[Comparative analysis of the informative value of 18F-fluorodeoxyglucose and 11C-methionine positron emission tomography in the differential diagnosis of solitary lung masses].

OBJECTIVE: To study the possibilities of enhancing the efficiency of differential diagnosis of solitary lung masses by optimizing the quantitative analysis of positron emission tomography (PET) data when two radiopharmaceuticals (RP) (18F-fluorodeoxyglucose (18F-FDG) and 11C-methionine) are used alone and in combination. MATERIAL AND METHODS: A comprehensive examination involving 18F-FDG and 11C-methionine PET was made in 116 patients with solitary lung masses of various genesis. A final diagnosis in the examinees was established from the results of postoperative material morphological analysis and/or laboratory tests and those of X-ray follow-up. RESULTS: No 18F-FDG and 11C-methionine hyperfixation was found in patients with benign tumors and in the majority of patients with focal pneumofibrosis. At 18F-FDG and 11C-methionine PET, RP accumulation was recorded in all patients with lung cancer (LC) and in patients with inflammatory diseases. Three patients with 18F-FDG PET-negative typical carcinoid tumors were noted to have increased 11C-methionine uptake. At 11C-methionine PET, RP accumulation was recorded in the projection of formation in all the patients with LC and in 38 of the 42 patients with inflammatory diseases. Regardless of the used RP, the Standardized Uptake Value (SUV) was significantly lower in the patients with inflammatory diseases than in those with LC (p ≤ 0.05). CONCLUSIONS: When RP is used alone, the diagnostic efficiency of C-methionine PET in the differential diagnosis of lung tumors and inflammations is higher than that of 18F-FDG PET. At the same time, the highest PET is seen when 18F-FDG and 11C-methionine are used in combination.

[Immunological changes in patients with pulmonary tuberculosis during glutoxim therapy]. / Dinamika immunologicheskikh pokazatelei u bol'nykh tuberkulezom legkikh pri lechenii glutoksimom.

The paper deals with the effect of glutoxim included into a preoperative preparation regimen on immunological parameters in patients with fibrocavernous pulmonary tuberculosis. On admission, all the patients had inadequate cellular immunity and activated humoral immunity. After termination of a course of glutoxim therapy, there was an increase in the baseline low values of lymphocytic proliferative activity, in the count of mature T lymphocytes, and in the production of IL-2 induced by phytohemagglutinin. At the same time the similar parameters remained unchanged in the control group. The drug exerted the most noticeable stimulating effect on cellular immunity in patients with a limited process. Glutoxim produced no noticeable effect on humoral immunity. The immunomodulating effect of glutoxim was followed by improvement of the clinical and X-ray pictures of the disease. In glutoxim-treated patients with baseline immunological disorders, progression was found to occur 1.5-2 times more infrequently than in the control group. Indications for the use of glutoxim in the treatment of tuberculosis are specified on the basis of the baseline immunological parameters of each patient.

[Prediction of the effectiveness of preoperative preparation of patients with fibro-cavernous pulmonary tuberculosis]. / Prognozirovanie éffektivnosti predoperatsionnoi podgotovki bol'nykh fibrozno-kavernoznym tuberkulezom legkikh.

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.

[Significance of mycobacterial drug resistance in pulmonary tuberculosis surgery]. / Znachenie lekarstvennoi ustoichivosti mikobakterii v khirurgii tuberkuleza legkikh.

The outcomes of surgical treatment of 546 patients with pulmonary tuberculosis were analyzed in relation to the bacteriological characteristics. Seeding detected sputum bacterial isolation in 52.4% of cases. Mycobacterial drug resistance was detected in 83.6% of the tested cultures. It has been concluded that the resistance is a first-order infectious agent whose action is shown in lowering the efficiency of preoperative courses of chemotherapy by 2.5 times, in increasing the incidence and severity of postoperative pleural and pulmonary complications by 6-7 times, in deteriorating the immediate outcomes of surgical treatment to 82.4% with a 7.4% mortality rate. Intensive bacterial isolation unarrested by surgery is a second-order infectious agent which more clearly shows a relationship of the efficiency of surgical treatment to a reduction in the cure rate to 74.2% with a total mortality of 15.2%. There is evidence for that it is advisable to apply an active surgical policy in a group of patients having an infectious risk factor.