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The article is devoted to the study of psychological characteristics in patients with multiple sclerosis and their role in treatment and rehabilitation. The polymorphic fluctuating psychological disorders (cognitive and personality disorders, neuropsychological symptoms and inadequate "internal picture of disease") were found. The characteristics of unconscious psychic activity were specified. It was supposed that not only psychological factors but also functional state of the brain underlie the peculiarity of psychological disorders in patients with multiple sclerosis. The interdependence of psychological and cerebral factors influences the interference between clinical and psychological presentations in patients and must be taken into consideration in the treatment and rehabilitation of multiple sclerosis.

Among 103 examinees, the most common clinical type was caseous pneumonia (45.6%), progressive fibrocavernous tuberculosis (20.4%), infiltrative caseous pneumonia (17.5%), disseminated tuberculosis (16.5%). Progression was characterized by cavern formation in 91.1% of patients, with large and giant caverns containing nonspecific microbes forming in 79.6%. All the patients were found to isolate bacteria and 93.5% showed their excess. Drug-resistant microbes were identified in 62.1% of patients; polydrug resistance was seen in 37.5%. Chemotherapy was performed at the first stage by using 5 drugs: isoniazid, rifampicin, pyrazinamide, ethambutol plus kanamycin or amikacin. A combination of reserve drugs, including prothionamide, ofloxacin (ciprofloxacin) amikacin, pyrazinamide, and ethambutol, was used in patients with polyresistance. Symptomatic and pathogenetic therapies should aim at correcting complications and concomitant abnormalities. Following 6 months, 80% of patients stopped isolating bacteria, the process became stable and they could be prepared for planned surgical treatment. In 20% of cases, the process was progressive and it required salvage operations.

By analyzing the present-day tuberculosis epidemiological situation in the country and sociomedical characteristics of new cases, the authors present methods for detecting and treating patients, which are of paramount importance for today. Of the most significance is the need to promptly identify patients with strains on their referral to the general somatic hospitals for complaints by using 3-multiple sputum bacterioscopy for Mycobacterium tuberculosis by the Ziehl-Neelsen method. The vital problem is also to change chemotherapeutical regimens as more severe progressive types of the disease require more active treatment in the first months after detection especially in the cohort of socially disadapted persons.

Comprehensive clinical, X-ray, cytochemical, morphological, biochemical, and immunological studies of 14 patients with caseous pneumonia have provided evidence that significant structural, metabolic, and functional disorders of mononuclear phagocytes (MNP) play a leading role in the pathogenesis of acute tuberculosis. Structural and metabolic disorders of macrophages and monocytes in patients with caseous pneumonia result from impaired mitochondrial oxidation and glycolysis, aggregation and latinization of the membranes of lysosomes, release of their contents into the cytosol with damages to intracellular structures and the cellular membrane itself. This is also suggested by a drastic rise in the production of prostaglandins E2 and F2 alpha, prostaglandins E2 in particular, in the supernatants of cultured monocytes (100 nM). This is determined as the membrane-damaging effect of MNP due to the toxic action of rapidly multiplying mycobacterial population not only in the lung, but even in blood. MNP structural and metabolic disturbances are an equivalent to their lowered functional activity, as evidenced by a considerable deficiency of synthesis of intracellular and secretory pools of interleukin I and by a fall in their migrational and adhesive activities, two thirds of macrophages having signs of dystrophy and cytolysis. On entering the specific inflammatory area of the lung, these cells abundantly disintegrate. Their destruction leads to the elaboration of enzymes, prostaglandins, and other biologically active agents, which promotes the occurrence of extensive caseously destructive changes and creates conditions for rapid multiplication of mycobacteria.

The formation of immunodeficiency whose likely mechanism is apoptosis of some immunocompetent cells was studied in 35 patients with caseous pneumonia. The leading clinical sign of apoptosis in acutely progressive tuberculosis is significant lymphopenia (4-10%). Immunological studies indicated a substantial reduction in the count of T lymphocytes and their regulatory subpopulations of different phenotypes. In vitro mitogenic induction causes a decline of activated CD3+, CD4+, and CD8+ cells on the average by 10-40%, a decrease in the proliferative and synthetic functions, as compared with those in patients with infiltrative tuberculosis of the lung and healthy donors. Cytochemical findings in the same patients show that half the lymphocytes in the blood samples from patients with caseous pneumonia has profound intracellular metabolic disturbances. These cells are unavailable and undergo apoptosis, which determines immunodeficiency in patients with acutely progressive tuberculosis.

Based on the follow-up of 1,600 patients with sarcoidosis from 1971 to 1996, the authors analyzed the value of various methods for identifying the disease, the frequency and nature of misdiagnoses. They showed the efficiency of basic treatments in patients with sarcoidosis: corticosteroidal hormones, nonhormonal antiinflammatory drugs, plasmapheresis, and physiotherapy. Recurrencies and progression were seen in 23.85% of patients. The likely causes of recurrent sarcoidosis are considered. It is concluded that recurrencies are one of the important problems of modern sarcoidosis.

Two-stage standard chemotherapy was performed in 149 newly detected patients with pulmonary tuberculosis, by isolating Mycobacteria. Within the first 2 months, the patients received 4 drugs: isoniazid, rifampicin, pyrazinamide, streptomycin or ethambutol. Treatment with two agents (isoniazid and rifampicin) was continued for 4 months. Mycobacterial isolation was stopped in 104 patients after 2 months of treatment, in other 26 after 3 months, which amounts to 80.2%. Higher therapeutical results were observed in patients who had isolated Mycobacteria resistant to 1 and even 2 drugs.

An examination was made of 77 patients with extensive segmentary and lobular pulmonary tuberculous lesions: caseous pneumonia (n = 26), infiltrative caseous pneumonia (n = 18), fibrocavernous pneumonia complicated by caseous pneumonia (n = 16), and disseminated tuberculosis (n = 17). All patients had destructive changes; in 82.7% of patients the caverns were large and great in size. Bacteria were isolated in 94.8%, mycobacterial drug resistance was noted in 51.8%. Four variants of the course of a disease were identified: 1) that with predominance of the intoxication syndrome (41.6%); 2) that with respiratory failure (24.7%); 3) that with pulmonary hemorrhage (15.6%), 4) that added by secondary microorganisms (18.2%). Chemotherapy included a combination of 4 or 5 drugs along with pathogenetic tools, which stabilized a process in 80% of patients and arrested bacterial isolation in 69.5%. In 20%, the process continued to progress and in 3 of them died.

The most extrapulmonary sites of the sarcoidosis erythema nodosum, such as peripheral lymph nodes, skin, subcutaneous fat, heart, liver, spleen, and kidney are described in the paper. During a follow-up of 502 patients with sarcoidosis in 1986-1993, the incidence of sarcoidosis of extrapulmonary site was 18.9%. Erythema nodosum is regarded as a nonspecific allergic syndrome. Sarcoidosis of extrapulmonary site is characterized by multiple involvements, suppressed T-cell immunity, recurrence, which requires adequate treatment and continuous monitoring.

The impact of millimetric electromagnetic radiation (MER) on the natural history of the disease was studied in 54 patients with various types of pulmonary tuberculosis. The patients were treated using wavelengths of 6.4 and 7.1 mm on a YAVOR device. Following 10 sessions of MER therapy used in combination with specific drugs, caverns were found to close in 50% of patients at months 2-3 of therapy and in the controls at months 5-6. Infiltrative changes at the site of lesion resolved at weeks 2-3 of MER exposure, but in the controls at months 1-2 of drug therapy. In 5 (10%) out of 54 patients, regional blood flow parameters became normal, 27 (50%) patients were ascertained to have a partial improvement and 22 (40%) had no changes. No changes were seen in the controls as long as 2 weeks either.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

According to WHO questionnaire data, reports of national ministries of health, medical associations and other medical institutions, tuberculosis morbidity in the majority of the East European countries and CIS surpasses that for the West Europe. In 1990-1992 it varied from 18 to 80 cases per 100,000 people. The lowest morbidity was recorded in the Czech Republic, the highest in Roumania and Kazakhstan. In Estonia, Latvia, Lithuania, Russia and Ukraine tuberculosis morbidity tends to a slow reduction, while in Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, Roumania, Turkmenistan mortality rates constantly grow. Antituberculous therapeutic and prophylactic policy in the East Europe and CIS should be aimed at finding the resources for adequate supply of the population with antituberculous medications, introduction of WHO-recommended short course of chemotherapy. On demand, health care system should be restructured and new educational programs for specialists and the population introduced.

A procedure was developed to determine the optimum wavelength used for each patient individually. Ultrahigh-frequency electromagnetic radiation was studied in 54 patients with various pulmonary tuberculosis forms for its impact on the course of the disease. Treatment was performed by using a YAVOR device at 6.4 and 7.1 mm. Is was found that following 10 sessions of UHF therapy used in combination with specific chemicals, caverns were closed in 50% of patients 2-3 months after therapy and in the controls 5-6 months later. Infiltrates in the lesion areas were resolved 2-3 weeks after UHF exposure, whereas in the controls 1-2 months following drug therapy alone.

PGE and PGF2 alpha were measured by radioimmunoassay in bronchoalveolar lavage fluid obtained from the affected and contralateral lung of 86 patients with different forms of pulmonary tuberculosis. The findings were correlated with parameters of external respiration. Bronchial obstruction (BO) was found to entail lower values of PGE in the intact lung though higher PGE2 alpha levels near the focus. To normalize the proportion PGE/PGF2 alpha in the respiratory tracts, 24 tuberculous patients with BO received adjuvant ultrasound inhalations of PGE2 (prostenon). The course of 10 daily procedures produced positive shifts in bronchial patency in 3/4 of the patients. This positive trend was still demonstrable two months later. Prostenon anti-BO effect proved the highest in new-onset tuberculosis, in tuberculosis-induced intoxication and in moderate BO.

External laser radiation (ELP) (18-20 daily procedures) was used together with chemotherapy in the combined treatment of 53 patients with destructive pulmonary tuberculosis characterized by delayed dynamics of the process and concurrent obstructive bronchial syndrome. ELR promoted acceleration of the process dynamics, closure of disintegration cavities and alleviation of bronchial obstruction phenomena. The mechanisms of a favourable ELR action were essentially due to the reduction of basal oxidative metabolism and enhancement of defensive reaction during contact with a specific pathogen in phagocytes, which was confirmed by the recorded results of the spontaneous and stimulated by the killed BCG culture NST rest in peripheral neutrophils and monocytes.

Overall 221 patients with fibrous-cavernous tuberculosis were examined. In patients carrying Hp 2-2 haptoglobin and HLA DR2, the disease runs an unfavourable course more frequently. Among the patients with Hp 2-2, the positive dynamics was attained by the 6th month of the treatment in 44.1%, among those with HLA DR2 in 42.3% of cases while in patients carrying the two genetic markers at a time, in only 32.4% of cases. Patients with Hp 2-2 and HLA DR2 require special attention of the treating physician since the very first day of the disease and use of every possible treatment methods.

In 80 patients with pulmonary tuberculosis aggravated by stage I-IIB cardiopulmonary insufficiency, the multimodality therapy included vektarion improving the ventilation/perfusion correlations (29 patients) and the combination of metabolic correctors (glutamevit and riboxin) (51 patients). The population analysis of peripheral blood erythrocytes (by the method of acidic erythrograms), the fractional composition of hemoglobin, the concentration of 2,3-diphosphoglycerine acid and the isozymic spectrum of LDH in erythrocytes served as methods of the treatment efficacy control. The treatment with vektarion noticeably reduced hypoxemia which was accompanied by positive shifts in erythrocyte metabolism and in the hemoglobin spectrum, producing but a negligible action on the population composition of erythrocytes. The combination of the metabolic correctors exerted a lesser effect on the fractional composition of hemoglobins, producing a well-defined positive action on erythrocyte function, decelerating the processes of their ageing. It is concluded that the highest positive effect may be produced by the combined use of all the three drugs bearing in mind their action mode.

A study of concomitant cases of alcoholism and pulmonary tuberculosis is reported, with reference to the incidence of alcoholism among the patients with pulmonary tuberculosis, causative relationships between the two diseases, clinical manifestations and course of pulmonary tuberculosis and alcoholism where the two are combined, as well as the treatment of alcoholism and pulmonary tuberculosis and its organizational aspects.

The authors analysed structural disorders of a pulmonary pattern in patients with non-obstructive, obstructive and purulent bronchitis. Characteristic x-ray symptom-complexes were singled out for each clinical variant of the disease. In addition to roentgenomorphological changes functional disorders showing changes of biomechanics in patients with chronic bronchitis were revealed at roentgenopneumopolygraphy.

The results of a dynamic x-ray study of 27 patients suffering from histiocytosis X with lung involvement were analyzed; the study was supplemented by CT in 4 cases. X-ray semiotics of the disease was investigated with relation to its stage. X-ray symptom complexes were defined: interstitial, interstitial-granulomatous, and focal (tumorous). The authors have emphasized the fact that the small focal-cystic and pneumothoracic x-ray variants of the disease, described in literature, are not nosological entities but reflect only its stage and complications.

Clinicoroentgenological and functional manifestations of exogenic allergic alveolitis (EAA) have been studied in 143 patients. The disease is often masked and runs in the form of chronic nonspecific bronchopulmonary inflammation. The presence of antigen-dependent symptom complexes associated with involvement of other organs characterizes EAA more specifically. Finally, the disease progresses to parenchymatous interstitial fibrosis. Pulmonary ventilation and blood oxygen saturation are reduced.

An investigation of 142 patients with primary destructive pulmonary tuberculosis was carried out using several immunological tests to estimate the quantitative and functional status of the T- and B-lymphocyte systems and the specific cell-mediated and humoral immunity. It was shown that the status of the immune system, and that of the specific antituberculosis immunity in particular, were dependent on the severity of the tuberculosis process. There were indications that the immune status largely determined the extent of the infiltrative lesions, as well as the course of the disease. In patients with no pronounced defects in cell-mediated immunity in general and in specific immunity in particular, the time needed for sputum samples to become bacterially negative and for the cavities to close was reduced, especially in cases where the initial bacterial excretion was not heavy and the degree of the infiltration was not severe. Defects in the immune system impeded the clinical progress of the tuberculosis patients; moreover, complete clinical recovery in such cases was delayed and there was a higher incidence of reactivation of the disease during the main chemotherapy course as well as of recurrence of the disease at a later date.