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New untreated infiltrate pulmonary tuberculosis patients commonly demonstrated the same referent level of MMP-8, MMP-3 and multiple increase of MMP-9 level on the background of diverse changes of inhibiting potential (retaining the reference level of TIMP-1 and reduced α2 -МG). Destructive process is related to unbalanced increase of рro-ММР-1 and ММР-9. At the same time the level of рro-ММР-1 correlates to changes in ROF, activity of proteinases of other classes (serine proteinases) and depends on the dissemination of the disease, while the changes in MMP-9 level are influenced by the massiveness of bacillary excretion.

Host-pathogen relations were analyzed on basis of the results of examinations of 42 patients with newly diagnosed, previously untreated infiltrative pulmonary tuberculosis (IPT) with regard for the biological characteristics of Mycobacterium tuberculosis (MBT) and the biomarkers of the inflammatory reaction — the acute phase proteins (APPs). The genotypes of MBT (Beijing and the others) and the efficacy of threeonth antituberculosis therapy were used as the grouping factors. Genotype Beijing MBT patients were significantly often characterised by multiple drug resistant, had widespread pulmonary damage and association of MBT cytoxicity with the effect of therapy. The patients with the best postreatment effect had initial (pretreatment) APPs levels in the range of the referent ones. These conclusions were confirmed by analysis of the correlation pleads of the characteristics of the “host-pathogen” system and their discriminant analysis with regard for MBT genotypes and results of antituberculosis three-month therapy. It was shown that the constellation of four host’s APP characteristics (haptoglobin, ceruloplasmin, elastase and adenoaminase activities) has above 90% prognostic efficacy of treatment in spite of MBT genotype. It is suggested that in IPT patients the first component of the “host-pathogen” system reflecting the reaction of the patient’s organism to the MBT induced inflammatory process is more prognostically important.

Functional activity of circulating phagocytes (macrophages and neutrophils — Ns) was studied in 30 patients with infiltrative and 30 patients with fibro-cavernous pulmonary tuberculosis (IPT and FCPT, respectively), characterized by similar biological properties of mycobacterium tuberculosis (MTB), dissemination of the process, and manifestations of intoxication. Differences of the functional activity of both types of cells depending on the PT form were found: a more significant increase in the oxygen-depending activity in FCPT while bactericide potential estimated with the zymosan induced NST-test was more pronounced in IPT patients. These data correlate with the blood levels of neopterin and elastase, the markers of the mononuclear and neutrophil activity, respectively. Involvement of adenosine deaminase (ADA) and neopterin in realization of intracellular oxygen-dependent processes was demonstrated. Results of the multivariate analysis of the whole set of the studied phagocyte parameters, reflecting their different roles in this pathological process demonstrated a prevailing role of mononuclears in newly diagnosed IPT and neutrophils in the chronic progressive process.

The comprehensive prospective examination of 66 patients with first established non-treated infiltrative tuberculosis of lungs was used to analyze the possibility of optimization of assessment of course of specific inflammatory process on the basis of levels of proteins-reactants of acute phase. The characteristics of dynamics of clinical roentgenologic data and terms of coming of abacillarization as a result of three months anti-tuberculosis therapy has been used as grouping factors. It is established that the constellation of 3 out of 12 basic (before treatment) analyzed level indicators are the most prognostic informative--haptoglobin, ceruloplasmin and blood albumin. Their combined application according the proposed decisive rule provides 90.6% of effectiveness of prognosis of the results of treatment in the discussed category of patients.

The authors have compared the informative value of the tests determining the activity of adenosine deaminase (ADA) and the levels of interferon-gamma (INF-gamma) and neopterin in the diagnosis of pleural effusions of tuberculous (n = 67) and nontuberculous (n = 30) origin. The equally high diagnostic value has been found in the study of the activities of ADA (94.8%) and INF-gamma, which are markers of lymphocytic cellular immunity. There are great differences in the sensitivity of the neopterin test depending whether tuberculosis is isolated or complicates the course of tuberculosis of the lung or intrathoracic lymph nodes, which may be regarded as a reflection of the different status of macrophageal cellular immunity.

Functional activity of the bronchoalveolar lavage fluid (BALF) phagocytes was studied in 33 and 16 patients with fibro-cavernous and infiltrative pulmonary tuberculosis (FCPT and IPT, respectively). Complex examination of BALF, alveolar macrophages and neutrophils sedimented from BALF has shown interrelationship between functional activity of the cells and the form of pulmonary tuberculosis. Higher neopterin content and activity of elastase mainly secreted into BALF by activated alveolar macrophages and neutrophils, respectively, reflect higher secretory activity of both types of cells in FCPT. In FCPT this is combined with higher bactericidal activity of neutrophils, which significantly correlates with their adenosine deaminase (ADA) activity. Comparison of changes of the biochemical parameters studied in BALF (neopterin, elastase, ADA and its isoenzymes, 2-deoxy-ADA) and bactericidal activity of the sedimented cells obviously reflects different sides of BALF phagocytes functioning. Taking into consideration modern concepts on the mechanisms of regulation of phagocyte cells one may suggest the existence of differences in intercellular interactions in various forms of pulmonary tuberculosis.

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.

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.

Functional activity of the bronchoalveolar lavage fluid (BALF) phagocytes was studied in 33 and 16 patients with fibro-cavernosis (FC) and infiltrative (I) pulmonary tuberculosis (PT), respectively. Complex examination of BALF, alveolar macrophages (AM) and neutrophils (N) sedimented from BALF revealed interrelationship between functional activity of the cells and the form of PT. Higher activities in BALF of neopterin and elastase mainly secreted by activated AM and N respectively, reflect a higher secretory activity of both types of cells in FC - PT. These patients are also characterized by more pronounced bactericide activity of Ns, which significantly correlates with adenosine deaminase (ADA) activity. It is suggested that changes in BALF of various biochemical parameters examined (neopterin, elastase, ADA and its isoenzymes, 2-deoxyADA) and bactericide activity of the sedimented cells represent are the consequences of differend sides of BALF phagocytes functioning. According to modem notions about the mechanisms of their regulation different intercellular relations are suggested in different form of PT.

The paper summarizes the results of studies of the activity of adenosine deaminase (ADA) in biological fluids (including that during tuberculin tests) as a tool for the differential diagnosis of different forms of extrapulmonary tuberculosis, such as pleuritis, synovitis, meningitis, tuberculosis of female genitals and peripheral lymph nodes, and uveitis. The threshold for the activity of ADA or the magnitude of its increase in antigenic stimulation, which provides the optimum ratio of the sensitivity to specificity of the tests and their maximum diagnostic efficiency, are given. The optimization of diagnosis of tuberculous synovitis is shown to facilitate the study of ADA activity concomitantly with the determination of the level of antituberculosis antibodies. The tests under discussion are economically sound and yield results in several hours and, in case of a provocative test, in 3 days.

In 20% of cases, tuberculous spondylitis running with a prevalence of the exudative-necrotic type of a local tissue reaction has an acute onset with febrile fever, severe pains, and progressive neurological disorders and clinically resembles acute hematogenous osteomyelitis of the spine. With a predominance of the productive type of a tissue reaction, tuberculous spondylitis resembles subacute hematogenous osteomyelitis of the spine. History data, laboratory parameters, and an X-ray follow-up are of great importance in its differential diagnosis.

The results of examination of 56 patients with destructive pulmonary tuberculosis, which involved the study of biochemical parameters characterizing different stages of an inflammatory process, as well as clinical and X-ray findings were analyzed, by applying various multivariate statistical methods. This approach was shown to be promising for estimating the severity of the process and for specifying the stage of development of an inflammatory process in some patients.

A hundred and three patients with destructive pulmonary tuberculosis were examined. These patients had heterodirectional changes in the serum levels of alpha2-macroglobulin (MG) and its forms. The lowering of the level of the F-form of the inhibitor outstripped the decrease in the activity of total alpha2-MG and it was detectable in the lobar processes with moderate symptoms of intoxication and with the inoculation of adjacent segments. The preservation of the low total activity of the inhibitor and its forms during antituberculous therapy characterize a diminished process. The high content of the S form of alpha2-MG is a feature in patients showing positive changes before and 2 months after treatment whereas the changes in total alpha2-MG and its F form may vary. Whether it is expedient to study the fractional composition of alpha2-MG is determined by the heterodirectionality of changes in its S and F forms depending on the pattern of a process.

Tuberculous spondylitis runs atypically with its acute onset, high fever, and violent pain in 20% of cases. This disease is characterized by a high specific activity of T lymphocytes, by high levels of antituberculous antibodies, by a higher activity of adenosine deaminase, by higher concentrations of IgA and IgE. The gradual onset and few-symptom course of hematogenous osteomyelitis were revealed in 15% of cases. In osteomyelitis, there was a low concentration of antituberculous antibodies, higher levels of low and medium molecular mass, and IgG.

Sixty-three patients with fibrocavernous pulmonary tuberculosis were examined before and 1 month after preoperative therapy with antituberculosis agents. The time course of changes in the clinical and X-ray characteristics of the severity of the disease were compared with the alterations of different biochemical indices, including acute-phase proteins, proteolysis inhibitors, intoxication severity. It was demonstrated that improvement of clinical and X-ray characteristics of the severity of a process after preoperative preparation could be predicted with an accuracy of 83% from the baseline serum concentrations of albumin and ceruloplasmin. The accuracy of prediction does not increase when the levels of protease inhibitors, C-reactive protein, adenosine deaminase, medium-weight molecules are simultaneously studied. The likelihood of the clinical and X-ray characteristics becoming better is higher with enhanced ceruloplasmin activity and decreased albumin levels.

The paper shows that there is an association of the pattern of lung lesion with the endogenous intoxication in adolescents patients with pulmonary tuberculosis. Based on the spectrograms of plasma and the levels of low and medium molecular-weight substances, the authors revealed clinical features in relation to the level of endogenous intoxication and to the values of cellular responses.

Adenosine deaminase (ADA) and 2-deoxyadenosine deaminase (2-deoxyADA) activities were measured in pleural exudation of different origin in 373 patients (124 of these with serous tuberculous pleurisy and 75 with specific empyema). High diagnostic value of ADA activity in the presence of threshold value higher than 35 Units/liter was established: the sensitivity of the test in the diagnosis of tuberculous pleurisy and empyema was 94.4 and 93.3% respectively, specificity 93.0 and 89.5%, respectively. Judging by the coefficient of 2-deoxyADA/ADA, total ADA activity is determined by the activity of ADA-2 isoenzyme, while in tuberculous empyema by ADA-1. Additional use of this coefficient, requiring measurement of 2-deoxyADA activity, does not improve the efficiency of the diagnostic process, including measurement of total ADA activity in pleural exudate.

An examination of 144 patients with different forms of pulmonary tuberculosis has revealed that serum adenosine deaminase (ADA) has a higher activity in the patients than in healthy individuals (a control group). The level of its activity is in proportion to the severity of a pulmonary process and achieves its peak in caseous pneumonia. In infiltrative tuberculosis, there is a direct relationship between the activity of ADA, the number of involved segments and bacterial isolation. The activity of ADA has been shown to be increased by its isoenzyme ADA-2. The unidirectional changes in the activity of ADA and the clinical and X-ray characteristics of the disease treated with antituberculous drugs make it possible to recommend this parameter as an additional criterion for evaluating the specific features of a process in the lung and the adequacy of therapy.

The paper provides data on the serum levels of adenosine deaminase (ADA) in patients with acutely progressive pulmonary tuberculosis (APPT). The highest levels corresponded to the severity of the disease, high bacterial isolation, the extent of destructive and infiltrative changes in lung tissue, and endotoxemia. This indicates that ADA measurement is an additional criterion for assessing the health status in APPT patients and the magnitude of destructive processes. Moreover, the measurement is of prognostic value as it provides an objective assessment of the course of an acute progressive process an the efficiency of chemotherapy used.

The serum activity of the enzyme adenosine desaminase (ADA) was studied in patients with infiltrative tuberculosis in relation to IL-1 beta, TNF-alpha, IL-2 productions, the magnitude of a lymphocytic proliferative response to PPD and PGA. There was an association of high ADA levels with the severity of a tuberculous process, with the least IL-2 production together with drastically increased IL1 beta and significant disorders in the TNF-alpha system. Moderate ADA increases reflect the regularly enhanced activity of immunocompetent cells in response to an infectious agent. The findings indicate that a simple biochemical test may be used for rapid preliminary evaluation of the severity of disease and immune performance.

Examining the activity of serum adenosine deaminase in 112 patients with lymphadenopathy of various etiology revealed its increase (at the discriminant level equal or exceeding 20 U/l) in 86% of 50 patients with active tuberculous infection. The specificity of the parameter as a test for tuberculous peripheral lymph nodal lesion is 90.3%, the positive and negative prognostic significances are 83 and 89%, respectively, the diagnostic efficiency is 88.4%.

The paper gives the results of treating 60 adolescents suffering from destructive pulmonary tuberculosis. A multimodality treatment using oliphenum, prednisolone or their combination causes an increase in therapeutical efficiency and a reduction in the time of treatment by the average of 2-3 months.

The multidimensional statistical analysis was used to thoroughly study the status of lipid peroxidation, the antioxidative system and proteolytic inhibitors in 22 patients with an active and 26 with a metatuberculous deforming osteoarticular process. In both cases, enhanced lipid peroxidation is followed by various changes in the systems of endogenous antioxidants and inhibitors of proteolysis. Imbalance of these systems in the active process, unlike the deforming osteoarticular one, requires a differential approach when proteolytic antioxidants and inhibitors are used.

Changes in lipid peroxidation parameters (LP), antioxidant system and proteinase inhibitors were studied at different evolutionary stages of experimental osteoarticular tuberculosis in 30 rabbits. All stages of the process were characterized by LP activation which in animals of all groups (except rabbits having the acute stage of arthritis) is accompanied by compensatory increase of superoxide dismutase and ceruloplasmin activity. Deficiency of superoxide dismutase found in the acute stage of arthritis with a growth of LP activity shows its inadequate production at a given stage of articular inflammation. Decrease in alpha 1-proteinase inhibitor activity at the stage of osteitis with reactive synovitis can be caused by the influence of LP products. The importance of this mechanism in the inhibition of alpha 1-proteinase inhibitor, together with reduction in its production at the acute stage of arthritis, cannot be ignored. The results obtained make it possible to recommend further study of the perspectives of antioxidants use in osteoarticular tuberculosis.

All the steps of osteoarticular tuberculosis evolution were accompanied by an increase in proteolytic activity in rabbit blood serum, which was compensated by activation of alpha 1-inhibitor of proteinases at the initial steps of osteitis. The system "proteinases-inhibitors" was imbalanced during the severe phases of arthritis independently on the rate of its development as follows: predominance of proteolytic potential over inhibitory activity, dissimilar activity of alpha 1-inhibitor of proteinases simultaneously with equal rate of alpha 2-macroglobulin content decrease. Dissimilar alterations in the system studied enabled to suggest that differential application of proteinases is suitable for treatment of inflammation with respect to the step of osteoarticular tuberculosis development.

A correlation between the informativeness of the proteinogram, blood ceruloplasmin and haptoglobin levels and connective tissue metabolism indices used to characterize the inflammatory process activity was performed in 55 patients with different stages of tuberculosis of bones and joints. Among the acute phase proteins examined, the most sensitive indices include ceruloplasmin and haptoglobin found in their combination. A higher urinary oxyproline and glycosaminoglycan excretion in different forms of osteoarticular tuberculosis (both of an inflammatory and a degenerative type) should not be interpreted as an indication of activity of the specific process.

Patterns of collagen metabolism were studied in 36 patients with hematogenic vertebral column osteomyelitis simultaneously with evaluation of C-reactive protein, haptoglobin and ceruloplasmin in blood and consideration of the clinico-morphological steps of the disease. Hyperhydroxyprolineuria proved to be a more informative evidence for inflammation in vertebral column as compared with the proteins of acute phase of inflammation importance of hydroxyproline measurement in biological fluids for evaluation of the osteomyelitis development was elevated as the inflammation activity decreased (which was estimated by content of the acute phase proteins).

Rifampicin excretion with urine and its plasma levels were studied in 46 patients with nephrophthisis treated with rifampicin alone or in combination with isoniazid in doses of 8--10 mg/kg bw with regard to the degree of renal insufficiency. It was shown that excretion of rifampicin with urine decreased with progression of renal insufficiency and had no effect on its plasma levels. The combined use of isoniazid and rifampicin in a single dose was accompanied by a decrease in the latter's excretion with urine and different changes in its plasma concentration. The use of the two drugs for 4--6 weeks resulted in a further decrease in rifampicin excretion with urine not dependent on renal function and in decreased plasma levels of the antibiotic in 1/3 of patients. The findings indicate that the use of rifampicin in a dose less than 10 mg/kg of the body weight in patients with chronic renal insufficiency is not advisable. The absence of rifampicin in the urine specimens collected during the first hours on the 2nd day after its single use or its use for 4--6 weeks indicate that rifampicin does not accumulate in patients with renal insufficiency.

A complex study of hemodynamics and renal function in 30 patients with adenoma of the prostate during peridural anesthesia has been carried out. The functional renal reaction depends upon the scope of the sympathetic blocade in peridural anesthesia and bears an intimate relation to hemodynamic and neurohumoral effects of the developing blocade. All these changes are of a temporary character and regain values close to the initial ones by the time of the adaptation of the body to peridural anesthesia and stabilization of hemodynamics.

A separate assessment of renal function by Howard and Rapoport tests was carried out upon 23 cases of unilateral and 5 cases of bilateral renal arterial stenosis diagnosed through angiography. Functionally significant stenosis was found in 18 unilateral cases (78.3%), 12 of them were operated upon. The results of investigations are presented.