[Clinical, x-ray, and laboratory features of tuberculosis and osteomyelitis of the spine].

In 20% of cases, tuberculous spondylitis running with a prevalence of the exudative-necrotic type of a local tissue reaction has an acute onset with febrile fever, severe pains, and progressive neurological disorders and clinically resembles acute hematogenous osteomyelitis of the spine. With a predominance of the productive type of a tissue reaction, tuberculous spondylitis resembles subacute hematogenous osteomyelitis of the spine. History data, laboratory parameters, and an X-ray follow-up are of great importance in its differential diagnosis.

[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.

[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.

[Clinical and laboratory features in tuberculosis and osteomyelitis of the spine]. / Kliniko-laboratornye osobennosti pri tuberkuleze i osteomielite pozvonochnika.

Tuberculous spondylitis runs atypically with its acute onset, high fever, and violent pain in 20% of cases. This disease is characterized by a high specific activity of T lymphocytes, by high levels of antituberculous antibodies, by a higher activity of adenosine deaminase, by higher concentrations of IgA and IgE. The gradual onset and few-symptom course of hematogenous osteomyelitis were revealed in 15% of cases. In osteomyelitis, there was a low concentration of antituberculous antibodies, higher levels of low and medium molecular mass, and IgG.

[TNF-alpha in prognosis of a recovery of the spinal marrow function in patients with spinal tuberculosis]. / Faktor nekroza opukholi alfa v prognoze vosstanovleniia funktsii spinnogo mozga pri tuberkuleze pozvonochnika.

The TNF-alpha significance in forecasting a degree of recovering of the spinal marrow functions was studied in complicated courses of tuberculous spondylitis in 37 patients with generalized and multiple tuberculosis. The TNF-alpha level in the cerebrospinal fluid was found to be related with a severity of inflammation and of neurological disorders, as well as with a degree of spinal marrow compression and with a speed of regression of postoperative disorders in the spinal marrow. The initial TNF-alpha concentration of > or = 400 pg/ml was indicative of a possibility to ensure a fast regression of postoperative disorders in the spinal marrow, while no complete recovery of spinal-marrow functions was observed in cases the TNF-alpha was < 400 pg/ml.

[Immunity in patients with active tuberculous spondylitis]. / Immunnyi status bol'nykh aktivnym tuberkuleznym spondilitom.

Immunological parameters were studied in 45 patients with active tuberculous spondylitis, admitted for surgical treatment, who were divided into 2 groups in accordance with the prevalence of exudative-necrotic, or productive components of inflammation in the vertebral bodies and paravertebral tissues. The patients with a predominantly exudative-necrotic component of inflammation exhibited a severe clinical course with frequent neurological disorders, large abscesses in the paravertebral tissues, inflammatory changes in the leukogram, enhanced specific T-lymphocytic activity in the PPD blast-transformation reaction, significant increases in the levels of tuberculosis antibodies and IgE, IL-2 and it soluble IL-2 receptor RR-alpha, an excessively high increase in the functional activity of neutrophilic granulocytes, and lower with IgG2. The degree of immunological disorders corresponds to the severity of a course of tuberculous spondylitis.

[Experience in standardization of immunological diagnosis of extrapulmonary tuberculosis]. / Opyt standartizatsii immunologicheskoi diagnostiki vnelegochnogo tuberkuleza.

An uniform multi-levelled approach to immunodiagnosis of tuberculosis of different sites is proposed with regard to latest information on the local immune response based on the detection of tuberculosis antibodies in blood and biological fluids from anatomic lesion areas. If necessary, immunological diagnosis is specified by using a set of serological tests and Koch's provocative test, as well as data on specific T-lymphocyte proliferation.

[Surgery on tuberculosis lymphatic system and abdominal organs]. / Khirurgiia tuberkuleza limfaticheskoi sistemy i organov briushnoi polosti.

The paper presents data on surgery for tuberculosis of the lymphatics and abdominal organs. Removal of tuberculosis-affected peripheral lymph nodes during etiotropic therapy yields positive therapeutical results in 84.6% of patients. The efficiency of early operations has been first evidenced by a dynamic study of the systemic immunity. Complicated abdominal tuberculosis is encountered in 44.2% and forced emergency and planned operations on the abdomen to be performed; good late results should be consolidated by combined bactericidal therapy.

[Immunological reactivity in tuberculosis in children]. / Immunologicheskaia reaktivnost' pri tuberkuleznoi patologii u detei.

Immunological reactivity was assessed comparatively in respiratory, intrathoracic and osteoarticular, urinary tuberculosis (122, 133, 38 children, respectively, versus 44 controls). References for age were made. The changes in immune system varied in nature, severity and relationships. Basing on these findings the author has created a complex of most informative tests in the diagnosis of childhood tuberculosis adjusted for age and site of the infection focus.

[A new method of B-cell rosette-forming reaction]. / Novyi sposob postanovki reaktsii B-rozetkoobrazovaniia.

To increase the effectiveness of diagnosing tuberculosis, a new procedure of defining B-rosette forming lymphocytes is proposed. A commercially available product, i.e. dry erythrocytic tuberculous phosphatidic diagnosticum produced by the Leningrad Vaccine and Serum Research Institute and meant for serologic examinations and antiphosphatidic antibody detection, was used in the above reaction for the first time. The following groups were selected for the examination: 51 patients with female genital, locomotor and ocular tuberculosis; 33 persons with nonspecific diseases of the same sites; and 19 donors. A significant drop in the absolute percentage of B-rosette forming lymphocytes (EAC-RFC-ph) in patients with active tuberculosis of all sites was found out. High diagnostic informativeness of the procedure is demonstrated. There was an inverse correlation between the level of antiphosphatidic antibodies and the content of B-rosette forming lymphocytes in tuberculosis patients and the examined controls.