[The dependence of the inflammatory reaction on the properties of mycobacterium tuberculosis and the course of specific pulmonary process].

The systemic analysis of the inflammatory process in untreated patients with newly diagnosed infiltrative-destructive tuberculosis has been performed in the context of host mycobacterium interaction. Variability of acute phase proteins (APP) reflecting mobilization of nonspecific protective systems of the body did not depend on cytotoxicity of Mycobacterium tuberculosis (MBT). In 87.5% of patients the dependence between effectiveness of antitubercular chemotherapy (for three months) and combination of MBT characteristics and initial APP levels was found. Patients with effectiveness of therapy, which was inadequate to MBT cytotoxicity, were characterized by its dependence on the APP level and MBT sensitivity to antitubercular agents. Results of multifactorial analysis of parameters reflecting intensity of the inflammatory response, pathological process in the lungs, and characteristics of MBT suggest that the overall result of the host-pathogen interactions primarily depend on adequateness of protective systems of the body

[The clinical laboratory comparison in the assessment of treatment prognosis in patients with infiltrative tuberculosis of lungs].

The comprehensive prospective examination of 66 patients with first established non-treated infiltrative tuberculosis of lungs was used to analyze the possibility of optimization of assessment of course of specific inflammatory process on the basis of levels of proteins-reactants of acute phase. The characteristics of dynamics of clinical roentgenologic data and terms of coming of abacillarization as a result of three months anti-tuberculosis therapy has been used as grouping factors. It is established that the constellation of 3 out of 12 basic (before treatment) analyzed level indicators are the most prognostic informative--haptoglobin, ceruloplasmin and blood albumin. Their combined application according the proposed decisive rule provides 90.6% of effectiveness of prognosis of the results of treatment in the discussed category of patients.

[Peculiarities of the circulating phagocytes functional activity in patients with different forms of drug-resistant pulmonary tuberculosis].

Functional activity of circulating phagocytes (macrophages--Ms and neutrophils--Ns) was studied in 30 patients with infiltrative (I) and 30 patients with fibro-cavernous (FC) pulmonary tuberculosis (PT). Difference of the functional activity of both types of cells depending on the PT form was revealed: more significant increase in the oxygen-depending activity in FCPT while bactericide potential estimated with a zymosane induced NST-test was more pronounced in IPT patients. These data correlate with the blood levels of neopterin and elastase, the markers of the M and N activity, respectively. Participation of intracellular ADA in realization of oxygen-depending processes was demonstrated. Results of the multivariant analysis of the whole complex of the studied phagocyte characteristics, reflect their different roles in ther pathological process a prevailing role of Ms in the firstly diagnosed acute tuberculosis process (IPT) and Ns in the chronic progressive process (FCT).

[Comparative significance of the biochemical markers of cell-mediated immunity in the diagnosis of tuberculous pleurisy].

The authors have compared the informative value of the tests determining the activity of adenosine deaminase (ADA) and the levels of interferon-gamma (INF-gamma) and neopterin in the diagnosis of pleural effusions of tuberculous (n = 67) and nontuberculous (n = 30) origin. The equally high diagnostic value has been found in the study of the activities of ADA (94.8%) and INF-gamma, which are markers of lymphocytic cellular immunity. There are great differences in the sensitivity of the neopterin test depending whether tuberculosis is isolated or complicates the course of tuberculosis of the lung or intrathoracic lymph nodes, which may be regarded as a reflection of the different status of macrophageal cellular immunity.

[Assessment of a risk for postoperative infectious complications in patients with fibrocarvous pulmonary tuberculosis].

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

[Laboratory methods for the diagnosis of postpericardiotomy syndrome].

The paper analyzes the diagnostic value of methods for the laboratory diagnosis of postpericardiotomy syndrome (PPS) in patients who have undergone open heart surgery. The prospective study included 63 patients, of whom 53 had the clinical manifestations of PPS. Ultrasensitive assay of serum procalcitonin and the determination of relative albumin levels in pleural and pericardial fluids are noted to be of high diagnostic value.

[Gamma-interferon and adenosine deaminase in the diagnosis of tuberculous pleurisy].

The paper compares the characteristics of the informative value of tests determining the activity of adenosine deaminase (ADA) activity and the level of gamma-interferon (gamma-IFN) for the differential diagnosis of tuberculous pleurisy (n = 35) and non-tuberculous pleural effusion (n = 53). Both tests were ascertained to have the similar differentially diagnostic capacities with their threshold values of 35 U/l and 180 pg/ ml, respectively. At the same time, the sensitivity and specificity of the ADA test were 98.4% and these of the gamma-IFN test were 94.3 and 96.2%, respectively, with the positive and negative predictive value being 91.3 and 98.3% and 94.3 and 96.2%, respectively, and with the diagnostic value of 94.5% for the ADA test and 96.4% for the gamma-IFN test. There was a high unidirectionality of changes in both values: it was higher than the cut-off points in 94.1% of the patients with tuberculous pleurisy and below them in 88.7% of those with other pleural effusions.

[Functional activity of phagocytes of bronchoalveolar lavage in patients with fibro-cavernosis and infiltrative pulmonary tuberculosis].

Functional activity of the bronchoalveolar lavage fluid (BALF) phagocytes was studied in 33 and 16 patients with fibro-cavernosis (FC) and infiltrative (I) pulmonary tuberculosis (PT), respectively. Complex examination of BALF, alveolar macrophages (AM) and neutrophils (N) sedimented from BALF revealed interrelationship between functional activity of the cells and the form of PT. Higher activities in BALF of neopterin and elastase mainly secreted by activated AM and N respectively, reflect a higher secretory activity of both types of cells in FC - PT. These patients are also characterized by more pronounced bactericide activity of Ns, which significantly correlates with adenosine deaminase (ADA) activity. It is suggested that changes in BALF of various biochemical parameters examined (neopterin, elastase, ADA and its isoenzymes, 2-deoxyADA) and bactericide activity of the sedimented cells represent are the consequences of differend sides of BALF phagocytes functioning. According to modem notions about the mechanisms of their regulation different intercellular relations are suggested in different form of PT.

[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.

[Characterization of destructive pulmonary tuberculosis (by the results of a clinicomathematical analysis)].

The results of examination of 56 patients with destructive pulmonary tuberculosis, which involved the study of biochemical parameters characterizing different stages of an inflammatory process, as well as clinical and X-ray findings were analyzed, by applying various multivariate statistical methods. This approach was shown to be promising for estimating the severity of the process and for specifying the stage of development of an inflammatory process in some patients.

[The activity of alpha2-macroglobulin and its forms in patients with destructive pulmonary tuberculosis]. / Aktivnost' alpha2-makroglobulina i ego form u bol'nykh destruktivnym tuberkulezom organov dykhaniia.

A hundred and three patients with destructive pulmonary tuberculosis were examined. These patients had heterodirectional changes in the serum levels of alpha2-macroglobulin (MG) and its forms. The lowering of the level of the F-form of the inhibitor outstripped the decrease in the activity of total alpha2-MG and it was detectable in the lobar processes with moderate symptoms of intoxication and with the inoculation of adjacent segments. The preservation of the low total activity of the inhibitor and its forms during antituberculous therapy characterize a diminished process. The high content of the S form of alpha2-MG is a feature in patients showing positive changes before and 2 months after treatment whereas the changes in total alpha2-MG and its F form may vary. Whether it is expedient to study the fractional composition of alpha2-MG is determined by the heterodirectionality of changes in its S and F forms depending on the pattern of a process.

[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.

[Prediction of the effectiveness of preoperative preparation of patients with fibro-cavernous pulmonary tuberculosis]. / Prognozirovanie éffektivnosti predoperatsionnoi podgotovki bol'nykh fibrozno-kavernoznym tuberkulezom legkikh.

Sixty-three patients with fibrocavernous pulmonary tuberculosis were examined before and 1 month after preoperative therapy with antituberculosis agents. The time course of changes in the clinical and X-ray characteristics of the severity of the disease were compared with the alterations of different biochemical indices, including acute-phase proteins, proteolysis inhibitors, intoxication severity. It was demonstrated that improvement of clinical and X-ray characteristics of the severity of a process after preoperative preparation could be predicted with an accuracy of 83% from the baseline serum concentrations of albumin and ceruloplasmin. The accuracy of prediction does not increase when the levels of protease inhibitors, C-reactive protein, adenosine deaminase, medium-weight molecules are simultaneously studied. The likelihood of the clinical and X-ray characteristics becoming better is higher with enhanced ceruloplasmin activity and decreased albumin levels.

[The activity of adenosine deaminase and its isoenzymes in patients with different forms of pulmonary tuberculosis]. / Aktivnost' adenozindezaminazy i ee izofermentov u bol'nykh s razlichnymi formami tuberkuleza legkikh.

An examination of 144 patients with different forms of pulmonary tuberculosis has revealed that serum adenosine deaminase (ADA) has a higher activity in the patients than in healthy individuals (a control group). The level of its activity is in proportion to the severity of a pulmonary process and achieves its peak in caseous pneumonia. In infiltrative tuberculosis, there is a direct relationship between the activity of ADA, the number of involved segments and bacterial isolation. The activity of ADA has been shown to be increased by its isoenzyme ADA-2. The unidirectional changes in the activity of ADA and the clinical and X-ray characteristics of the disease treated with antituberculous drugs make it possible to recommend this parameter as an additional criterion for evaluating the specific features of a process in the lung and the adequacy of therapy.

[Informative value of adenosine deaminase and 2-deoxyadenosine deaminase in the diagnosis of tuberculous pleurisy]. / Informativnost' adenozindezaminazy i 2-dezoksiadenozindezaminazy v diagnostike tuberkuleznykh plevritov.

Adenosine deaminase (ADA) and 2-deoxyadenosine deaminase (2-deoxyADA) activities were measured in pleural exudation of different origin in 373 patients (124 of these with serous tuberculous pleurisy and 75 with specific empyema). High diagnostic value of ADA activity in the presence of threshold value higher than 35 Units/liter was established: the sensitivity of the test in the diagnosis of tuberculous pleurisy and empyema was 94.4 and 93.3% respectively, specificity 93.0 and 89.5%, respectively. Judging by the coefficient of 2-deoxyADA/ADA, total ADA activity is determined by the activity of ADA-2 isoenzyme, while in tuberculous empyema by ADA-1. Additional use of this coefficient, requiring measurement of 2-deoxyADA activity, does not improve the efficiency of the diagnostic process, including measurement of total ADA activity in pleural exudate.

[Principles in the diagnosis of primary and occult manifestation of tuberculous infection in children]. / Printsipy diagnostiki nachal'nykh i malovyrazhennykh proiavlenii tuberkuleznoi infektsii u detei.

An algorithm of complex examination is proposed for early diagnosis of tuberculosis in children with different manifestations of tuberculous infection. The results of clinical and laboratory studies of 209 children by using the most informative values in its diagnosis may establish it in 81.8% of cases in the outpatient setting. While revealing high specific sensitization, some signs of functional disorders or 1-2 direct X-ray signs of an intrathoracic lymph nodal response were detected in 53.1% of the children with suspected tuberculosis, this condition may be interpreted as a borderline between Mycobacterium tuberculosis infection and disease.

[Characteristics of endogenous intoxication of adolescents with tuberculosis]. / Kharakteristika éndogennoi intoksikatsii u bol'nykh tuberkulezom podrostkov.

The paper shows that there is an association of the pattern of lung lesion with the endogenous intoxication in adolescents patients with pulmonary tuberculosis. Based on the spectrograms of plasma and the levels of low and medium molecular-weight substances, the authors revealed clinical features in relation to the level of endogenous intoxication and to the values of cellular responses.

[Diagnostic and prognostic significance of adenosine deaminase in acutely progressive pulmonary tuberculosis]. / Diagnosticheskoe i prognosticheskoe znachenie adenozindezaminazy pri ostroprogressiruiushchem tuberkuleze legkikh

The paper provides data on the serum levels of adenosine deaminase (ADA) in patients with acutely progressive pulmonary tuberculosis (APPT). The highest levels corresponded to the severity of the disease, high bacterial isolation, the extent of destructive and infiltrative changes in lung tissue, and endotoxemia. This indicates that ADA measurement is an additional criterion for assessing the health status in APPT patients and the magnitude of destructive processes. Moreover, the measurement is of prognostic value as it provides an objective assessment of the course of an acute progressive process an the efficiency of chemotherapy used.