[Osteal scintigraphy in the evaluation of the course of reparative processes after surgical treatment for tuberculous and nonspecific arthritis, by using constrained bone grafting].

Osteal scintigraphy was used to study the course of reparative processes after surgical treatment in 106 patients with large joint lesions, including 76 patients with tuberculous arthritis and their sequels and 30 with nonspecific and dystrophicones before and 2-3 weeks after operations (those with and without articular tissue revascularization (n = 43 and n = 63); mobilizing (n = 64) and stabilizing (n = 42) operations), of them 22 being performed in late periods (1-3 years (n = 16)). It was established that after mobilizing operations with revascularization, the early postoperative period was marked by a significant increase in radionuclide accumulation (by 1.52 times) and after those without revascularization, there was a less significant rise (by 1.34 times); following stabilizing operations with revascularization, hyperfixation was similar before and after surgery whereas following those without revascularization it significantly reduced (by 1.53% in 70% of patients). The late postoperative period was characterized by reduced hyperfixation, which was more evident after mobilizing operations with revascularization. Osteal scintigraphy quantifies the course of reparative processes and determines the efficiency of different operations.

[Bone tissue metabolic features in tuberculous and nonspecific large joint lesions as evidenced by osteoscintigraphy].

Osteoscintigraphy was employed to study the bone tissue in 405 patients referred for tuberculous arthritis and its sequels or suspected tuberculosis. Tuberculous lesion was identified in 228 patients; there were nonspecific arthritides (n = 69), dystrophic diseases (n = 88), tumors (n = 8), and no bone involvement (n = 12). In active tuberculous ostitis, radiotracer hyperfixation (HF) was found to be marked and it was normal when the disease subsided. In tuberculous arthritis in the arthritic phase (synovitis and in full swing) HF was higher than that in arthrosis; in complicated forms (fistulas and abscesses) HF showed 5-to 15-fold increases in 19.5%. An insignificant HF was observed at the stage of subsidence. In nonspecific arthritis and dystrophic arthrosis, HF depended on the activity and stage of involvement. This procedure could provide an objective assessment of bone tissue changes, by substantially supplementing the basic X-ray study in both the examination of patients and the determination of further treatment policy.

[Sociomedical efficiency of reparative operations in progressive tuberculosis of the hip joint].

The disability rates and life quality indices were analyzed in 69 patients operated on for active tuberculous coxitis revealed a clear-cut advantage of early radical operations in their complex treatment. Prolongation of the time of surgical interventions results in progression of destructive processes in the affected joint, shows a 2.5-fold increase in the disability rates and drastically reduces the quality of their life.

[Adenosine deaminase in the complex diagnosis of different forms of extrapulmonary tuberculosis].

The paper summarizes the results of studies of the activity of adenosine deaminase (ADA) in biological fluids (including that during tuberculin tests) as a tool for the differential diagnosis of different forms of extrapulmonary tuberculosis, such as pleuritis, synovitis, meningitis, tuberculosis of female genitals and peripheral lymph nodes, and uveitis. The threshold for the activity of ADA or the magnitude of its increase in antigenic stimulation, which provides the optimum ratio of the sensitivity to specificity of the tests and their maximum diagnostic efficiency, are given. The optimization of diagnosis of tuberculous synovitis is shown to facilitate the study of ADA activity concomitantly with the determination of the level of antituberculosis antibodies. The tests under discussion are economically sound and yield results in several hours and, in case of a provocative test, in 3 days.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Osseous-perichondral autoplasty in surgery for tuberculosis of the joints]. / Kostno-peikhondrial'naia autoplastika v khirurgii tuberkuleza sustavov.

The results of 68 reconstruction surgeries made in the hip and knee joints in tuberculosis and concomitant diseases were studied. Advantages of operations involving the component plasty of joint ends (osseous autoplasty, as well as auto-perichondral plasty and their variations), including under the conditions of revascularization of the osseous bed, were proven on the basis of the results of a comparative analysis of clinical-and-functional data and X-ray examinations. The use of the method ensuring additional sources for vascularizing the joint tissues improves the conditions of autograft assimilation; the application of perichondral grafting preserves or expands the joint split, which provides an increased mobility amplitude in a damaged joint. The use of perichondral plasty and of its combination with revascularization of the joint osseous joint tissues secured more favorable results as compared to the implementation of osseous-plasty interventions alone.

[Efficiency of plastic surgery for osteoarticular tuberculosis by using revascularization of osseous tissue bed and graft]. / Effektivnost' plasticheskikh operatsii pri kostno-sustavnom tuberkuleze s primeneniem revaskuliarizatsii kostnoi tkani lozha i transplantanta.

The paper provides the results of using original procedures for revascularization of the osseous bed and free bony grafts by transplanting osteovascular complexes in patients with tuberculosis of the hip joint and spine. A total of 20 patients with tuberculous coxitis and 14 with spondylitis were operated on. These interventions were found to have advantages over plastic surgery with bony grafts and mobilizing operations without plasty in similar skeletal lesions, appeared as a great scope of movements in the operated joints is achieved, less time for grafts to adhere with the bed and bony block of vertebrae, and enhanced accumulation of a radioopaque agent in the area to be replaced.

[Experimental rationale and clinical evaluation of perichondroplasty used in surgery for tuberculosis and nonspecific joint diseases]. / Eksperimental'noe obosnovanie i klinicheskaia otsenka primeneniia perikhondroplastiki v khirurgii tuberkuleza i nespetsificheskikh zabolevanii sustavov.

Experiments on 77 rabbits studied the specific features of chondrogenesis during different grafting modifications for the perichondrium. The latter was found to have a high chondroplastic potential. The factors predisposing to cartilaginification and inhibiting this process were identified. Experimental positive results of perichondrial arthroplasty, in tuberculous arthritis as well, were achieved. By taking into account the experimental data, original methods for reparative operations used in patients with tuberculosis and nonspecific diseases of the joints were developed in the clinical setting. Their use in 12 patients yielded positive results, suggesting that the above methods are promising and their further study is advisable.

[Pathogenetic rationale and diagnostic methods in allergic tuberculous synovitis of the knee joint]. / Patogeneticheskoe obosnovanie i metodika diagnostiki tuberkulezno-allergicheskogo sinovita kolennogo sustava.

The pathogenesis of tuberculous allergic synovitis was specified in the experiments on 44 rabbits by applying original simulation methods, including bivalent sensibilization, parallel study of the synovial fluid and serum of laboratory animals. A role of the synovial layer as an organ of immunogenesis and its impact on antibody titers were defined. A new diagnostic test, involving a diagnostic parameter and an equation for its calculation was developed. An algorithm was proposed for examining patients with synovitis (arthritis) of unknown etiology, which includes a set of significant clinical and laboratory parameters. Its testing in 64 patients enabled the tuberculous nature of the disease to be identified in 30% of cases.

[Lipid peroxidation and proteinase inhibitors in experimental osteoarticular tuberculosis]. / Perekisnoe okislenie lipidov i ingibitory proteinaz pri éksperimental'nom kostno-sustavnom tuberkuleze.

Changes in lipid peroxidation parameters (LP), antioxidant system and proteinase inhibitors were studied at different evolutionary stages of experimental osteoarticular tuberculosis in 30 rabbits. All stages of the process were characterized by LP activation which in animals of all groups (except rabbits having the acute stage of arthritis) is accompanied by compensatory increase of superoxide dismutase and ceruloplasmin activity. Deficiency of superoxide dismutase found in the acute stage of arthritis with a growth of LP activity shows its inadequate production at a given stage of articular inflammation. Decrease in alpha 1-proteinase inhibitor activity at the stage of osteitis with reactive synovitis can be caused by the influence of LP products. The importance of this mechanism in the inhibition of alpha 1-proteinase inhibitor, together with reduction in its production at the acute stage of arthritis, cannot be ignored. The results obtained make it possible to recommend further study of the perspectives of antioxidants use in osteoarticular tuberculosis.

[Character of changes in protease inhibitory capacity of blood in experimental osteoarticular tuberculosis]. / Kharakter izmenenii pokazatelei proteazno-ingibitornoi emkosti krovi pri éksperimental'nom kostno-sustavnom tuberkuleze.

All the steps of osteoarticular tuberculosis evolution were accompanied by an increase in proteolytic activity in rabbit blood serum, which was compensated by activation of alpha 1-inhibitor of proteinases at the initial steps of osteitis. The system "proteinases-inhibitors" was imbalanced during the severe phases of arthritis independently on the rate of its development as follows: predominance of proteolytic potential over inhibitory activity, dissimilar activity of alpha 1-inhibitor of proteinases simultaneously with equal rate of alpha 2-macroglobulin content decrease. Dissimilar alterations in the system studied enabled to suggest that differential application of proteinases is suitable for treatment of inflammation with respect to the step of osteoarticular tuberculosis development.

[Substantiation of the use of terrilytin in the treatment of spinal cord disorders in tuberculous spondylitis]. / Obosnovaniia primeneniia terrilitina v lechenii spinno-mozgovykh rasstroistv pri tuberkuleznom spondilite.

Experiments on mice and studies with organotype cultures of the spinal ganglion showed that terrilytin, a proteolytic enzyme had neurite stimulating activity and promoted regeneration of the spinal marrow tissue after affection (squeeze). On the basis of this property and a previously observed favourable effect of the enzyme on microcirculation, the capacity for more rapid rarefaction and elimination of caseous masses and prevention of excessive fibrosis, it was recommended for use in treatment of cerebrospinal disorders in tuberculous spondylitis. A procedure for the treatment was developed. The clinical trials with 46 patients (22 in the main group and 24 in the control group) showed high efficiency of the procedure.

[Changes in intraorganic hemomicrocirculation in renal tuberculosis in the light of experimental morphofunctional studies]. / Izmeneniia vnutriorgannoi gemomikrotsirkuliatsii pri tuberkuleze pochek v svete eksperimental'nykh morfofunktsional'nykh issledovanii.

As a result of long-term (from 1969) and extended (800 rabbits) experimental studies using an original complex of specific methods including intravital microscopy with video recording, new evidence on regulation of intrarenal circulation and its impairment in nephrotuberculosis was obtained. The role of the Trueta shunts in this was shown to be insignificant. Of importance was periglomerular shunting. It was concluded that extended microcirculatory disorders in the region of the intact renal parenchima defining development of renal insufficiency were possibly of tuberculosis allergic origin. Measures for their prevention and treatment are proposed.