[Laser therapy in the complex treatment of prostatic tuberculosis at the sanatorium stage of rehabilitation].

Seventy nine patients with prostatic tuberculosis were examined and treated at the specialized "Glukhovskaya" sanatorium. All the patients were divided into 2 groups: a study group and a control one. In the study group patients, low-intensity laser radiotherapy was additionally performed in combination with etiological and pathogenetical treatments. The performed studies demonstrated that in the patients exposed to low-intensity laser radiation, there was a rapid relief of dysuric symptoms, cessation or diminishment of the signs of copulative dysfunction; positive changes in life quality indices and laboratory parameters were statistically significantly more frequently and more rapidly recorded. Laser therapy simultaneously was found to affect a few links of the pathogenesis of genitourinary tuberculosis, to have limited number of contraindications, to be well tolerated, and to be an effective method of the complex treatment of patients with prostatic tuberculosis during sanatorium rehabilitation.

[Surgical treatment of patients with micro-cystitis of tuberculous and other etiology].

The urinary bladder was reconstructed by using different segments of the gastrointestinal tract in 45 patients aged 21 to 72 years. The indication for surgery was microcystis of tuberculous and other etiology in 28 (62.2%) and 17 (37.8%) patients, respectively. The overall post-operative mortality was 2.2% (1 patient). Early and late complications were observed in 17.8 and 30.4% patients, respectively. Analysis of the causes of complications has indicated that they are associated with the urine diversion method and with the scope of urinary bladder resection. Seven repeated operations were performed. Augmentation cystoplasty should follow subtotal microcystectomy. For correction of azotemia and for prevention of stricture in the early postoperative period, the neocystis should be continuously irrigated with antiseptic solutions in order to eliminate urine, mucus, and blood clots.

[Diagnosis and treatment of urinary bladder dysfunctions in patients with nephrotuberculosis].

A combined, including urodynamic, study was made in 129 patients with abnormal reservoir function of the urinary bladder (UB). Of them, 82 patients had nephrotuberculosis (NT). Cystoscopy was made in 93 patients, endovesical multifocal biopsy of the bladder wall-- in 23. Correction was conducted with alpha-adrenoblocker alfusozine. In NT, sensory functional disorders of UB prevail (60%). The degree of fibrous-inflammatory involvement of the bladder wall by biopsy findings and severity of urodynamic disorders do not correlate (r < 0.03). Miction recovered in 81.5% patients with NT taking alfusozine. Ileocystoplasty (n = 20) was made in treatment failure and total UB fibrosis. Long-term pathogenic action of specific infection on the neuroreceptor system of the UB may cause defects in its activity. Complex urodynamic investigations of the lower urinary tracts in NT patients identify the type of the disorder and help in making choice of pharmacological or surgical correction. Alfusoxine is a drug of choice in UB hypersensitivity.

[Surgical treatment of obstructive urinary tract diseases in patients with pulmonary tuberculosis]. / Khirurgicheskoe lechenie obstruktivnykh zabolevanii mochevyvodiashchikh putei u bol'nykh tuberkulezom legkikh.

The paper presents the data of an examination of 92 patients [males (59-64.1%) and females (33-35.9%)] with active pulmonary tuberculosis concurrent with obstructive urinary tract diseases of various etiology. The patients' age ranged from 39 to 90 years (mean 58.2 +/- 2.5 years). Seventy-six (82.0%) patients suffered from infiltrative tuberculosis; 12 (13.0%) and 4 (4.3%) patients had cavernous and fibrocavernous tuberculosis, respectively. A relationship was found between pulmonary tuberculosis and obstructive urinary tract diseases leading to uniform changes in the upper urinary tract. The use of currently available methods for examination and treatment to eliminate infra- and supravesical obstruction permits performance of surgical interventions in patients with active pulmonary tuberculosis.

[Neutrophilic and lymphocytic factors of an immune response in renal tuberculosis]. / Neitrofil'nye i limfotsitarnye faktory immunnogo otveta pri nefrotuberkuleze.

Fifty-eight patients with nephrotuberculosis at its peak were found to have a high functional activity of neutrophilic granulocytes, as determined by the lysosomal cation test, by the levels of myeloperoxidase and lactoferrin. The subpopulation of lymphocytes, concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), as well as those of IL-2 in a combination with its soluble receptor (SR-2) in the serum and supernatant of cellular cultures stimulated by phytohemagglutitin and PPD were studied. The findings suggest that there is a close correlation between the high concentrations of IL-2 and PP-alpha and the decreased content of activated lymphocytes expressing receptors to IL-2 (CD25+). Clinical remission has been ascertained to be attended only by a partial normalization of immunological parameters with antituberculous therapy.

[Lymphotropic therapy with antitubercular agents in the treatment of tuberculous epididymitis]. / Limfotropnaia terapiia protivotuberkuleznymi preparatami pri lechenii tuberkuleznogo épididimita.

Whether endolymphatic intranodular injection (ELII) of isoniazid can be used in the combined treatment of male genital tuberculosis is considered. Clinical trials were performed and this method used in the combined treatment of tuberculous epididymitis was assessed. The bacteriostatic activity and blood and tissue concentration of the agent given as ELII were studied and compared with its intramuscular route of administration. The authors show it possible to employ scrotum ultrasound studies to evaluate the efficiency of treatment and estimate the scope of a surgical intervention. Based on the data of morphological study of postoperative specimens, the authors defined the time and worked out criteria for epididymectomy in tuberculous epididymitis.

[Spectrum of tuberculosis antibodies in patients with tuberculosis and borderline urinary tract diseases]. / Spektr protivotuberkuleznykh antitel u bol'nykh tuberkulezom i pogranichnymi zabolevaniiami mochevydelitel'noi sistemy.

The spectrum of tuberculosis antibodies detectable by indirect hemagglutination test, complement consumption, passive hemaagglutilution test (PHAT), and enzyme-linked immunosorbent assay (EISA) in patients with urinary tract diseases (tuberculosis, nonspecific disorders) was studied. In untreated bacteria-isolating patients in the early phase of disease, antibodies were found in 61.8%, their different types were detectable at different rates so it is more advisable to explore responses by using several serological tests. During treatment there is an increase in antibody detection rates by ELISA. At this time only can PHAT and ELISA be made. High seropositive rates (85-100%) are ensured by PHAT and ELISA in new case in end-stage disease. The antibodies are detected in 75 of the pretreated patients with nephrotuberculosis largely by PHAT and ELISA. Examination of patients with nonspecific disease by ELISA clarifies the clinical status of these patients.

[Surgical treatment of renal tuberculosis]. / Operativnye metody lecheniia nefrotuberkuleza.

The analysis of the results of surgical treatment of 178 patients with destructive nephrotuberculosis indicates that operative methods are justified in the treatment of nephrotuberculosis as they provide cleansing of the infection focus, restoration of renal and urinary tract function, help to avoid long-term and massive chemotherapy. Organ-preserving and reconstructive operations on the kidneys and urinary tracts in early disease.

[Epidemiological and clinical aspects of extrapulmonary tuberculosis in North-Western Russia]. / Epidemiologicheskie i klinicheskie aspekty vnelegochnogo tuberkuleza na Severo-Zapade Rossii.

North-western Russia is characterized by poor extrapulmonary tuberculosis (EPT) epidemiological trends. There is an increase in the incidence of EPT mainly in childhood and youth. Due to incomplete and untimely detection of extrapulmonary tuberculosis, the decreased level of recorded parameters and its severe clinical pattern are observed in most areas.

[Evaluation of complex therapy efficiency for urogenital tuberculosis]. / Otsenka éffektivnosti kompleksnoi terapii tuberkuleza mochepolovykh organov.

It is most expedient to develop effective modes of improving the etiotropic therapy of urogenital tuberculosis, by applying the multipronged approach which includes chemoenzyme therapy with native and immobilized terrilytine, enhanced activity of basic tuberculostatic agents through their combination with nonspecific antibiotics and the use of helium-neon laser, and delivery of drugs just to the focus of tuberculous inflammation by endolymphatic injection.

[Clinical and epidemiological characteristics of patients with eye tuberculosis]. / Kliniko-épidemiologicheskaia kharakteristika bol'nykh tuberkulezom glaz.

The study has analyzed 514 new cases of eye tuberculosis registered in the dispensaries of 23 regions. Eye tuberculosis more frequently affects young and middle-aged women, urban citizens, persons who have adequate living and domestic conditions, moderate income, who are clerks or skilled workers, who have no bad habits, who suffer one or two concurrent diseases, who have no opportunity of receiving adequate treatment in a hospital or sanatorium due to familial or professional circumstances and more commonly those whose posterior eyeball is involved (chorioretinitis). Of great concern is eye tuberculosis detected in 87.4% of referrals, which determines the high proportion of advanced and far-advanced cases.

[Characteristics of nephrotuberculosis in children, adolescents and young persons]. / Osobennosti techeniia nefrotuberkuleza u detei, podrostkov i lits molodogo vozrasta.

According to the author, urogenital tuberculosis in children and young subjects occurs in 10% of all the cases with this disease. Antituberculosis service registers 71.2% of cases in preschool children, whereas in schoolchildren 70.4% of diagnoses are made by general practitioners. 90% of nephrotuberculosis cases are detected early, in 85% bacteriological examination.

[Current methodologic approaches to the study of epidemiology extrapulmonary tuberculosis in the Russian Federation]. / Novye metodologicheskie podkhody k izucheniiu épidemiologicheskoi situatsii po vnelegochnomu tuberkulezu v Rossiiskoi Federatsii.

The study of the extrapulmonary tuberculosis epidemiological situation by using the routine methods leads to misinterpreted and subjective assessment of epidemiological parameters. The application of untraditional epidemiological analysis allows one to ascertain that in 1986-1990 the extrapulmonary tuberculosis epidemiological situation in the areas where the Saint-Petersburg Research Institute of Phthisiopulmonology is monitoring it is very similar to the average federation situation both in the incidence of active extrapulmonary tuberculosis and in the magnitude of changes in the rates of its incidence and prevalence. The lack of significant extrapulmonary tuberculosis shifts is the evidence that the existing measure system for detecting and treating patients in the areas (in the Far Eastern areas and autonomous districts of the Far North in particular) is far from perfect and it yields no adequate results in the prevention, treatment and diagnosis.

[The possibilities for improving the organization of the surgical treatment of extrapulmonary tuberculosis]. / Vozmozhnosti sovershenstvovaniia organizatsii khirurgicheskogo lecheniia vnelegochnogo tuberkuleza.

An examination of 1230 patients with an analysis of results of the data obtained has proved rationality of using the evolutionary pathogenetic classification. New information was obtained on the relation of stages of the disease development with the duration and activity of the pathological process which allows orientation of specialists to the development of corresponding trends in surgical treatment of extrapulmonary tuberculosis, radically prophylactic and restorative operations in particular.

[Paraspecific changes in the kidney in experimental tuberculosis of extrapulmonary localization]. / Paraspetsificheskie izmeneniia pochek pri vnelegochnykh lokalizatsiiakh tuberkuleza v éksperimente.

The renal specimens from experimental animals infected and exposed to antigenic materials (killed mycobacteria) by various routes with and without specific sensitization were examined histologically and morphometrically. Under all the experimental conditions, there were impairments associated with immune inflammation in the renal tissue: increased capillary permeability, interstitial lymphohistocytic infiltration and sclerosis and secondary lesions in the renal tubules. The renal dysfunction observed in patients with tuberculosis of various localization can be associated with such affections.

[Effect of terrilytin on tissue bacteriostatic activity in the chemotherapy of renal and female genital tuberculosis in an experiment]. / Vliianie terrilitina na bakteriostaticheskuiu aktivnost' tkanei pri khimioterapii tuberkuleza pochek i zhenskikh polovykh organov v éksperimente.

The effect of terrilytin on the bacteriostatic activity of the tissues (BAT) under conditions of antibacterial therapy was studied on experimental models of tuberculosis of the kidneys and female genitalia in 46 rabbits. It was shown statistically that terrilytin promoted an increase in the BAT and might be used as an agent increasing the effect of antibacterial therapy of tuberculosis. The level of the increase of the BAT depended on its initial level which was inversely proportional to the level of the lesions. At the same time the effect of terrilytin was directly proportional to the level of these lesions unfavourable for the drug penetration into the tissues and tuberculous foci. The results of the study are promising in increasing the efficacy of antibacterial therapy of extrapulmonary tuberculosis of the above localizations by the use of terrilytin.