[Complex morphological diagnostics of tuberculosis and sarcoidosis of the lungs].

Differential diagnosis of disseminated lung diseases, particularly tuberculosis and sarcoidosis, presents certain difficulties for clinicians. In the verification of the diagnosis a decisive role belongs to the morphological study, for which the most commonly used material is transbronchial biopsy. Diagnostic signs of active disseminated pulmonary tuberculosis are presence of different-sized granulomas with signs merger, necrosis, infiltration of polymorphonuclear leukocytes, weakly expressed fibrillogenesis. Cytological markers of a specific process are young biosinteziruyuschie macrophages and acid-fast bacilli. The diagnostic features of pulmonary sarcoidosis are monomorphic granulomas with no tendency to merge and necrotisation expressed fibrosis and hyalinization processes. Cytological marker for the disease is the high content of epithelioid cells with signs of secretion.

[Cytologic features of bronchoalveolar lavage in evaluation of course of exogenous allergic alveolitis].

Application of complex of modern cytologic methods of research bronchoalveolar lavage allowed to allocate most characteristics of development of lymphocytic and macrophagic reaction of bronchial tree in different course of exogenous allergic alveolitis. The most indicative in assessment of origin of exogenous allergic alveolitis development is the characteristics of macrophagic population. In acute course of exogenous allergic alveolitis the considerable number of young activated and non-activated macrophages, increased number of mature phagocytes is observed. Even more significant increase of phagocytic macrophages is observed at dissemination which is primarily is connected with participation of these cells in lymphocytic apoptosis which takes place in high percentage of lymphocytes (up to 49%). Increased number of mature phagocytes is observed at chronic course of exogenous allergic alveolitis that is an important diagnostic pattern of this option of development of exogenous allergic alveolitis in association with the lowest T-helpers/T-supressors index.

[Role of lung biopsy in diagnosis of pulmonary pathology at the prehospital level].

The aim of the work was to assess the value of biopsy techniques for fibrobronchoscopy under local anesthesia in patients with pulmonary pathology at the prehospital level. It included 706 subjects with lobular, segmental or diffuse lesions in the lungs of specific (tuberculosis), non-specific (pneumonia, exogenous alveolitis), and other origin. All known methods of endobronchial biopsy were employed (bronchoalveolar lavage or liquid lung biopsy, tissue biopsy, transbronchial biopsy, brush biopsy, puncture and aspiration biopsy) with subsequent cytomorphological and bacteriological studies of bioptates. Diagnostic efficiency of direct biopsy was estimated at 97%, transbronchial biopsy at 5-90% depending on nosological form of lung disease, brush and puncture biopsy 20-50 and 6% respectively. Reversible complications occurred in 1.4% and were resolved by therapeutic methods. Cost effectiveness of prehospital instrumental examination of patients with pulmonary pathology is 10 times the intrahospital one.

[Results of use of surfactant in complex therapy of patients with destructive pulmonary tuberculosis].

Many years' experience in studying the surfactant system in patients with pulmonary tuberculosis has allowed recommendation of using surfactant agents in the treatment of tuberculosis. The purpose of the study was to evaluate the efficacy of surfactant-BL (Russia) as a pathogenetic agent in chemotherapy in patients with destructive pulmonary tuberculosis. The results of treatment were compared in two groups of 70 persons in each, which were matched by gender, age, the extent of a tuberculous process, and the presence of drug resistance in the causative agent, including multidrug resistance. In the study group, the patients received surfactant inhalations (8 weeks) during chemotherapy while the control patients had only chemotherapy. Drugs were chosen on an individual basis, by taking into account the pathogen's drug sensitivity and a patient's tolerability of a drug. The cumulative dose of the surfactant was 700 mg. There were no adverse reactions to the surfactant in the study group of patients. After 2-5 surfactant inhalations, the amount of sputum increase, its discharge became easier, and cough diminished. Following 4 weeks, the level of bacterial isolation decreased in 49 (70.0%) patients from the study group and in 20 (28.6%) from the control one. Two months of treatment, bacterial isolation ceased in 82.9 and 64.3% in the study and control groups, respectively. In the study group, X-ray trend in infiltration resolution and cavernous closure was significantly better in the study group. By month 4, cavernous closure was achieved in 72.9% in the study group and in 41.4% in the control one. The changes in the cellular composition of the lung in surfactant-treated and untreated patients were analyzed by the data on broncho-alveolar lavage. The findings indicate that inhaled Surfactant-BL as a two-month therapy has a pathogenetic effect and during chemotherapy improves the efficiency of treatment reduces its time in pulmonary tuberculosis.

[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.

[Cellular composition of bronchopulmonary lavage fluid in pulmonary tuberculosis]. / Kletochnyi sostav bronkhoal'veoliarnogo smyva pri tuberkuleze legkikh.

Bronchoalveolar lavage fluids from 219 patients with active pulmonary tuberculosis were analyzed. This may suggest that the lymphocytic reaction in the pulmonary tissue is major in tuberculosis (as in other pulmonary granulomatoses) and different factors among which there are most important ones, including lung tissue decay, bacterial abundance, concurrence of nonspecific inflammation, appear as higher rates and magnitude of neutrophilic reactions. It should be noted that in 19.2% of patients with active pulmonary tuberculosis, the bronchoalveolar fluid cytogram is normal (significantly more common in males), i.e., it shows no lung tissue response to a pathological process.

[Use of monoclonal antibodies for immunodiagnosis of lung cancer]. / Ispl'zovanie monoklonal'nykh antitel dlia immunodiagnostiki raka legkikh.

Fifty-three patients with lung cancer of different histological types and 72 with other lung diseases were examined by employing the panel containing 5 monoclonal antibodies (MAb) in the indirect immunofluorescence test (IFT). with tissue biopsy specimens, lung cancer could be revealed in 100% of patients with glandular carcinomas and adenocarcinoma of the lung, in 89% of those with small-cell carcinoma, and in 61% with squamous-cell carcinoma. With this, MAb reacted with cancer cellular membranes, by causing their fluorescence and failed to react and to cause the luminescence of inflammation cell membranes, the altered and intact bronchoalveolar epithelium in patients cancer and nontumoral diseases of the lung. IFT with MAb to lung cancerous surface antigens with the cells of tissue biopsy specimens may be a supplementation to cytological studies.

[Endoscopic diagnosis of tuberculosis and other granulomatous diseases of respiratory organs: advances and prospects]. / Dostizheniia i perspektivy razvitiia endoskopicheskoi diagnostiki tuberkuleza i drugikh granulematoznykh zabolevanii organov dykhaniia.

The paper presents data on the use of various bioptic methods in phthisiatry and pulmonology. Particular attention is given to granulomatous diseases of the lung whose misdiagnosis may be during clinical examinations in 50-70% of cases. Making the methods of transbronchial biopsies, including those of the lung and bronchoalveolar lavage, better, putting them into practice widely, and developing new studies (microbiological, electron microscopic, immunological, morphological) for biopsy specimens may improve the diagnosis of lung diseases.

[Use of bronchovaxom in the treatment of patients with chronic obstructive bronchitis and bronchial asthma]. / Primenenie bronkhovaksoma v lechenii bol'nykh j khronicheskim obstruktivnym bronkhitom i bronkhial'noi astmoi.

Polyvalent vaccine bronchovaxom (BV) was studied for efficacy against chronic obstructive bronchitis and bronchial asthma exacerbation. Good results were reported: reduction of disability duration, number of recurrences, cough intensity, discharged sputum. Laboratory tests discovered that BV brought about IgE decrease, IgA, T3, T4/T8 increase in bronchoalveolar lavage.

[Cytograms of bronchoalveolar lavage fluid in disseminated lung processes and their correlation with cytomorphological pattern of biopsy specimens]. / Tsitogrammy bronkhoal'veoliarnogo smyva pri nekotorykh disseminirovannykh protsessakh v legkikh i ikh korreliatsiia s tsitomorfologicheskoi kartinoi bioptatov.

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%).

[The status of mucociliary clearance in patients with pulmonary tuberculosis]. / Sostoianie mukotsiliarnogo klirensa u bol'nykh tuberkulezom legkikh.

The authors present the findings of mucociliary clearance (MCC) in 64 patients, including 45 with different forms of pulmonary tuberculosis and 19 with chronic nonspecific pulmonary diseases. MCC was determined with the radioaerosol method with the use of TCK-5 kit human albumin suspension and 99mTc radioisotope. Fibrobronchoscopy was performed in all the patients and a brush bronchial mucosa biopsy in 34 of them. MCC indices in patients with different pulmonary diseases were analysed. The obtained data were compared with the status of the bronchial epithelium from cytologic study of bronchial biopsy specimens. A relationship of MCC drop in case of pathology in the bronchial villous apparatus was revealed.