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Among HIV-infected patients there are individuals with masked chronic diseases that affect life quality and life-span. Their timely detection and treatment can improve life quality of HIV-infected patients. The screening examination allows to establish prevalence level, structure and features of concomitant diseases under HIV- infection to provide timely medical preventive care.

Lung monitoring and visualization in intensive care unit (ICU) patients is a difficult task. Chest X-ray and auscultation are the most commonly used methods today. The new technique vibration response imaging (VRI) based on the vibration that is generated by airflow in the lung and that is its surrogate manifestation allows visualization of lung function. This method provides clinicians with an easy-to-use, non-radiation, non-invasive acoustic-based imaging technique of visual and quantitative evaluation of the lung. VRI objective dynamic image is a clinical addition to the existing static visual modalities used in the ICU.

The paper sums up the work of the Diagnosis Department of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences in the past 30 years. It also presents the results of examinations, treatment, and follow-ups of 5000 patients with sarcoidosis, exogenous allergic alveolitis, pulmonary tuberculosis of questionable activity, pneumonia, benign and malignant tumors, respiratory malformations, systemic vasculitis, pulmonary eosinophilia, lymphogranulomatosis, and rare lung diseases.

Examinations of 111 patients with chronic non-specific pulmonary lesion revealed the dysplastic changes in the bronchial wall in 90 of them. 47 patients received the routine anti-inflammatory therapy course and another 43 patients underwent the endoscopic laser therapy. Cytometry, made before and after therapy, provided for an objective differentiation of signs in different-severity bronchial dysplasia. The application of endoscopic laser irradiation in the correction of pretumor changers in the bronchial tree was shown to be effective in 95.3% of cases, whereas the routine treatment turned out to be ineffective.

Tracheobronchography using tantal powder was used to study the functional activity of the intact and altered bronchial mucosa that manifested itself as the unchanged outline of the mucosa and its clearance (mucociliary clearance). With the intact mucosa, the sequence of its clearance was established; the mechanism of powder transport was studied, which showed up as the appearance of metachronal fields, fusion of particles into conglomerates that form currents that direct towards the larynx. The clearance of the mucosa was over by hours 20-24. With the altered mucosa (tuberculosis and other diseases), the sequence and mechanism of its clearance were impaired. The outline of the mucosa was chaotic; there was a long powder retention (48-72-hour or more) in cancer and bronchoectases. There was retrograde transport of particles into the minor bronchi. The found differences in the activity of the mucosa in pulmonary tuberculosis and lung cancer allow this method to be used for differential diagnosis.

Forty-two patients with pulmonary mycobacteriosis were clinically characterized. In most patients, mycobacteriosis developed in the presence of residual changes in the lungs after cured tuberculosis. The torpid onset of mycobacteriosis with a gradual augmentation of symptoms of intoxication was observed. All the examinees were found to have destructive lung tissue changes that were characterized by the presence of caverns with a significantly transformed lung pattern.

Analyzing the data on 1812 patients with respiratory diseases, mainly pulmonary tuberculosis, urgently admitted to a tuberculosis hospital for the pulmonary hemorrhage (PH) syndrome during 5.5 years showed that there was no seasonal prevalence in the development of a complication. There was a steady-state regularity of the prevalent admission of patients to hospital from 10 a.m. to 8 p.m. and no hemorrhage in 39% of them on admission. Evidence was provided for the low diagnostic value of hemoptysis in assessing the prediction of the developed PH syndrome. In PH syndrome, the hospital mortality decreased by 2.6 times (from 20.0 to 7.7%) due to a wider use of the artificial hypotension method, endoscopic bronchial blockade, to the development and introduction of new modes of intraoperative protection and sanitation of the tracheobronchial tree, to the prevention of asphyxia, hemo-aspiration pneumonia, and its pathogenetically resultant acute progression of tuberculosis.

The paper analyzes the treatment made in 110 children with tuberculosis and non-specific lung diseases (NSLD) and in 52 control children without concurrent tuberculous pathology in sanatoria and health resorts. Evolving local tuberculosis was observed in 11.9% of the children with concurrent diseases and infection and an exacerbation of tuberculous process was seen in 26.5%. Failures in the treatment are accounted for not only by the aggravating impact of NSLD, but by physicians' poor attention to comorbidity.

From 1986 to 1997, the Unit made 2637 diagnostic operations: 1687 thoracoscopies, 49 telethoracoscopies, 232 mediastinoscopies, 171, diagnostic thoracotomies, 108 open pleural biopsies, 390 peripheral nodal biopsies. The diseases detected were arranged as follows: tuberculosis (33.8%), nonspecific (32.5%), malignant (16.3%), sarcoidosis (9.9%), alveolitis (2.5%). Verification was 95.3%.

A latex antibody diagnostic kit was used to reveal microbacterial antigens in the sputum of patients with tuberculous and nonspecific lung disease in 54 and 38% of cases, respectively. It is suggested that Mycobacterium antigens are present in different tissues of an infected macroorganism.

The levels of surfactant phospholipid from bronchoalveolar lavage were measured in 70 patients with pulmonary diseases and in 10 apparently healthy individuals. The levels of surfactant phospholipid components were lower in patients with peripheral lung cancer, infiltrative tuberculosis, focal pneumonia, most significant in cancer; differential diagnostic criteria for these diseases are defined.

A hundred and seventy one patients with revealed rounded lung formations of tuberculous and non-tuberculous origins were examined. Mycobacterial antigens, cellular antituberculosis immunity, and antituberculosis antigens were determined. Cellular sensitization to mycobacterial antigens was found to develop in about 50% of patients with round lung formations of tuberculous origin. This sensitization to PPD was more revealed by BTR rather than by TMR. At the same time, the latter is positive in healthy donors and in patients with non-tuberculous abnormality. Finally it can be concluded that cell tests are little suitable for immunodiagnosis of tuberculosis. It was also ascertained that determination of antituberculosis antigens and antigenemia might be a important component of examinations of patients with rounded lung formations in order to make a differential diagnosis of tuberculosis and non-tuberculous abnormality as with their determination, high sensitivity and specificity of appropriate tests can be achieved. These tests are more informative for the immunodiagnosis of tuberculosis than that of infiltrative tuberculosis.

The cytological and histological studies of biopsy specimens obtained from 51 patients with infiltrative pneumonic formations in the lung (Group 1) and in 30 with its round formations (Group 2) at transbronchial intrapulmonary biopsy could verify the etiology of the disease in 86.2 and 20.0% in Groups 1 and 2, respectively. Different diseases may run under the mask of tuberculosis in 36.6% of these patients.

In 61 patients, pulmonary tuberculosis was complicated by thrombosis of the pulmonary artery or its embolism and by bronchial asthma. In various lung diseases, there was a combination of some factors predisposing to chronic cor pulmonale. These included specific infection, sympathoadrenal activation, reduced capillaries, and hypoxia in pulmonary tuberculosis, alveolar hypoventilation with arteriolar spasms, and elevated intrathoracic pressure in bronchial asthma; higher pulmonary arterial systolic pressure due to spasms of the pulmonary branches and drastically reduced arterial bed in pulmonary thromboembolism.

A new method for analysis of volatile endogenous compounds in exhaled air using portable gas chromatographer with photoionization detector has been developed. Detection threshold for ethanol and acetone is 0.1 mg/ml, this permitting one to omit the step of concentrating the exhaled air samples. The accuracy of detection is 5.9 to 7.7%. The concentration of endogenous ethanol in health was 0.12 to 0.3 mg/m3, that of acetone 0.6 to 2.8 mg/m3, that in cardiopulmonary patients 0.8 to 6.4 mg/m3 for ethanol and 2.9 to 47.2 mg/m3 for acetone. Fasting for 24 h led to 15-fold increase of acetone concentration in exhaled air.

The method employs identification of M. tuberculosis marker, tuberculostearinic acid. Bacterial culture and sputum from tuberculous and nontuberculous pulmonary disease patients were examined. The results of bacterial and chromatic mass-spectrometry methods in tuberculous patients proved identical. The latter technique is highly sensitive and provides quick results.

Outbreaks of diseases caused by toxic waste discharge took place in some cities where microbiological and petrochemical plants are located. The diseases manifested clinically with pulmonary edemas, irritative and intoxication syndromes and affected only subjects with chronic nonspecific lesions of the lungs. A hypophysis on bronchial asthma outbreaks secondary to paprin discharges in the atmosphere by microbiological plants was not confirmed.

The paper outlines difficulties in tuberculosis diagnosis and effectiveness of various methods of mycobacteria identification. The latter along with direct and indirect determination of mycobacterial drug resistance require perfection. There is a need in investigation of diagnostic samples from tuberculous and respiratory sarcoidosis patients for mycobacterial granular forms. A multimodality diagnostic approach to examination of clinical material from tuberculous patients is advocated.

Tuberculous antigens and antibodies, antigens and antibodies to pneumococcus, haemophilus bacteria. Klebsiella pneumonia, proteus bacteria were determined in 100 adolescents (87 with tuberculosis and 13 with nonspecific lung diseases). Specific antigens and antibodies were detected in 62% of tuberculous and 7.7% of nontuberculous patients. The most pronounced immune response to M. tuberculosis antigens and antibodies as well as to nonspecific flora was registered in patients with long-term and disseminated processes. Immunological investigations are thought an important tool in diagnosis, differential diagnosis of tuberculosis and planning combined treatment policy.

The immunological survey of 1,688 patients with tuberculosis and 486 with non-specific pulmonary diseases was made. Criteria were identified for immunodiagnosis. The use of current mathematical methods of analysis allowed the development of high performance immunodiagnostic systems for pulmonary abnormalities, which included diagnostic tables and discriminant analysis by employing a computer. The major immunological disorders were determined, which in agreement with the definite direction of a tuberculous process with the subsequent use of data for monitoring the patient's status and correcting the treatment. The most potent immunocorrective drugs were studied, indications for their use were specified, proceeding from the immunological characterization of a specific patient. It was shown that the comprehensive assessment of various links of the immune system is of undoubtful value for the diagnosis and prediction of diseases, and prescription of immunocorrective therapy for pulmonary tuberculosis.

Sonoluminescent parameters of plasma obtained from 124 patients with pulmonary tuberculosis, 57 patients with intrathoracic sarcoidosis and 39 pulmonary cancer patients were found different. The authors propose to use the standard integral index of sonoluminescence which proved significantly different. Utilization of DIS-1 apparatus appeared by 23-29% more efficient as it induced more intensive luminescence yet noted.

The paper summarizes the results obtained at examination of industrial workers using a modified screening. This included questionnaires, oriented general examination, evaluation of external respiration with its monitoring during working hours. Such approach proved informative and provided a sufficient symptom complex to make diagnosis of occupational asthma.

The direction of research work in phthisiology and pulmonology is determined by the epidemiologic situation for tuberculosis and CNPD in the republic. The results of a complex research work in phthisiology and pulmonology carried out in the rural areas of Uzbekistan, and in the cotton--growing regions in particular, are given. Practical significance of this work is stressed, which comprises direct inspection of the tuberculosis infection foci and subjects in contact and subsequent accomplishment of preventive and health--improvement measures, comprehensive screening of the rural population for tuberculosis and CNPD detection, conduction of chemotherapy and pathogenetic and surgical treatment of tuberculosis patients. The results of research into phthisiology and pulmonology will make the basis of the national program with respect to tuberculosis in Uzbekistan.

The experience of computer technology application at the Phthisiology Department of the Kazan Medical Institute over the last 5 years was generalized. Four classes of the teaching programs were described: program control of the accumulated experience, diagnostic search, a mathematical model of an emergency situation and expert medical systems. Preference is given to the latter two types of programs. It is emphasized that application of the IBM-compatible systems as the most prevalent in clinical practice is promising. Description of the specific programs is presented.

A procedure for parasternal mediastinopleuroscopy (PMS) has been proposed for biopsy of pulmonary tissue and intrasternal lymph nodes. A surgical technique of intervention is described in the paper. PMS was performed in 81 patients with diffuse lesions of the lungs and the disease was morphologically verified. The clinical and X-ray diagnosis was found to be incoincident with their final morphological diagnosis after PMS had been performed in 48 out of 81 patients. To obtain an informative biopsy specimen needed for a morphological diagnosis, biopsies of the lung and lymph nodes should be taken in all cases. Complications occurred in 2 patients. These included bleedings from the intercostal arteries, which required vascular ligation.

The authors present the data on special features of the course of tuberculosis in adolescents having other diverse conditions such as nonspecific pulmonary diseases and congenital abnormalities, prior acute respiratory diseases and concurrent iron deficiency anemia. The combination of tuberculosis with other diseases results in a longer course of tuberculosis with slow clinical and X-ray dynamics and in a number of cases (++prior acute respiratory diseases) in bouts of the specific process. The favourable outcomes of the disease are determined by the correct combined treatment of tuberculosis and concurrent diseases. When tuberculosis runs along with congenital abnormalities the effectiveness of treatment is achieved by surgical methods after specific chemotherapy.

Examination included the findings of 141 patients with various granulomatous pulmonary diseases: tuberculosis (26), sarcoidosis (100) and exogenous-allergic alveolitis (15). The biopsy specimens were divided into 3 groups depending on the nature of changes: (1) the presence of epithelioid-cellular granulomas (EG) (80); (2) fibrous changes (47); (3) caseous detritus (14). Patients with EG in the biopsy specimens had mean lymphocytosis of 41.3 +/- 6% in bronchoalveolar washings (BAW) in all granulomatous diseases. Correlation between the cellular BAW composition and cytomorphologic pattern of the biopsy specimens has revealed more stable links between the presence of EG in biopsy specimens and lymphocytosis in BAW in tuberculosis, sarcoidosis and endogenous-allergic alveolitis. Tuberculosis patients, in addition to lymphocytosis in BAW, have increased neutrophils which depended on the degree of exudative-necrotic reactions that accompanied the formation of tuberculous granulomas. Patients with fibrous changes in the biopsy specimens had varying increases in neutrophil counts in BAW (11.7 +/- 2.3%). The lymphocyte count in BAW in the presence of caseous detritus in the biopsy specimens in tuberculosis in the absence of granulomas decreased (47.8 +/- 7.5 and 12.5 +/- 3.3%) and the neutrophil count increased (20.6 +/- 6.3 and 24.9 +/- 6.9%).

Comprehensive laboratory studies were performed to develop and introduce new techniques for examining patients with respiratory tuberculosis and some other pulmonary diseases. The techniques should improve and develop the immunologic and bacteriological diagnosis of tuberculosis, sarcoidosis, various exogenous allergic alveolitis and nonspecific inflammatory (microbial and mycotic) pulmonary diseases. Some of the methods were elaborated for morphological verification of sarcoidosis, alveolitis and rare pulmonary diseases. Radioimmuno-, enzyme immuno-, and other assays for the activity of various enzymes, as well as biochemical methods for assessing the superficial properties of individual cellular elements have found application in performing biochemical studies in pulmonary tuberculosis and non-specific diseases. Immunologic, bacteriological, cytologic and biochemical methods of study have been adjusted to examine the amount of bronchoalveolar washings in patients with different pulmonary diseases.

The efficiency of complex methods of examination, including that of the new special ones, for the diagnosis of disseminated processes in the lungs has been studied in 300 patients between the ages of 20 and 76 years. The following methods were used: microbiological (including a new nutritive medium for mycobacteria activation), immuno-enzymatic (detection of specific antigens), immuno-morphologic with determination of antigen determinants of tuberculosis mycobacteria and their L-forms with the help of specific antisera, cytologic, biochemical (the content of phospholipids and their fractions in the bronchoalveolar washing and blood plasma cortisol/insulin ratio), ++tracheo-bronchoscopic and surgical methods. A possibility of the verification of the clinical diagnosis of various diseases was established with the help of each method being used. Surgical intervention (thoracoscopy with lung biopsy and open lung biopsy) which confirm the diagnosis in 96.4% of cases proved to be the most informative diagnostic method.

The accumulated experience and the literature data allow for the separation of a group of granulomatous pulmonary diseases among pulmonary diseases of different etiology. Etiologically heterogeneous granulomatous diseases are united by the general signs: granuloma development, immunologic disturbances mainly within the cellular system and mediators as well as systemic vascular affection in the form of vasculitis. In our opinion, granulomatous diseases include disseminated tuberculosis, sarcoidosis of respiratory organs, exogenic and idiopathic fibrous alveolitis, Wegener's granulomatosis, histiocytosis X, primary hemosiderosis, Goodpasture's syndrome and some other rare diseases. Granulomatous diseases are diagnosed on the basis of the ++clinico-roentgenologic findings with an obligatory cytological and histological study of the bioptic specimen; immunologic diseases are diagnosed proceeding from the study of the immunologic status and detection of specific antibodies; of great significance for the diagnosis of pulmonary granuloma caused by infectious pathogens are microbiologic studies which provide for the detection of microorganisms and fungi. Study of the clinicoroentgenologic and laboratory data made it possible to distinguish a number of features typical for each disease and to unite them into diagnostic symptom complexes. Despite the different course of granulomatous pulmonary diseases they may end in recovery and granuloma resolution, development of lung fibrosis in a chronic course and in certain diseases in lung tissue destruction with cavity formation (tuberculosis, Wegener's granulomatosis). A fatal outcome may also ensue due to an acute or chronic course of the diseases.

The results of a computer analysis of immunograms for the differential diagnosis of tuberculosis, cancer, pneumonia and sarcoidosis are presented. The findings indicate that computer immunodiagnosis may be used as a supplementary tool that increases the effectiveness of diagnosis in difficult cases. The advantage of the elaborated system is to rapidly apply a systemic approach to the assessment of the patient's immune status and to objective diagnosis by using computer algorithms.

Stemming from the results of a complex immunologic examination of 653 patients with lung diseases, 4 immunologic reactions of highly diagnostic value were identified, i. e. specific antibody formation, blast transformation with PPD and PHA and spontaneous rosette formation. The most valuable combinations of these reactions were defined for each type of the pathology. For tuberculosis, 16 such combinations were found, including 5 without specific antibody formation; 5 in cancer; 3 in nonspecific inflammation; and 1 in sarcoidosis. Diagnostically important combinations of the above immunologic reactions are summarized in the Table whose use in differential diagnosis of doubtful cases of tuberculosis, cancer, nonspecific pneumonia and sarcoidosis can increase their diagnostic probability up to 0.95-0.99 in 30 per cent of the patients without employing invasive methods.

Tuberculosis-related examination of 123 children during hospital treatment in 2 pneumologic departments has revealed 9.8% of tuberculosis patients. Among the children with destructive lung processes one-third had tuberculosis in a destructive phase. Timely diagnosis of childhood tuberculosis in children's somatic hospitals, especially in those of a pneumologic type, requires the obligatory Mantoux test with 2 TU PPD-L and in children with destructive lung processes bacteriologic sputum examination for Mycobacterium tuberculosis.

The serum angiotensin-converting enzyme activity (ACE) was studied in 198 patients (116 had sarcoidosis and 82 pulmonary diseases with sarcoidosis-like X-ray picture). Rise of ACE activity in sarcoidosis patients was clearly associated with the process phase (93% in active sarcoidosis and 35.7% in nonactive). Rise of serum ACE activity was found in 46.3% of the patients having sarcoidosis-like diseases (in 41% with tuberculosis 56.3% with nonspecific inflammatory diseases and also in patients with fibrosing alveolitis, histiocytosis X and pneumoconiosis). Though the blood serum ACE activity has a high rate of the increase in sarcoidosis, this test should be considered only in the general complex of differential diagnosis signs. This can be explained by a sufficiently high probability of ACE activity rise in all diseases that most commonly require differentiation with sarcoidosis.

The paper deals with the data of follow-up of adolescents with disseminated pulmonary processes of different etiology. Among the patients who were treated in the department during the last 10 years disseminated processes amounted to 3.3%, with disseminated pulmonary tuberculosis being recorded in 1.3% and dissemination of the nontuberculous etiology in 2% of the patients. Mucoviscidosis, metastasis, of the thyroid cancer, histiocytosis X, toxoplasmosis and echinococcosis were among the disseminations of the nontuberculous etiology. Basic diagnostic criteria have been determined.

Diagnostic enzyme immunoassay kits were used for the examination of parallel tests of venous and capillary blood in 43 patients with nonspecific pulmonary diseases for the presence of antibodies to tuberculosis pathogen. The method of parallel tests has revealed that disregarding the site of blood collection (vein, finger) the EIA results are identical. Analysis sensitivity in tuberculosis patients varies within 30 and 86% in relation to the clinical activity of a tuberculosis process. Analysis specificity in tuberculosis patients is 3.4%.