[Computed tomography in evaluating the development of different types of pulmonary fibrosis in patients with interstitial lung diseases].

OBJECTIVE: to assess the favorable and unfavorable types of lung tissue fibrotic changes in patients with interstitial lung diseases (ILD) detected by high-resolution computed tomography (HRCT). MATERIAL AND METHODS. The results of examinations were analyzed in 385 patients: 181 with respiratory organ sarcoidosis, 130 with fibrosing alveolitis, 36 with histiocytosis X, and 38 with lymphangiolciomyomatosis. All the patients underwent HRCT; the data were compared with the results of comprehensive functional study of external respiration (CFSER), histological examination (in 70.1%), and the pattern of the disease. RESULTS: Comparison of the clinical and functional course of ILD with the types of lung tissue fibrotic changes detected by HRCT and morphological examination showed that the favorable types of pulmonary fibrosis included stringy central and peripheral interstitial fibrotic changes and the atelectatic type of fibrosis, the occurrence of which failed to affect the development of obvious perfusion and diffusion disorders and to give rise to respiratory failure. The unfavorable types of pulmonary fibrosis included the peripheral pulmonary interstitial fibrotic changes (acinar fibrosis, honeycomb lung), which led to restrictive changes and perfusion disorders, which were accompanied by significant respiratory failure, decreases in quality of life and survival, as well as fibrotic changes in the walls of long-lasting air-containing cysts and a fibrotic Aevity mass that resulted Ind complications (pulmonary hemorrhage, pneumothorax, and pneumomediastinum). CONCLUSION: The type of pulmonary fibrosis development is one of the major prognostic criteria for he course of ILD. HRCT makes it possible to assess its clinical picture as a whole and to reveal the type of development of fibrotic changes, their extent, the degree of involvement of the tracheobronchial tree in the process (formation of different types of bronchiectasis), concomitant extrapulmonary changes that may be clinically and functionally relevant (chest bone frame deformation, varying pleural changes, vascular disorders). Estimation of prognosis of the disease is most effective in comparing clinical, morphological, HRCT, and CFSER data.

[The morphological examination in the differential diagnosis of tuberculosis and sarcoidosis].

The paper considers the results of histological and bacterioscopic examinations of biopsy specimens from the lung and mediastinal lymph nodes of 120 patients with an unclear diagnosis of tuberculosis and sarcoidosis and with problem of their differential diagnosis. One hundred and five of these patients were microscopically diagnosed as having either tuberculosis or sarcoidosis. Additional examination of differently stained sections and that using immunohistochemical M. tuberculosis detection were conducted in 15 cases, which could diagnose tuberculosis and sarcoidosis in 7 and 8 patients, respectively. Bacterioscopic examination, in terms of extreme variability the phenotypic properties of mycobacteria, is of decisive importance in the differential diagnosis of tuberculosis and sarcoidosis.

[Multicenter retrospective analysis of the patients with sarcoidosis with a 10 year interval in observations].

Comparison of the state of 83 patients with histologically confirmed sarcoidosis observed with a 10 year interval revealed remission in 47% of the cases. The main factors having negative effect on prognosis of the disease included extrapulmonary symptoms, the use ofcorticosteroids (at all stages, especially at stage I and in Lofgren syndrome) and antituberculosis drugs, positive TB test. Risk factors of relapses were stage II sarcoidosis, the use of systemic corticosteroids in patients with Lofgren syndrome and antituberculosis drugs, initially low FEV1/FVLC ratio and the number of lymphocytes in peripheral blood.

[Transbronchial biopsy of the lungs in diagnosis of respiratory sarcoidosis].

AIM: To specify diagnostic potentialities of transbronchial biopsy of the lungs (TBB) in respiratory sarcoidosis (RS). MATERIAL AND METHODS: TBB of the lungs was performed in bronchofibroscopy under local anesthesia and TV x-ray control with intake of 4-5 biopsy specimens. RESULTS: Biopsy specimens consisted primarily of alveolar tissue in 62.5% patients, of bronchial wall - in 34.8%, were insufficiently informative - in 2.4% patients. Histological examination of the biopsies detected sarcoid granulemas which served the basis for RS diagnosis in 62.5% patients (stage 1 - 51.1%, stage 2 - 70.4%, stage 3 - in 61.6%). Sarcoid granulemas were detected more frequently in alveolar tissue than in bronchial walls (75.3 and 38.5%, respectively, p < 0.05). In RS stage 1 granulemas in the bronchial walls were found less often than in stages 2 and 3 (56.3, 42.9%, respectively, p < 0.01). CONCLUSION: TBB provides morphological RS diagnosis in 2/3 patients and is a safe method. Obtaining biopsies containing alveolar tissue raises efficacy of TBB, especially in the disease stage 1.

[Endobronchial biopsy in the diagnosis of pulmonary sarcoidosis].

Bronchofiberscopy (BFS) with endobronchial biopsy (EBB) was performed in 66 patients with pulmonary sarcoidosis (PS). Transbronchial biopsy (TBB) was made in 49 patients from this group to compare the diagnostic value of EBB and TBB. The normal endoscopic picture was observed in 19.6% of patients. Bronchial mucosal hypervascularization and thickening were found in 25.7% of cases; the signs of enlarged bronchopulmonary lymph nodes were detected in 13.6%; catarrhal endobronchitis in 10.6%, and tuberosity changes in 4.5%. Epithelioid granulomas in the bronchial mucosa were identified in 37.8% of cases (30.75 and 39.6% in the intact and abnormal mucosa, respectively). The diagnostic value of TBB was 65.3%. EBB could reveal epithelioid-cell granulomas in 4 of the 17 patients with negative TBB. The findings suggest that BFS with EBB should be included as a necessary diagnostic method for the examination of patients with PS.

[Pulmonary lymphangioleiomyomatosis].

A clinicomorphological analysis of 41 pulmonary lymphangioleiomyomatosis (PLAM) cases has been performed. Focal (7 cases) and diffuse (34 cases) forms were identified. Expression of NMB-45, desmin, actin, vimentin prove myogenic nature of the disease and confirm combination of two morphogenesis directions - proliferation of smooth muscle cells at the active phase of the growth and fibrosis at late stages. The presence of estrogen and progesteron receptors in smooth muscle cells shows hormonal dependance of cell proliferation. Thus, LAM is multisystem disease linked with abdominal tumors (angiomyolipomas, angioleiomyomas). Prognosis in the focal form is favourable, that in the diffuse form- unfavourable.

[Weight-reducing diet therapy in the combined treatment of pulmonary sarcoidosis]. / Razgruzochno-dieticheskaia terapiia v kompleksnom lechenii sarkoidoza legkikh.

We have studied the effect of therapeutic fasting in 76 patients with pulmonary sarcoidosis (28, 45 and 3 patients with stage I, II and III, respectively). Fifty-two patients with PS stage I, II and minimal clinical symptoms received fasting alone. Twenty-four patients with PS stage II, III and frequent recurrences received combined treatment (fasting and oral corticosteroids). The efficacy of the treatment was evaluated by clinical symptoms, X-ray picture, pulmonary capillary blood flow and immunological parameters. We have found that therapeutic fasting reduced clinical symptoms in 85% of the patients, improved x-ray picture in 62% of the patients. Positive trend was also registered in immunological parameters. Therapeutic fasting produced maximal positive effect in patients with PS stage I, II and duration of the disease less than 1 year. Patients with PS stage II, III and the disease duration more than 1 year should be treated with fasting in combination with corticosteroids.