[Differential diagnosis of tuberculosis of respiratory organs and pulmonary eosinophilia].

The reasons for misdiagnosis of tuberculosis in patients with pulmonary eosinophilia were analyzed, by using 6 clinical cases as an example. In most cases, the reasons for diagnostic errors are underestimation of elevated eosinophil levels and late afterexamination to verify the diagnosis. With general practitioners' increasing alertness, the inefficiency of antibiotics in patients with initially presumed pneumonia is frequently interpreted as an argument in favor of tuberculosis. Examining the cellular composition of bronchoalveolar lavage permits verification of the diagnosis of pulmonary eosinophilia in questionable cases. It is advisable to use a short course of test therapy with small-dose glucocorticosteroids for differential diagnosis of tuberculosis and pulmonary eosinophilias.

[Atypical and unfavorable variants in the course of sarcoidosis]. / Atipichnye i neblagopriiatnye varianty techeniia sarkoidoza.

Sarcoidosis with atypical clinical manifestations and a poor course accounts for 5.6% (78 individuals per 1400 patients). The paper describes the atypical manifestations of sarcoidosis (fever, hypereosinophilia, lymphocytosis, etc.) and its poor course, which are similar to those of lymphoproliferative diseases, fibrosing alveolitis-type sarcoidosis, infiltrative pneumonic forms). Each of the above manifestations has complex differentially diagnostic aspects.

[Radiation diagnosis of Langerhans cell histiocytosis (LCH) of lung]. / Luchevaia diagnostika porazhenii legkikh pri langergansokletochnom gistiotsitoze.

The authors studied the pattern of X-ray changes detectable in the lungs of 41 patients with LCH. The results of classical X-ray study were supplemented by the data of computed tomography, ultrasonography, and 99mTc and 67Ga citrate radioisotopic studies. The diagnostic values of these techniques were compared. X-ray syndromes of changes in the lung in LCH were found to be interstitial, interstitial and granulomatous, tumorous (focal). The authors emphasize the multisystematic character of a lesion, the phasic nature and progression of the disease into fibrosis.

[Radiation diagnosis of interstitial lung diseases]. / Luchevaia diagnostika interstsitsial'nykh boleznei legkikh.

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.

[X-ray criteria for assessing the activity of lung sarcoidosis at follow-up]. / Rentgenologicheskie kritetii otsenki aktivnosti sarkoidoza legkikh pri dispansernom nabliudenii.

The results of comprehensive X-ray findings in 300 patients with different clinical and X-ray forms of respiratory sarcoidosis who had been registered to be followed up at the Consulting Outpatient Department, Central Research Institute of Tuberculosis Russian Academy of Medical Sciences, were analyzed. The follow-up lasted 3 to 20 years. X-ray study heads the list of the most informative techniques for assessing the activity of sarcoidosis. The time of following up patients with sarcoidosis in dispensary registration groups is recommended in accordance with the recommendations of the sarcoidosis Consensus Commission. X-ray criteria for stabilization of the disease and the optimum methodological complex of radiation diagnosis are defined.

[Significance and role of radiation studies in complex diagnosis of exogenous allergic alveolitis]. / Znachenie i mesto metodov luchevogo issledovaniia v kompleksnoi diagnostike ékzogennogo allergicheskogo al'veolita.

The authors highlight X-ray symptom complexes (XRSC) (emphysematointerstitial, parenchymatointerstitial, and pneumonic) which are characteristic of exogenous allergic alveolitis (EAA). The above XRSC are comparable with the clinical types of EAA. The semeiotics typical of each XRSC and the value of radiation diagnostic methods in specifying changes in lung tissue and intrathoracic lymph nodes, the activity of the process are presented. Each study (classical X-ray, CT, radionuclide scintigraphy) has its own advantages and resolution limits. Radiation studies in the diagnosis of EAA should be used purposefully in combination with other studies (immunology, external respiratory function test, bacterial cytology, morphology) by taking into account the clinical manifestations of the disease.

[Use of plasmacytapheresis in combined modality therapy of patients with fibrosing alveolitis]. / Primenenie plazmotsitafereza v kompleksnom lechenii bol'nykh fibroziruiushchimi al'veolitami.

The authors describe the results of examination of 67 patients with exogenous allergic and idiopathic fibrosing alveolitis. Of these, 42 patients underwent plasmocytapheresis in addition to corticosteroid therapy. The clinical improvement, positive x-ray dynamics of pulmonary lesions, normalization of the altered laboratory indicators were noted in 39 out of the 42 patients treated with the use of plasmocytopheresis and in 15 out of 25 who received pharmacotherapy alone. The use of plasmocytapheresis at the inpatient stage of the treatment enabled the dose of corticosteroids to be reduced by 26% of the initial on the average in 3/4 of the patients and subsequent hospitalization requirement to be noticeably decreased. Plasmocytapheresis did not produce any complications.

[X-ray semeiotics of functional changes of the respiratory organs in patients with tuberculosis of the lungs and the obstructive syndrome]. / Rentgenosemiotika funktsional'nykh izmenenii organov dykhaniia u bol'nykh tuberkulezom legkikh s obstruktivnym sindromom.

Examination included 178 patients with active pulmonary tuberculosis and moderate obstruction (74 subjects) or severe obstructive syndrome (104 subjects). The dynamic morphofunctional X-ray examination along with a study of external respiratory function made it possible to study the pattern of functional disturbances in patients with tuberculosis of respiratory organs and concurrent bronchial obstruction. Roentgeno-pneumopolygraphy supplemented with physical exercise tests and berotec specified the localization, extent and the character of disorders of bronchial patency and enabled one to study the compensatory mechanisms of external respiratory function during antibacterial therapy. According to the data of roentgeno-pneumopolygraphy, the more serious air-filling disorders are, the more pronounced the bronchial obstructive changes are, while the degree of respiratory disorders depends on the type and extent of the process and on the duration of the disease and its genesis.

[The x-ray morphological characteristics of the early manifestations of sarcoidosis]. / Rentgenomorfologicheskaia kharakteristika rannykh proiavlenii sarkoidoza.

The paper is devoted to an analysis of combined x-ray findings supplemented by CT findings in patients with sarcoidosis detected for the first time with early signs of this disease. A conclusion has been made that apart from lymph node enlargement, sarcoidosis is characterized by lung parenchymal changes which manifest themselves as symptoms of broncho-alveolitis. Characteristic x-ray symptom complexes are described. Roentgeno-semiotics of these changes were compared with the results of morphological investigation of transbronchial puncture specimens. Roentgenologically detectable changes showed good correlation with morphology findings. The authors have also emphasized the importance of morphological verification of this disease at early stages.

[Clinical variants of the course and the characteristics of the x-ray changes in extrinsic allergic alveolitis--tobacco growers' disease]. / Klinicheskie varianty techeniia i kharakteristika rentgenologicheskikh izmenenii pri ékzogennom allergicheskom al'veolite--"bolezni tabakovodov".

Analysis is made of the clinical varieties and x-ray changes in the lungs in 143 persons engaged in tobacco growing. The immunological studies revealed sensitization to tobacco antigen in all the patients. Pointing to the polymorphism of the x-ray appearance the authors group at the same time the main signs into the x-ray symptom complexes: emphysematous interstitial, parenchymatous interstitial and pneumonic. Preliminary analysis indicates that the x-ray symptom complexes thus distinguished correlate with the main clinical varieties of the disease which may run its course by the type of obstructive bronchitis, bronchial asthma and recurrent pneumonias.

[Roentgenological symptoms of functional changes in the respiratory organs of patients with pulmonary tuberculosis]. / Rentgenosemiotika funktsional'nykh izmenenii organov dykhaniia u bol'nykh tuberkulezom legkikh.

To study typical disorders in the external respiration function of patients with pulmonary tuberculosis without concurrent bronchial obstruction and to find out an information potential of the roentgeno-pneumo-polygraphic+ (RPPG) method in detecting local obstructive disturbances, 53 subjects aged from 23 to 52 years with respiratory tuberculosis, including 38 and 15 of them with a limited or disseminated process, respectively, were examined. X-ray functional examination conducted in dynamics and with the use of physical load and bronchodilators made in possible to discover both local and disseminated occult bronchial obstruction. Application of RPPG method and administration of such bronchodilator, as berotec, revealed a functional nature of the bronchial obstruction. According to RPPG data. In a lingering tuberculous process a costal component is predominant in the course of respiration.

[Clinical manifestations of extrinsic allergic alveolitis--a disease of tobacco growers]. / Klinicheskie proiavleniia ékzogennogo allergicheskogo al'veolita- al'veolita--bolezni tabakovodov.

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.

[Differential x-ray diagnosis of disseminated tuberculosis and sarcoidosis of the lungs]. / Differentsial'naia rentgenodiagnostika disseminirovannogo tuberkuleza i sarkoidoza legkikh.

In the polymorphous picture of roentgenological shifts in disseminated tuberculosis and sarcoidosis of the lungs the authors mark out x-ray symptom complexes of differential diagnosis value. The complexes are based on predominating affection of the bronchopulmonary structures, x-ray characteristics of granulomas, nature and extent of the affections of the lymph nodes of the lung roots and mediastinum and the type of hypertension development in pulmonary circulation.

[A comparative evaluation of the results of classical x-ray study and computed tomography in patients with exogenous allergic alveolitis]. / Sravnitel'naia otsenka rezul'tatov klassicheskogo rentgenologicheskogoissledovaniia i komp'iuternoi tomografii u bol'nykh ékzogennym allergicheskim al'veolitom.

A correlative study of the results of x-ray investigation using routine methods and computerized tomography (CT) was conducted to specify the roentgenomorphological substrate of changes in patients with exogenous allergic alveolitis. The established complex of routine methods is informative enough to interpret the revealed changes. However, at early stages CT helps to specify semiotics and permits obtaining additional information, particularly on quantitative, i.e. densitometric changes. In diffuse and disseminated pulmonary lesions CT can be used as an additional method.