[Morphological signs of inflammatory activity in different clinical forms of drug-resistant pulmonary tuberculosis]. / Morfologicheskie priznaki aktivnosti vospaleniia pri razlichnykh klinicheskikh formakh lekarstvenno-ustoichivogo tuberkuleza.

AIM: to determine whether the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant pulmonary tuberculosis. SUBJECTS AND METHODS: The material taken from 310 patients operated on in 2010-2015 were retrospectively examined. The patients underwent economical lung resections of limited extent (typical and atypical ones of up to 3 segments) for circumscribed forms of tuberculosis with bacterial excretion. A study group consisted of 161 (51.9%) patients with drug-resistant variants of pulmonary tuberculosis. A control group included 149 (48.1%) patients with preserved susceptibility of Mycobacterium tuberculosis to anti-TB drugs. The activity of specific changes in tuberculosis was morphologically evaluated in accordance with the classification proposed by B.M. Ariel in 1998. RESULTS: The highest activity of fourth-to-fifth degree specific inflammation, including that outside the primary involvement focus, was obtained in the drug-resistant pulmonary tuberculosis group due to the predominance of patients with cavernous and fibrous-cavernous tuberculosis versus those in whom the susceptibility to chemotherapeutic agents was preserved. A macroscopic study showed that the primary lesion focus had a median size in one-half of the all the examinees; but large tuberculomas, caverns, and fibrous caverns over 4 cm in diameter were multiple and detected in the drug-resistant pulmonary tuberculosis group. Multidrug resistance was observed in more than 60% of the patients with fibrous-cavernous pulmonary tuberculosis, extensive drug resistance was seen in those with cavernous tuberculosis, which is an aggravating factor. The data obtained from the morphological study of the intraoperative material can specify the clinical form of tuberculosis and evaluate the efficiency of preoperative specific therapy. The highest activity of specific inflammation was observed in patients with multiple drug-resistant pulmonary tuberculosis, the prevalence of third-to-fourth degree specific changes was seen in those with multiple and extensively drug-resistant tuberculosis. CONCLUSION: The findings suggest that the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant tuberculosis and with a spectrum of drug resistance.

[Prognostic value of morphological signs of the activity of tuberculous inflammation in patients with circumscribed drug-resistant pulmonary tuberculosis].

The paper provides the morphological characteristics of a specific process in patients with drug-resistant pulmonary tuberculosis. Morphological study of intraoperative samples has shown a predominance of common active inflammatory changes in most cases. There is evidence for an association of the morphological activity of a tuberculous process with the clinical types and duration of the disease and their spectrum of drug resistance. The high morphological activity of specific inflammation (IV-V) substantially increases the risk of specific postoperative complications and relapses in the late follow-up periods.

[Drug resistance in Mycobacterium tuberculosis during chronic intoxication by tobacco: clinical and experimental studies].

Case histories were studied in 405 smoking patients (including 84 inveterate tobacco smokers) (a study group) and 193 nonsmoking patients (a control group) with new-onset pulmonary tuberculosis. Smoking was found to lead to a significant increase in the cases of drug resistance (including multidrug resistance (MDR)) in Mycobacterium tuberculosis (MBT): the resistant strains were 42.9% in the smokers and 54.4% in the inveterate tobacco smokers versus 31.9% in the control group (p < 0.01). The experiments showed that after two MBT strains (H37 Ra and 4688) had grown on the tobacco smoke condensate media, 57.1% of the experimental cultures were resistant to both one and several agents (including MDR), as shown by a study using the absolute concentration method.

[Tobacco smoke condensate-induced structural changes in Mycobacteria tuberculosis]. / Izmenenie struktury mikobakterii tuberkuleza pod deistviem kondensata tabachnogo dyma.

The paper shows how a tobacco smoke condensate affects the anatomy of Mycobacteria tuberculosis. Gas chromatography was used to detect quantitative changes in the composition of fatty acids. Electron microscopy indicated larger microcolonies, thickened lipid capsular cover, increased number of polysomes in experimental mycobacterial strains.

[Causes of delayed detection of pulmonary tuberculosis]. / Prichiny nesvoevremennogo vyiavleniia bol'nykh tuberkulezom legkikh.

As shown by analysis of 335 case histories, low alertness for tuberculosis among the population and doctors, underestimation of the clinical and anamnestic data, late and inadequate x-ray and bacteriological investigations are responsible for late diagnosis of pulmonary tuberculosis in primary care institutions. Measures to correct the situation are proposed.

[Effectiveness of chemotherapy in combination with electrophoresis and ultraviolet irradiation of blood in newly diagnosed patients with destructive pulmonary tuberculosis]. / Effektivnost' khimioterapii v sochetanii s organnym élektroforezom i ul'trafioletovym oblucheniem krovi u bol'nykh s vpervye vyiavlennym destruktivnym tuberkulezom legkikh.

Efficacy of inpatient treatment was compared for 222 new-onset cases of destructive tuberculosis of the lungs. 86 patients received chemotherapy plus electrophoresis and UV blood irradiation (group 1), 136 patients received chemotherapy alone (group 2). Group 1 patients benefitted more; bacterial discharge ceased in 100%, destruction in 89% of patients within 3 months against 59% and 38%, respectively, in controls. Combined therapy prevents toxic allergic reactions and shortens hospital stay by 48 days.

[Effects of tobacco smoking on the course of infiltrative pulmonary tuberculosis and effectiveness of its treatment]. / Vliianie tabakokureniia na techenie infil'trativnogo tuberkuleza legkikh i éffektivnost' ego lecheniia.

Case records analyzed for 297 smokers and 141 nonsmokers with new-onset infiltrative pulmonary tuberculosis revealed strong relationships between smoking and the disease course, relevant treatment results. In smokers the disease took more severe and disseminated pattern with pulmonary tissue destruction and bacterial discharge. Involution of the specific process in smokers advanced slowly and prolonged hospital stay to 1.2 month. Discontinuation of bacterial discharge took place in 90.1% of smoking patients and in 100% of nonsmokers, the destruction caverns got closed in 58.2% and 76.4%, respectively. Educational antismoking activity and smoking treatment promotion in smoking patients with pulmonary tuberculosis are needed.

[Diagnosis of tuberculosis of gastrointestinal tract]. / Diagnostika tuberculeza zheludochno-kishechnogo trakta.

The article deals with the difficulties of establishing the diagnosis of abdominal tuberculosis. Seven patients were under observation. In 5 the diagnosis was made histologically after operative intervention. In 6 patients abdominal tuberculosis was combined with a specific process in the lungs. Two cases of tuberculosis of the stomach, intestine, and mesenteric lymph nodes following a course resembling that of an abdominal "tumor" are described. For the exclusion of tuberculosis it is recommended that fluorographic examination of the lungs should be included in the complex preoperative management of patients.