Search

The paper sets forth the stages of design and introduction of the new Russian tuberculosis (TB) drug perchlozon registered in the Russian Federation in 2012. Based on the results of Phases I-III clinical trials, the authors evaluate the efficacy and safety of the agent and consider the adverse effects of its treatment for respiratory TB. The use of perchlozon as a component of combination therapy versus standard chemotherapy regimens significantly reduces abacillation time in pulmonary TB caused by its drug-resistant pathogen. In terms of the higher prevalence of TB induced by its pathogen resistant to many drugs (with multiple and broad-spectrum drug resistance), perchlozon is an essential drug that has antituberculous activity mainly against multidrug-resistant Mycobacterium tuberculosis strains and gives patients with the severest and epidemiologically poor form of TB the chance to recover.

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 2–3 weeks in 20% of cases and above 1–3 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.

The paper presents a rare clinical case--congenital tuberculosis in a premature newborn.

The paper describes clinical cases of concomitant lung and intrathoracic lymph node involvements as evidenced by conventional radiography and computed tomography (CT). It shows difficulties in the differential diagnosis of different nosological entities in pulmonary tuberculosis. The x-ray semiotics of concomitant lung injuries is also depicted.

The paper gives differential diagnostic signs in different pulmonary focal changes detected on computed tomography, characteristics of the major types of pulmonary foci, and a diagnostic algorithm in the detection of focal dissemination or mixed changes in lung tissue.

The paper provides the morphological characteristics of a specific process in patients with drug-resistant pulmonary tuberculosis. Morphological study of intraoperative samples has shown a predominance of common active inflammatory changes in most cases. There is evidence for an association of the morphological activity of a tuberculous process with the clinical types and duration of the disease and their spectrum of drug resistance. The high morphological activity of specific inflammation (IV-V) substantially increases the risk of specific postoperative complications and relapses in the late follow-up periods.

The authors analyzed the immediate results of surgical treatment in 110 patients with destructive pulmonary tuberculosis with extreme drug resistance in Mycobacterium tuberculosis. Out of the 110 patients, 118 were discharged from hospital and 2 continued treatment at the study. A complete clinical effect (abacillation and no decay cavities) was achieved in 96 (88.9%) patients; improvement (abacillation with the decay cavity being preserved in the contralateral lung) was seen in 5 (4.6%) patients. In the discharged patients, decay cavities and bacterial excretion were preserved in 7 (6.5%) cases after palliative unilateral surgery for bilateral destructive pulmonaty tuberculosis. However, they showed a certain resolution as bleeding arrest or reduced intoxication. All postoperative complications developing in 18 (16.4%) patients were eliminated. There were no fatal outcomes. The paper discusses surgical techniques used in drug-resistant tuberculosis. Key words: surgical treatment, destructive pulmonary tuberculosis.

The paper gives the results of an original study of the morphological pattern of serum elementary association along with ELISA determination of collagen type III autoantibody levels in the sera of 84 children with active pulmonary tuberculosis and 25 children from risk groups as shown by the data of tuberculin diagnosis. There is evidence that a package of these methods is highly effective in evaluating lung tissue reparative processes in children with pulmonary tuberculosis. The proposed original analysis matrix that permits the outcome of the specific process to be predicted from the concentration of collagen type III autoantibodies and the type of leaf-shaped structures is promising for use at specialized facilities.

The paper describes the risk factors that influence the clinical course of respiratory tuberculosis in children from a family infection focus. The most important risk factors in children are a contact with their bacteria-excreting tuberculosis parents, a low family social level, comorbidity in a child, inadequate preventive measures in an infection focus. When the local form of tuberculosis is suspected in these children, it is expedient to make a comprehensive examination that comprises multi-slice computed tomography (CT) and CT angiography.

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 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 describes the results of comparatively analyzing the parameters of apoptosis, micro- and macroelement spectrum of peripheral blood lymphocytes in healthy donors and in patients with chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis. In drug-responsive and drug-resistant pulmonary tuberculosis, unidirectional pretreatment changes were generally recorded in the activity of apoptosis and the spectrum of chemical elements of peripheral blood lymphocytes, which were most pronounced after completion of a phase of intensive antituberculosis chemotherapy. After termination of a complete course of the therapy, apoptotic activity lowered with the cationic composition of cells being normalized. The parameters differentiating pulmonary tuberculosis from COPD were ascertained, these included increases in the count of apoptotic cells and the cell concentrations of Ca2+, Zn2+, and Mg2+.

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 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 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.

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 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 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 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.

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 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 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 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 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.

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 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.

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.

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.

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 reviews the development of biochemical studies in phthisiosurgery, by comparing the needs of resuscitation and anesthetic provision of major thoracic operations and the management of the postoperative period. Emphasis is laid on the leading role of biochemical monitoring in the prevention and treatment of postoperative events, such as acute renal failure, metabolic alkalosis, thrombohemorrhagic syndrome, pulmonary thromboembolism, and others. The prospects of further researches dealing with the problems of postoperative pathophysiology are considered in patients with 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 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 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.

The paper briefly describes data on the first operations on the lung made in children at the Central Research Institute of Tuberculosis for pulmonary tuberculosis under anesthesia. According to L. K. Bogush's recommendations, the author has first made clinicomorphological and bacteriological comparisons of different pathological tissue from 105 children and adolescents operated on for pulmonary tuberculosis, 81 biopsy specimens being abacillary. Mycobacterium tuberculosis was found in 54.3% of the operative biopsy specimens from the patients long (mean 1.5 to 2 years) treated by antibiotics. L. K. Bogush defined indications for surgical treatment for different clinical forms of pulmonary tuberculosis in children and adolescents. Six hundred and twenty-seven operations were performed in 589 children and adolescents. All types and volumes of lung resections, pneumonectomy, pleuropneumonectomy, pleurectomy, lymphonudulectomy(tomy), and main bronchi occlusion were made. Operations were performed mainly via lateral access, without crossing the ribs.

The paper first describes the experience in performing operations in 34 children and adolescents with different forms of tuberculosis of the lung and intrathoracic lymph nodes via mini-invasive access (a 4-6-cm skin cut), by applying video-assisted thoracoscopy. Practice has provided evidence that lung resections of any scope can be made in children and adolescents with pulmonary tuberculosis and nonspecific lung diseases during video-assisted thoracoscopic operations. The latter have a lot of advantages over the traditional thoracic operations; these included decreases in the duration of operations, in intraoperative and early postoperative blood and plasma losses and the duration of inpatient treatment of pulmonary tuberculosis in children and adolescents, and earlier activation.

The paper presents a model of laboratory service in implementing a complex program aimed at detecting and treating patients with tuberculosis in the Tomsk Region. Organizational, methodological, and managerial measures to set up bacteriological stations and a main (reference) laboratory for microbiological sputum study in Tomsk, intensification of this work at all clinical-and-diagnostic laboratories of general health care facilities have improved the quality of the whole system detecting bacterial isolators and ensured a close organizational and methodological interaction between the therapeutic-and-diagnostic institutions of the general medical system and tuberculosis-controlling service.

Hemorrhage is one of the most pressing problems in lung diseases. The paper analyzes the results of medical and surgical treatments for pulmonary hemorrhages. A total of 724 patients with hemoptysis and bleedings of various etiology were treated at the Thoracic Unit in 1985-2003. Pulmonary hemorrhages occurred in 442 (61%) patients with pulmonary tuberculosis and in 282 (39%) patients with nonspecific lung diseases. X-ray study revealed right-sided lung lesions in 268 (37%) patients; left-sided lung lesions in 203 (28%), bilateral lesions in 170 (23.5%). The visible X-ray changes were not found in 83 (11.5%) patients. Destructive pulmonary parenchymal changes were detected in 366 (50.5%) patients. Bronchological study was conducted in 703 patients with pulmonary hemorrhage: 377 (53.7%) and 214 (30.4%) patients were found to have its direct and indirect signs, respectively. Neither changes nor hemorrhagic traces were detected in 112 (15.9%) patients since they underwent bronchoscopy in a later period when bleeding had already stopped. Foam rubber sponge tamponade of the main and lobar bronchi was made in 75 (10.4%) patients with profuse bleeding; a positive effect was achieved in 61 (81.3%) patients. The treatment policy for pulmonary hemorrhage is determined by its severity and etiology and the health status of the patient. A major role was assigned to medical hemostatic therapy in the treatment of pulmonary hemorrhages. If it was ineffective, surgical treatment was used. The use of hypotension controlled by ganglionic blockers (more commonly pentamine): bleedings were suppressed in 359 (74%) of 485 patients with second- and third-degree hemorrhages yielded good results. They were medically stopped in 558 (77%) patients; death occurred in 14 (2.4%) cases. A hundred and fifty two (20.9%) were operated on; of them 8 patients underwent segmentectomy; 85 had lobectomy. Pulmonectomy, cavernostomy, and thoracoplasty were performed in 48, 4, and 7 patients, respectively. Twenty-six patients were operated on at the peak of hemorrhage. Bleedings were suppressed in 140 (92%) patients (they recovered; 12 (7.9%) patients died. In the postoperative period different complications were noted in 30 (19.7%) patients. The final results of medical and surgical treatment were as follows: bleedings were stopped in 698 (96.4%) patients (they recovered) and 26 (3.6%) died.

The paper describes the results of a clinical trial of itraconasole as suspension in the treatment of Candida-induced lower respiratory tract lesions in patients with pulmonary tuberculosis. The first course of the therapy stopped the growth of fungal culture in 34 (68%) patients; after its repeated course, there were 42 (84%) recovered patients out of 50. After the first course of orangul therapy, there was a decrease in the titer of fungal growth in 15 (30%) patients. The repeated course of the therapy resulted in fungal eradication in 8 of the 15 patients, a further decrease in the baseline titer of the fungi was observed in 4 patients. The treatment was ineffective only in 1 (2%) patient, which was associated with the progression of disseminated pulmonary tuberculosisand with the presence of the dose-dependent fungal strain C. glabrata.

The paper presents the data of a follow-up of 51 patients in whom a bronchial stump suture was additionally fixed at surgery by applying Tochocomb plates (in 30 patients) or an autoangiograft from the removed lung (in 21 patients) in order to prevent a bronchial fistula. The preliminary findings were positively appraised. The authors recommend that this procedure be used in phthisiosurgery and surgical pulmonology.

The fact that genetic factors largely determine susceptibility to different diseases, including those of infectious nature is beyond question now. Tuberculosis is not an exception in this respect. HLA genes that determine different immunological phenomena make a certain contribution to tuberculosis susceptibility. This paper presents the results of typing using the polymerase chain reaction from the specificities of the HLA gene DRB1 in patients with pulmonary tuberculosis and healthy individuals in different regions of the Republic of Tuva. The studies in these regions of Tuva have revealed a significant positive association of tuberculosis with the specificities of HLA DRb1 13(6) and HLA DRB1 14(6). Analyzing 14 families of patients with tuberculosis has shown that HLA haplotypes from the sick parents who carry the specificities of HLA DRB1 13 and/or DRb1 14 are more frequently transmitted to sick children than to healthy ones. High morbidity in the indigenous dwellers of the Republic of Tuva may be associated with these specificities of the HLA gene DRB1, which is due to the national peculiarities of the native population of this republic.

The authors retrospectively analyzed the quality of RCT differentiation of destructive lung lesions at outpatient diagnostic units of multidisciplinary polyclinics. At the first stage, the recognition accuracy rate was not more than 73%, which is attributable to the high macroscopic similarity of bacterial destructive inflammations and specific tuberculous processes. Both conditions were frequently complicated by the addition of fungal invasion that made their differentiation all the more difficult. It has found that during the tense epidemiological situation associated with tuberculosis, there is its explainable, but not always justified hyperdiagnosis. The ratio of false-negative to false-positive tuberculosis results was 1:2. The paper is illustrated by different types of destructive inflammations that mimic tuberculosis and by the trend of some of the types is shown. Emphasis is laid on the neglects and errors that cause diagnostic differences. A half of them is attributable to the objective complexities of its diagnosis; the other (subjective) half is a potential reserve for upgrading the quality of differential diagnosis in phthisiopulmonology.

The activities of two federal and regional tuberculosis sanatoriums for children and adolescents were analyzed. The clinical characteristics and the results of the examination and treatment were studied in 510 patients aged 12-17 years who had various manifestations of tuberculous infection. The beds in the sanatoriums were ascertained to occupy irrationally: the proportion of patients with local forms of tuberculosis there is not more than 30%. Guidelines for selection of children and adolescents with tuberculosis from risk groups and for detection of the disease were developed. A proposal was made to set up consultative and diagnostic centers at the sanatorium basis. The paper shows it possible and expedient to treat children and adolescents with new-onset local, non-destructive forms of tuberculosis under the conditions of a sanatorium.