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The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

The paper shows how a tuberculosis monitoring system is under development at the level of the Russian Federation subject--the Belgorod Region. The tuberculosis monitoring system allows an effective control of both tuberculosis-controlling measures determined by the existing normative documents and orders and supplementary measures to enhance the effectiveness of tuberculosis control in the region. Tuberculosis monitoring should be further improved at the regional region by the sections: outpatient visit, antiepidemic measures in the foci; children's sanatorium work, cohorts to be examined by a physio pediatrician.

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

Reasons for laboratory misdiagnosis that is observed in general health care network (GHCN) and penitentiaries were studied. The clinical efficiency of the diagnosis of tuberculosis in the GHCN by the Ziehl-Neelsen method is largely determined by three major factors, each of which is fundamentally important in assessing the result. The first factor is the adequacy of making up a cohort of patients having the symptoms of productive cough in the course of 2-3 weeks or more who are to be examined for tuberculosis by laboratory studies. The second is the quality of a diagnostic material. The third is the quality of laboratory specialists' work. The paper shows it necessary to implement programs for the internal control and external assessment of the quality of laboratory studies and to optimize (centralize) the activities of laboratories under the conditions of a regional network.

The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.

The paper presents data on vaccine prophylaxis in Russia. A sophisticated analysis of the data available in the literature on approaches to vaccination against tuberculosis in different countries of the world is provided. The results of the studies made by Russian investigators to develop different regimes of BCG re-administrations an their frequencies are given. The fact that it is necessary to change a tuberculosis prophylaxis calendar under the present conditions, by keeping in mind the age of a child and the epidemic situation in the country's region, has been established. A particular section is dedicated to the problem associated with the occurrence of complications in response to tuberculosis vaccine. Based on the Federal Center data on complications due to BCG/ BCG-M, the authors provide information on the incidence and pattern of complications occurring in Russia. As compared with 1995, the incidence of postvaccination complications slightly changed (21.1 in 100,000 in 1995 versus 20.3 in 2002-2003). In the children inoculated at a maternity hospital, postvaccination lymphadenitis was observed 2 times more frequently than in those vaccinated at a polyclini (77.1 and 37% of cases, respectively) and cold abscesses were 3.3 times less frequently than those inoculated at the polyclinic (19.1 and 63% of cases, respectively). The study has ascertained main reasons for the higher incidence of severe complications as BCG ostitis.

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.

The paper gives the results of immunological and clinical studies made in 162 elderly and senile patients with tuberculous exudative pleurisy and a control group of 162 tuberculous pleurisy aged 20-40 years. The elderly and senile patients were found to have more significant immunological responsiveness impairments, suppressed T-cell immunity, and inhibited pleural granulomatous reactions than in the young patients. These alterations substantially worsen the course and outcome of the disease and require im munological correction.

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 paper presents the results of a population-based, geneticoepidemiological, and immunological study conducted in two regions of Tatarstan. The population-based risks for tuberculosis were established for males and females. Based on the population and family data, the authors calculated the genetic liability to tuberculosis, namely hereditability that is in the range of 0.8 to 1.0 and includes the contribution of nongenetic and environmental factors. Analysis of the results of immunogenetic studies of the northwestern region of Tatarstan has ascertained that patients have an association with the HLA antigen B22, in the Kama Region there is an association with other HLA antigens: B12 and B16. The higher frequency of the HLA antigens B28 and CW1 in healthy individuals as compared with that in patients with pulmonary tuberculosis (PT) suggests the resistance of PT carriers of these antigens for the disease. A study of the distribution of HLA genes by polymerase chain reaction has established the association of the disease with the DR-B1-15 genes in the Kama Region.

The paper presents the clinical, X-ray, and laboratory characteristics of patients with pulmonary tuberculosis. Both general regularities and differences in the frequency of alleles of the HLA-DQB1* locus have been revealed in the groups of patients with pulmonary tuberculosis as compared with healthy individuals. There are specificities associated with the risk of pulmonary tuberculosis and the variants of the course of infection; thus, allele 05 of the HLA-DQB1* locus is positively associated with the incidence of tuberculosis. Specificity 03 of the HLA-DQB1* locus has been ascertained to be associated with the poor course of the disease. The most pronounced immunological changes have been observed in patients with the poor course of the disease, who are the carriers of specificity 05 of the HLA-DQB1* locus. The totality of immunological parameters and the data of genetic studies provide a basis for using the selective immunomodulator rIL-2 (roncoleukin) in the most seriously ill patients who are carriers of specificity 05.

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.

This paper provides the clinical and morphological characteristics of tuberculosis of peripheral lymph nodes. The disease has been found to occur as a manifestation of the secondary period of tuberculous infection at the age of 21-50 years and to be isolated and asymptomatic with reduced tuberculin sensitivity and immunity in the patients. The caseous and productive forms were detected in 76.04 and 22.92%, respectively; the indurative form was found in the remaining 1.04%. Mycobacterium tuberculosis was cultured in 26% cases of inoculation of puncture specimens and removed lymph nodes. The findings suggest the induced pathomorphism of peripheral node tuberculosis at the present stage that requires the development of new approaches to and methods for treating the patients.

The paper presents the diagnostic features of 95 cases with complicated forms of abdominal tuberculosis (AT). The latter has been found to be concurrent with disseminated progressive pulmonary tuberculosis in 97.3% of cases. HIV infection is present in 25.2% of the patients. In 42.1%, a complication of AT is its first onset. The late diagnosis of AT in the phase of development of complications is due to its asymptomatic course at the early stage, the similarity of clinical manifestations with various nonspecific abdominal diseases, the low informative value of radiodiagnostic techniques, and scanty bacterial excretion. In this connection, AT is detectable in 92.6% with the development of acute surgical abdominal pathology requiring emergency diagnostic laparoscopy and surgery. Among all acute surgical abdominal diseases, complicated abdominal tuberculosis ranks third, which in the presence of any abdominal symptoms, particularly those concurrent with pulmonary tuberculosis needs examination for abdominal tuberculosis. Various surgical interventions (more commonly right-sided hemicolectomy, enterectomy, and abdominal abscess lancing) were made in 92 patients with complicated abdominal tuberculosis. There were intraoperative complications, such as perforated tuberculous intestinal ulcers (54.7%), ileus (30.5), abdominal and retroperitoneal abscesses (11.6%), as well as other rare complications, such as intestinal hemorrhage, perforated tuberculous gastric ulcer, and splenic abscess (3.2%). In 42.1% of cases, surgery was ineffective and it was followed by the development of recurrent complications that required surgery. In HIV-infected patients, AT ran more severely. Overall mortality in patients with AT was 47.4%, that in patients with and without HIV infection was 58.3 and 43.7%, respectively.

The paper compares the characteristics of the informative value of tests determining the activity of adenosine deaminase (ADA) activity and the level of gamma-interferon (gamma-IFN) for the differential diagnosis of tuberculous pleurisy (n = 35) and non-tuberculous pleural effusion (n = 53). Both tests were ascertained to have the similar differentially diagnostic capacities with their threshold values of 35 U/l and 180 pg/ ml, respectively. At the same time, the sensitivity and specificity of the ADA test were 98.4% and these of the gamma-IFN test were 94.3 and 96.2%, respectively, with the positive and negative predictive value being 91.3 and 98.3% and 94.3 and 96.2%, respectively, and with the diagnostic value of 94.5% for the ADA test and 96.4% for the gamma-IFN test. There was a high unidirectionality of changes in both values: it was higher than the cut-off points in 94.1% of the patients with tuberculous pleurisy and below them in 88.7% of those with other pleural effusions.

The paper presents the results of treatment in 30 patients aged 16-59 years who have bronchial asthma and chronic obstructive pulmonary disease, by using a bacterial vaccine (bronchomunal) containing antigens of opportunistic bacteria: Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus viridans, Streptococcus piogenes, Moraxella catarrhalis. Immunotherapy with the vaccine had good and excellent effects in 73.33 of cases; the mean duration of acute respiratory viral infection decreased from 16 to 9 days after vaccination and a need for antibiotics. In the comparison group, a good effect was noted in 40% of the patients during one-year follow-up; the difference was statistically significant. The vaccine's tolerance was good; only 3 (9.9%) patients were observed to have vaccination-induced complications: exacerbations of chronic maxillary sinusitis and chronic bronchitis in 2 and 1 patients, respectively. The positive effect of bronchomunal was associated with the better values of cellular immunity, stabilized phagocytosis, and lower IgE levels.

The paper analyzes the results of the 1995-to-2006 follow-ups of 36 children with extrapulmonary tuberculosis. Tuberculosis of the kidney, peripheral lymph nodes, and skeletal system was diagnosed in 16, 11, and 6 patients, respectively. Generalized tuberculosis was present in 1 child and cutaneous tuberculosis in 2. A contact with a tuberculosis patient, significant or progressive tuberculin sensitivity, and a lower BCG vaccination efficiency were the most important risk factors of the disease. The history of nonspecific renal and urinary tract diseases was a significant risk factor of nephrotuberculosis. The priority lines in the detection of extrapulmonary tuberculosis in children include planned systematic tuberculin diagnosis, a followup of persons who are in contact with patients with active tuberculosis, as well as dynamic bacteriological and histological studies of autoptic and biological materials.

The paper gives the results of studies to determine blood bacteriostatic activity (BBA) in the use of a patient's autostrain and semiliquid medium versus the clinical and laboratory parameters of the course of a process in 101 patients with pulmonary tuberculosis. There is evidence for the relationship of the BBA to the sensitivity to isoniazid and the structure of drug resistance. The zero values of BBA correspond to the severest course of the disease. The efficiency of treatment is much higher in patients with high and moderate BBA. The latter's determination using the semiliquid medium permits an objective evaluation of the efficiency of chemotherapy, identification of patients with a poor prognosis, and then choice of an individual treatment regimen on day 7 after the test just before obtaining the data on drug sensitivity.

The presented paper discusses the experience with exogenous nitric oxide (NO) and argon plasma coagulation (APC) used at cavernotomy in 31 patients with multidrug-resistant fibrocavernous pulmonary tuberculosis. Supplementary treatments depending in infectious risk factors were comprehensively evaluated. The application of APC and NO significantly improved the results of open cavern sanitation, as evidenced by the bacterial excretion index, and doubled the immediate efficiency of surgical treatment.

The high efficiency of etiopathogenetic treatment was established in patients with the proliferative form of isolated tuberculosis of peripheral lymph nodes, by using a combination of antituberculosis chemotherapy and low-energy laser radiation without surgical intervention. At the same time after 2.5-3-months, there was a persistent improvement, suggested by the elimination of clinical and laboratory signs of tuberculosis intoxication, disappearance of enlarged lymph nodes and a tendency of the body's tuberculosis sensitivity to reduce, evidenced by Mantoux 2 TE PPD-L test. The paper shows it efficient to pursue medical treatment policy in early isolated tuberculosis of peripheral lymph nodes.

The paper describes the influence of socially significant factors, such as a family, children, interpersonal attitudes, and relatives' support, on the course of a tuberculous process in the mentally ill patients long receiving hospital treatment. Positive changes in a tuberculous process are favored by frequent visits of patients, a personal contact of relatives with them, a warm kind attitude of patients towards their relatives and people. The paper shows it necessary to implement educational programs among relatives and rehabilitative and psychocorrective measures with patients, the objective of which is to make and maintain the close and interacting contact - physician-relative-patient, which causes positive changes in the course of pulmonary tuberculosis in mentally ill patients.

Special geoinformation technologies (GIS), a new method for the pictorial data presentation as space-time ratios, have emerged in the past decade. The paper considers the theory of geoinformation analysis and the possibilities of applying GIS for tuberculosis monitoring. GIS may be effectively used in phthisiology only provided that the routine procedures for tuberculosis detection are practiced widely. GIS analysis may assist in detecting tuberculosis when contacts cannot be monitored in the usual fashion. Its results may be used to correct tuberculosis-controlling measures towards their point application. Extended studies can answer to what extent, the efficiency of tuberculosis-controlling measure will increase when they are used in the most possible tuberculosis transmission areas determined by the GIS techniques.

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.

The paper analyzes the impact of various millimeter-range electromagnetic radiation schedules on immunological parameters in 152 patients with new-onset respiratory sarcoidosis. It shows that the immunomodulatory effect of millimeter-range therapy depends on the treatment regimen chosen. There is evidence for the advantages of millimeter-range noise electromagnetic radiation.

The paper deals with the important problem of pulmonary surgery--the capacities of surgical treatment in concomitance of pulmonary tuberculosis and lung cancer. In 1990 to 2002, the Santarishkes Republican Tuberculosis and Lung Diseases Hospital and the Department of Thoracic Surgery and Oncology, Vilnius University Cancer Institute operated on 2218 patients with lung cancer, of them 46 (2.1%) were diagnosed as having concomitance of lung cancer and tuberculosis. The diagnosis of central and peripheral lung cancer was established in 37 (80.4%) and 9 (19.6%) patients, respectively. Histology revealed squamous-cell tumors in 24 (52.2%) patients, adenocarcinoma in 10 (21.7%), and adenosquamous-cell carcinomas in 12 (26.1%) patients. Stages I, II, and III were established in 12 (26.1%), 11 (23.9%), and 23 (50%) patients, respectively. Pulmonectomy was performed in 18 (39.2%) patients; 10 (21.7%), 10 (21.7%), and 8 (17.4%) patients underwent lobectomy, bilobectomy, and segmentectomy, respectively. Postoperative complications were observed in 28 (60.8%) patients. There were 6 (13%) cases of death. Twenty-three (50%) patients received complex treatment. Surgery is the method of choice in the treatment of concomitance of pulmonary tuberculosis and lung cancer. In such patients, survival averaged 28 +/- 2 months.

Medical and psychological studies have established that the personality of a psychosomatic patient has characteristic specific features that determine his emotional reactions and lead to psychological and physiological destructions. Searching for the specificity of psychogenesis of pulmonary tuberculosis may be guided by the V. N. Myasishchev provisions of psychology of relations and should be aimed at analyzing the patients' significant experiences that cause their prolonged affective tension. This paper defines the tasks of studying the psychological and neuropsychological features of patients with pulmonary tuberculosis and specifies an adequate set of psychodiagnostic procedures to solve the put problems. The findings may provide insight into the specific character of psychogenesis of pulmonary tuberculosis and into a relationship of the psychological traits of patients with this nosological entity to the physiological processes at the somatic and cerebral level.

The present paper analyzes trends in tuberculosis mortality rates in relation to suicide rates in Belarus from 19970 to 2005, by applying the time-series test. The analysis suggests the close association between the two time series in the period of 1984 to 1996. The findings support the idea that the rate of tuberculosis mortality can be considered as an indicator of psychosocial distress.

The paper describes the follow-up and treatment of patients with tuberculosis concurrent with HIV infection in Moscow in 2004-2005. Major epidemiological parameters, such as morbidity, mortality, and prevalence of this comorbidity, are given. Analysis of these indices suggests that the epidemic situation associated with tuberculosis concurrent with HIV infection became worse in the past 2 years. As compared with 2004, in 2005 the number of such patients increased from 294 to 445, including that of first detected patients rose from 123 to 174. In this group of patients, there was a preponderance of young males aged 29 to 39 years. Most patients with this pathology suffered from drug addiction and alcoholism and other concomitant diseases. The bulk of them were unemployed and disabled. In the HIV-infected, the clinical forms of tuberculosis were severe with a predominance of acute and disseminated processes; the rate of drug resistance, including multidrug resistance, was high, which made treatment difficult and resulted in high mortality.

The paper provides the data of analysis of antituberculous care to teenagers in Moscow and characterizes its problems. Emphasis is placed on the tense and unstable situation associated with the detection of the disease in this age group. In the bulk of adolescents, the disease is identifies when they come to see a doctor, including at somatic hospitals. Active tuberculosis detection techniques (tuberculin diagnosis and fluorography) fail to produce adequate effect mainly due to organizational problems (the bulk of teenagers are outside the organized collective bodies or the latter are frequently changed; the detection of tuberculosis in Moscow nonresidents or in whose who enter secondary specialized colleges claims attention). Age-related sociomedical risk factors, such as hormonal rearrangement, comorbidity, a negative attitude towards preventive medical measures, deviant behavior, social family, and dysadaption, are of importance for the development of tuberculosis. A sociomedical portrait of an adolescent with tuberculosis is given. Attention is drawn to the fact that on implementing antituberculous measures, it is a need for an interaction of a tuberculosis-controlling service with general care health network facilities, including those that deal with the problems of social diseases and educational establishments.

The paper presents the results of a 5-year follow-up of simulative manifestations of tuberculosis at penitentiaries. The high rate of use of penitentiaries as an object of these manifestations has been established, predominantly relapse aggravation of process activity being observed when treatment is continued. The causes of simulative manifestations are diverse; along with a qualitative physical examination, they should be borne in mind by a phthisiatrician in order to make a timely diagnosis.

The paper presents the results of studying the time course of changes in tuberculosis antibodies by enzyme immunoassay (EIA) and immune blotting (IB) in 34 patients with pulmonary tuberculosis. In 76.5% of cases, EIA were established to reveal tuberculosis antibodies whose concentration is most pronounced in lung tissue destruction. The detection rate of specific antibodies to Mycobacterium tuberculosis (MBT) structural components by IB was 100%, which was 23.6% greater than that by EIA. The MBT structural components with a molecular weight of 11-20, 21-30, and 101-160 kDa were found to have high immunogenic properties, as suggested by the maximum levels of antibodies and by the marked antigenic proteins of proteins with a molecular weight of 11-20, 21-30, and 41-50 kDa, which showed itself as the generation of the maximum levels of circulating immune complexes with antigens of this specificity.

The paper presents the results of using sylvinite speleotherapy, general salt baths and their combination in 120 patients with Stages I-II chronic obstructive pulmonary disease at a damped exacerbation and remission. It is shown that in the patients with this disease treated by the above procedures, the inflammatory process regresses, bronchial patency, central hemodynamics, exercise performance, and psychoemotional background improves and, during a long-term followup, the progression of the disease becomes slower, remissions prolong, exercise performance increases, and social adaptation improves.

The protective properties of artificial mycobacterial particles versus BCG vaccine were studied in laboratory animals with experimental tuberculosis. The findings of the decreased rate of a tuberculous process and on the increased mean life span in animals inoculated with M. bovis suggest that immunization of guinea-pigs with mycobacterial particles promotes the enhanced development of antituberculous immunity in the animals. The paper proposes a promising method for designing artificial immunogens, the high-polymer antigenic structures that imitates mycobacterial particles.

A hundred and thirteen case histories of patients with isolated and generalized forms of abdominal tuberculosis were analyzed. The patients' age was 15 to 79 years; there were 86 (76.1%) males and 27 (23.9%) females. The patients were admitted more frequently from other tuberculosis facilities (66.7%) and less frequently from general hospitals (33.3%). In 62 (54.9%) cases, abdominal tuberculosis showed a complicated course. The residents of Moscow and its region, predominantly the unemployed (85.8%), prevailed in the structure of detected patients with abdominal tuberculosis. In the period of 2001 to 2004, there was a rise in the incidence of new-onset abdominal tuberculosis, its rate increased from 4.4 (2001) to 8.3% (2004) of the total number of patients admitted to Moscow clinical hospital No. 7 for extrapulmonary tuberculosis admitted. This gives no way of considering this site of tuberculosis to be rare. In the structure of abdominal tuberculosis, its generalized forms were prevalent (86.7%), which was associated with the late detection of abdominal tuberculosis and the significant increase in the number of HIV-infected patients from 14.3 (2000) to 33.3% (2004). Abdominal organ lesions were more frequently observed in severe generalized pulmonary processes, such as disseminated (45.1%), infiltrative (18.6%) or fibrocavernous (15.9%) tuberculosis. An algorithm of diagnosis of abdominal tuberculosis and the rates of its detection by various studies are presented in the paper. Abdominal tuberculosis was diagnosed in 8.9% of cases by noninvasive comprehensive examination methods, in 18.6% by laparoscopy, and in most cases (57.5%) intraoperatively. In socially dysadapted persons, postmortem abdominal tuberculosis was detected in 15% of cases.

The paper presents data on bed reductions at tuberculosis care facilities in the Sverdlovsk Region. These data are compared with those in the neighboring regions. The main topic of the paper is the advantages of a day hospital over those of a day-and-night one. Indications for admission to a day hospital are presented. The 2004 statistical data on the work of a day hospital are given. The paper shows that hospital-replacing technologies are promising in the treatment and rehabilitation of patients with tuberculosis in the Sverdlovsk Region.

The species composition of pathogenic fungi isolated from various clinical materials was studied in the diagnosis of respiratory mycotic infections in patients with tuberculosis. The paper presents data on the composition of detected opportunistic microscopic fungi from a group of likely pathogens of bronchopulmonary mycoses, as well as fungi that have pronounced toxicogenic and allergenic properties.

The paper analyzes the detection rate of drug-resistant (DR) Mycobacterium tuberculosis (MBT) in Yakutia. The proportion of DR MBT strains taken from bacterial isolating patients with pulmonary tuberculosis was found to be 70% and to have no tendency for decrease. The structure of DR MBT deteriorated due to the increase in multidrug-resistance (MDR). MDR in MBT was recorded in 45-50% of cases. Examination of lung resection specimens from patients with abacillary tuberculosis identified a population of typical MBT. The authors regarded this phenomenon as latent MBT carriage. The specific feature of this population is that it preserves a high metabolic activity in latency; DR was established in 76.3% of patients. Its most malignant form - MDR was established in a third (31.6%) of the patients. Under certain conditions, this mycobacterial infection may be of epidemic value in the spread of MBT in general and MDR strains in particular. Solution of the problems associated with the surgical treatment of patients with MDR tuberculosis may be beneficial in diminishing the most dangerous reservoir of tuberculous infection. Surgical intervention in MDR tuberculosis is one of the basic treatments.

The paper analyzes cases of familial sarcoidosis that have occurred in the Ryazan regional tuberculosis dispensary in the past 10 years. Certain patterns in the course of the disease have been revealed in blood relatives.

The paper summarizes the results of surgical treatment in 25 patients with atlantoaxial spondylitis, including 15 with spondylitis of tuberculous etiology and 10 with nonspecific etiology. Ten patients were found to have severe neurological disorder requiring application of skeletal traction behind the malar arches in 5 cases and that of a halo-apparatus to 2 cases in order to eliminate the occurred dislocation and to relieve neurological symptoms. According to the P. Denis concept adapted for the craniovertebral region, all the patients were divided into 3 groups in relation to the degree of anatomic and biomechanical changes. Group 1 patients received medical treatment with firm collar fixation. Group 2 patients with anterior pillar injury underwent transpharyngeal sanitation of an infectious focus and occipitospondylodesis. Decompressive stabilizing operations were performed in all the patients, which consisted of two stages: 1) occipitospondylodesis made, by using a titanium wire and No. 91/198 Simplex bone cement (Howmedica, United Kingdom); 2) transoral access with abscess cavity sanitation; removal of necrotic tissues; thrifty resections of bone tissue portions within the intact tissues; anterior stabilization of the affected portion with an autologous bone graft. Postoperatively, the cervical spine was fixed with a head holder for as long as 3-5 months (until there were clear X-ray signs of bony ankylosis (block) in the area of osteoplasty). Quaternary antituberculous therapy was compulsorily made for 6-9 months. The described procedure for surgical treatment of craniovertebral spondylitis could yield positive results in all cases, by abolishing neurological symptoms and forming bony ankylosis in the atlantoaxial area to restore the supporting capacity of the cervical spine.

The paper presents the main points of the authors' own concept of the centralization of mycobacteriological service in large towns of the Russian Federation. The main points of step-by-step organizational and methodological measures required to solve this problem are described in detail. Consecutive measures to realize the proposed mycobacteriological service centralization model originated in January 2004 on a model of the Moscow Eastern Administrative District with 1380 thousand inhabitants are described.

The paper analyzes the results of a study of X-ray features of disseminated pulmonary tuberculosis in HIV infection on the basis of a retrospective analysis of the case histories of 65 HIV-infected patients with disseminated pulmonary tuberculosis and 60 patients with disseminated tuberculosis without HIV infection, who have been followed up in the Krasnodar Territory. X-ray changes characteristic for patients with disseminated tuberculosis in HIV infection and their difference from those with disseminated tuberculosis without HIV infection have been ascertained, which assists in timely establishing the diagnosis of tuberculosis in HIV infection.

Endoscopic techniques in the treatment of patients with cicatricial stenoses of the trachea have become customary in clinical practice. They may be used alone and in combination with open surgery. The present paper discusses various endoscopic therapy modalities. The long-term results of stenting of the trachea for its stenosis are recent and of practical importance, which permits revision of the established opinion on this treatment option.

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.

The paper describes the results of radiometric BACTEC assay of drug susceptibility of Mycobacterium tuberculosis strains, isolated from 81 new cases of tuberculosis, to first- and second-line antituberculosis drugs in four administrative areas of the North-Western Federal District of the Russian Federation. The results of determination of drug susceptibility to the antituberculosis drugs by the absolute concentration method and the BACTEC method are also compared. Primary drug resistance has been revealed in 58.0%; multidrug resistance in 34.6%. Comparison of the results of determination of drug susceptibility by the methods revealed no significant discrepancy between both methods; however, the procedure for drug susceptibility to some drugs requires improvement.

The fact that the treatment of pulmonary tuberculosis is a topical problem is beyond question. At present, it is well known that there is dissociation between the time of a negative sputum reaction and later cavernous healing, resolution of inflammatory changes. Therefore, search for new possibilities of pathogenetic action on the course of a tuberculous process, healing of destructive changes, and the maximum recovery of functional disorders are one of the ways of enhancing the efficiency of treatment in patients with destructive pulmonary tuberculosis. Over 70 years' history of the discovery and studies of the pulmonary surfactant system has made it possible to formulate a current concept of surfactant as a multicomponent system of cellular and non-cellular elements that ensure the antiatelectatic, antiedematous, protective, and other functions of the lung. The effects of surfactant preparations as an agent of pathogenetic therapy are being investigated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. The present paper presents the results of changes in external respiratory function and gas exchange before and after surfactant therapy in 64 patients with established drug-resistant infiltrative pulmonary tuberculosis. Along with the performed antituberculous therapy, the natural agent Surfactant-BL made in Russia was used by taking into account individual sensitivity. The agent was inhalationally administered in a daily dose of 25 mg by the schedule for 8 weeks.

The paper details the procedure of a modified tuberculin challenge test, by keeping in mind the new parameters--the microcirculation of the urinary tract mucosa, which is recorded by Doppler laser flowmetry. The efficiency of the procedure was evaluated in 55 patients, including 25 patients diagnosed as having urinary tract tuberculosis and 30 with nonspecific infections. The urethral microcirculatory parameters studied during the tuberculin challenge confirmed the changes available in all the patients with urinary tract tuberculosis while they were absent in patients with nonspecific pathology. The proposed procedure may objectively record a diagnostic parameter. which improves the quality of diagnosis.

The paper describes the effects of peppermint (Mentha piperita) essential oil inhaled by patients with infiltrative pulmonary tuberculosis in the penitentiary system. This procedure is shown to be most effective in infiltrative pulmonary tuberculosis in the phase of resorption of infiltrates and/or closure of decay cavities. The efficiency is determined by the rapid positive changes in a tuberculous process, which appear as a rapider regression of tuberculous inflammation, causing small residual changes. This procedure may be used to prevent recurrences and exacerbations of pulmonary tuberculosis.

The paper pools some experience with 6 videothoracoscopic and 505 video-assisted thoracoscopic (VATS) resections of the lung and 105 VATS pneumonectomies. The bulk of the operations [451 (73.2%)] was made for pulmonary tuberculosis in patients aged 7 to 77 years. 81% operations by separately treating root elements, including all pneumonectomies and major lung resections, were performed. A new SOMI-80 suturing apparatus designed for mini-invasive surgery was employed to suture lung tissue in most cases. Intraoperative and postoperative complications occurred in 5 and 8 cases, respectively. The efficiency of operations for tuberculosis was 98.6%.

The paper presents the data of examination of 62 patients with acute purulent diseases of the lung and pleura (abscess, empyema, pyopneumothorax). The persistent and virulent characteristics of causative agents isolated just from a suppuration focus during its puncture are described. There was an association of the high level of antilysozyme, anticomplementary, and hemolytic activities of bacterial pathogens with the severe course of a disease. On this basis, a mathematical model that can predict the course of acute purulent diseases of the lung and pleura with an accuracy of as high as 95% has been constructed.