[Criteria for prediction of recurrent sarcoidosis].

The study based on history data, including age, educational level, social status, smoking, occupational risk factors, and a history of allergy and comorbidity, and on radiation diagnostic and fibroscopic findings could yield criteria for predicting potential recurrent sarcoidosis at the early stages of diagnosis of the pathological process.

[The cytokine profile in granulomatous lung diseases].

Twenty-five patients with new-onset pulmonary tuberculosis, 52 patients with active sarcoidosis, and 5 healthy donors were examined. Cytokines (IL-2, IL-4, IL-6, TNF-alpha, and gamma-1FN were determined by enzyme immunoassay in the serum and cultured mononuclear supernatant from peripheral blood. IL-2, TNF-alpha, and gamma-IFN) were found in the sera of all the examinees. There were significant differences in the presence of IL-4 that was more commonly detected in sarcoidosis than in tuberculosis (96.2% versus 68%; p = 0.001) and in healthy individuals (40%; p = 0.0001) and in the presence of IL-6 (84.6% in patients with sarcoidosis; 20% in healthy individuals; p = 0.0015; 12% in patients with tuberculosis; p < 0.0001). Supernatant studies showed that IL-4 was absent in 25% of patients with sarcoidosis, nor gamma-IFN in 21.7% of patients with tuberculosis and in 12.5% of patients with sarcoidosis. In tuberculosis, the mean levels of IL-2, IL-4, IL-6, TNF-alpha, and gamma-IFN were greater than those in the control group; but these differences were not statistically significant primarily due to the fact that there was a great scatter of readings. In sarcoidosis, the serum levels of IL-4 (40.9 +/- 38.5 pg/ml) and IL-6 (19.0 +/- 2.7 pg/ml) were significantly higher than those in healthy individuals (p = 0.01 and p = 0.026, respectively) and in patients with tuberculosis (p = 0.0005 and p < 0.0001). The supernatant from patients with tuberculosis showed no significant differences in the content of cytokines than that from donors. In patients with sarcoidosis, the increase in the level of TNF-alpha (757.8 +/- 142.8 pg/ml) was statistically significant, as compared with the controls (p = 0.036) and patients with tuberculosis (p = 0.018), so as that of gamma-IFN (272.9 +/- 58.0 pg/ml), as compared with patients with tuberculosis (p = 0.046). Thus, the serum levels of IL-6 and IL-4 and the capacity of monocytes and macrophages for synthesizing TNF-alpha and gamma-IFN may be used as an auxiliary criterion for the nosological diagnosis of sarcoidosis and tuberculosis.

[Free radical processes in the phagocytes of the lung in the diagnosis of granulomatous diseases].

The functional activity of pulmonary phagocytes (alveolar macrophages and macrophages isolated from biopsy specimens) was studied in patients with active sarcoidosis and active tuberculosis, by examining the level of free radical processes in them by luminol-enhanced chemiluminescence (CL). The CL parameters of alveolar macrophages were found to significantly differ in their baseline and peak CL-induced levels and the time of emergence of the peak CL-induced level. The CL level of macrophages isolated from the biopsy specimens does not play a prominent role in the differential diagnosis between these groups of diseases. The time of emergence of the peak of CL-induced alveolar macrophages in response to Mycobacterium BCG strain stimulation is of the most informative value in the differential diagnosis of active tuberculosis and active sarcoidosis. A relationship was found between the clinical and laboratory manifestations and the parameters of free radical processes of pulmonary phagocytes in a granulomatous inflammatory process (in case of sarcoidosis). The CL alveolar macrophage parameters that characterize the activity of the process were related to the magnitude of patients' complaints, the levels of haptoglobin and neutrophils in blood samples. The CL parameters of macrophages isolated from the biopsy specimens correlated with the levels of haptoglobin and gamma-globulin.

[The composition and drug sensitivity of a mycobacterial population in patients with suspected tuberculosis].

By using the diagnostic material (175 sputum samples and 103 bronchoalveolar lavage fluid samples) taken from 39 patients with suspected tuberculous infection during a 2.5-month follow-up, the authors traced the time course of changes in the composition and drug sensitivity of a mycobacterial population to rifampicin. Along with the traditional microbiological studies, the latest molecular biological studies, a TB-BIOCHIP test system (enzyme immunoassay) in particular, were employed to detect the bacterial and L-transformed forms of the causative agent. A molecular biological assay was first developed to detect the drug sensitivity of L-forms of Mycobacterium tuberculosis.

[Viral inclusions of sarcoid granuloma into the epitheliocytes]. / Virusnye vkliucheniia v épitelioidnykh kletkakh sarkoidnoi granulemy.

Electron microscopy was used study the cellular composition of sarcoid granulomas in the lung of 10 patients. In 4 patients, epithelioid cells contained herpes virus virions. In these patients, the disease clinically began acutely, ran along with erythema nodosum; their treatment involved glucocorticosteroids. In the other patients, the cells of sarcoid granulomas did not contain viruses, the granulomas were at the fibrosing stage; diffuse pneumosclerosis was clinically diagnosed. It is suggested that in sarcoidosis, immunity is of not sterile character and the phagocytosis of virus aggregates with epithelioid cells demonstrates the degree of endocytobiosis. This process takes place in tuberculosis, which is a manifestation of the biological expediency of endocytobiosis as this allows infection immunity to be maintained.

[Dynamics of the indices of the immune system as affected by endobronchial laser therapy in patients with complicated tuberculosis of the lungs]. / Dinamika pokazatelei immunnoi sistemy pod vliianiem éndobronkhial'noi lazernoi terapii u bol'nykh oslozhnennym tuberkulezom legkikh.

The results of study of the local and humoral immune defense during endobronchial laser therapy of nonspecific endobronchitis in patients with newly diagnosed pulmonary tuberculosis are presented. Laser therapy proved to have no negative action on the humoral immunity in pulmonary tuberculosis patients during treatment of catarrhal and purulent endobronchitis, while a marked increase in IgM levels, thus rapidly reacting and well opsonizing antibodies can be regarded as a positive or stimulating the impact on the whole immune system. Endobronchial laser therapy for catarrhal and especially purulent inflammatory bronchial process in the multimodality treatment of patients with newly diagnosed pulmonary tuberculosis normalized parameters of the local immune system, especially that of locally secreted immunoglobulins, i.e. helium-neon laser radiation has a favourable influence on local immune defense, which is essential in increasing the efficacy of therapy of this category of patients.

[Study of immunoglobulin E in sera and bronchoalveolar fluid of patients with pulmonary tuberculosis]. / Issledovanie immunoglobulina E v syvorotkakh i bronkhoal'veolarnoi zhidkosti bol'nykh tuberkulezom legkikh.

A highly sensitive sandwich-variety of EIA was used to measure the content of IgE in 144 sera and 59 samples of the bronchoalveolar fluid (BAF) of patients with pulmonary tuberculosis. As compared to normal persons, the content of serum IgE in the patients was significantly increased; the content of IgE in tuberculosis patients appeared as high as that in patients suffering from atopic allergy (pollenosis, bronchial asthma). The highest content of IgE was detected in patients with disseminated pulmonary tuberculosis, in the active disease phase, including those with bacterial isolation. The content of IgE was much higher in a group of patients with delayed process involution and inadequate treatment results than in a group with beneficial treatment results. The findings of the clinicoimmunological analysis permit the high content of serum IgE to be estimated as an unfavourable prognostic sign. In the BAF of patients with pulmonary tuberculosis, IgE was discovered in 30% of cases. A good correlation was noted between the IgE content in the serum and the frequency of IgE demonstration in the BAF.