval, tracheobronchial, pulmonary and paratracheal. 25 children were diagnosed to have minor form of ITLN tuberculosis (nodes size 6-10 mm), 3 children had more prominent adenopathy up to 20 mm in diameter. Three groups of preventive policy are identified: with minor tuberculosis of ITLN, intrathoracic micropolyadenopathy and normal CT picture of the lungs and mediastinum.

[Calcinosis of the arterial ligament and tuberculous adenitis of the aortic window in children: computerized tomography]. / Kal'tsinat arterial'noi sviazki i tuberkuleznyi adenit aortal'nogo okna u detei pri komp'iuternoi tomografii.

The paper provides a retrospective analysis of scans of chest computed tomography (CT) in children who had different forms of intrathoracic or were tuberculin positive. The children had no cardiovascular diseases or clinical signs of Botallo's duct patency. CT was performed without contrast reinforcement. Arterial ligament calcification (ALC) was detected in 16 children, of them 9 had concurrently tuberculous adenopathy of several groups, as well as aortic window nodes being in 2. ALC was the only respiratory alteration in 7 children. The calcified aortic ligament was misinterpreted as the calcified lymph node of the aortic window.

[Role of computerized tomography in the diagnosis of cirrhotic pulmonary tuberculosis]. / Rol' komp'iuternoi tomografii v diagnostike tsirroticheskogo tuberkuleza legkikh.

Computed tomography (CT) revealed cirrhotic tuberculosis in 52 patients. In most patients, cirrhosis resulted from infiltrative and fibrocavernous tuberculosis, less frequently from tuberculous bronchoadenitis, disseminated and focal tuberculosis, caseous pneumonia. Segmental cirrhosis was present in 15 patients, multisegmental and lobar cirrhosis in 19, and bilateral lung cirrhosis in 2. In 8 patients, pulmonary cirrhosis was accompanied by tuberculous empyema; in 8 more patients lobar cirrhosis was the metatuberculous syndrome of fibrocavernous tuberculosis. Evaluation of the diagnostic potentialities of CT in cirrhotic pulmonary tuberculosis revealed that the major CT semiotics of this clinical type was identical to the basic skialogic signs of routine X-ray study. However, unlike the latter that assesses mainly indirect X-ray signs of the cirrhotic transformation of lung tissue, such as reduced lung volumes, chest deformity, CT objectively detects morphological changes in cirrhosis, the presence and magnitude of specific and metatuberculous changes, interprets clinical and X-ray variants of this form of tuberculosis and its related pulmonary vascular alterations.

Caseous and infiltrative-caseous pneumonia in computed tomography. / Kazeoznaia i infil'trativn-kazeoznaia pneumonii pri komp'iuternoi tomografii.

Computer tomography (CT) imaging was made in 22 patients with acute tuberculosis--caseous and infiltrative-caseous pneumonia. CT role in detection of caseous changes, assessment of the extent and structure of caseosis, in differentiation of caseous and infiltrative-caseous pneumonia is described. CT is suggested to be an optimal roentgenological method of identifying caseous-pneumonic forms of tuberculosis.