[Comparative analysis of the semiotics of disseminated pulmonary tuberculosis and exogenous allergic alveolitis in accordance with the data of computed tomography].

OBJECTIVE: to improve the differential diagnosis of disseminated pulmonary tuberculosis (DPT) and exogenous allergic alveolitis (EAA) via comparative investigation of their computed tomography (CT) semiotics and identification of the most informative diagnostic criteria. MATERIAL AND METHODS: 70 patients, including 40 patients with DPT in a phase of infiltration and 30 patients with acute EAA, were studied using a Somatom Emotion 16 multi-slice spiral CT scanner (Siemens). All the patients underwent spiral scanning from the upper chest aperture to the costodiaphragmatic recesses with a high CT algorithm at 0.8-mm slice thickness and a 1.5-mm step. RESULTS: Analysis of the spread of dissemination foci established that pathological changes were peribronchovascularly located in both nosological entities and characterized by a preponderance of septal and intrabronchial locations in DPT and by a centrilobular distribution in EAA. Centrilobular foci were more commonly poorly defined in EAA and mixed foci were observed in DPT. In the latter, peribronchovascular, centrilobular foci were revealed at a distance from the visceral pleura (the boundary of the deep and superficial lymphatic network, respectively) in 38% and more than half of the cases (62%) with the involvement of the visceral and parietal pleura; in EAA, the centrilobular foci were more often combined with the involvement of the visceral pleura in more than 92% of cases. The tree-in-bud sign was significantly more common in DPT. The latter was mostly characterized by apicocaudal regression of dissemination. In EAA, the foci were more frequently located asymmetrically. Monomorphic foci with destruction, as well as their polymorphism were seen in DPT; those without destruction were predominantly observed in EAA. CT ground glass and mosaic perfusion syndromes were significantly more often in EAA. In DPT, the visceral and parietal pleuras were involved in the process in 62% of cases and changes were also more common in the extrapleural fat. CONCLUSION: In addition to the peribronchovascular location of foci, the characteristic CT signs for DPT are a preponderance of intrabronchial and septal locations of foci, their apicocaudal regression, the presence of the CT tree-in-bud sign, and thickened extrapleural fat. EAA showed a prevalence of asymmetrical foci with centrilobular location with the involvement of the visceral pleura into the process, with the presence of CT ground glass and mosaic perfusion syndromes, as well as the bronchial lumen visualized in the peripheral segments of the lung.

[The radiation therapy of skin cancer of the face]. / Luchevaia terapiia raka kozhi litsa.

Results of three-year radiotherapy are assessed in 586 patients with skin cancer, with tumors localized on the skin of the face in 484 of these. The results of treatment were found to depend on the histological structure of the tumor and disease stage: 100% cure was attained in patients with basal-cell carcinomas and T1 stage, whereas only 7% of patients with T4 stage were cured; in patients with squamous-cell carcinoma these figures were, respectively, 96.2 and 10%.

[Probit analysis in assessing the results of radiation therapy of disseminated cancer of the tongue and floor of the mouth]. / Probit-analiz v otsenke rezul'tatov luchevoi terapii rasprostranennogo raka iazyka i dna rta.

The results of radiation therapy were compared in 217 patients at advanced stages of cancer of the tongue (131) and fundus of the mouth (86) using split courses of conventional (SCF) and dynamic fractionation (SDF) and SDF combined with metronidazole. Dose-effect curves were evaluated by probit-analysis. SCF at a total focal dose increased from 64-76 up to 78-82 Gy did not improve therapeutic results. The predicted limits of efficacy were higher in SDF as compared to SCF. The most effective was the use of SDF in combination with metronidazole (one year after therapy discontinuation 52% of patients with cancer of the tongue and 36% of patients with cancer of the fundus of the mouth were alive). In a total focal dose increased up to 68-72 Gy a rise of efficacy in T3 was 11% for cancer of the tongue and 18% for cancer of the fundus of the mouth. This method permits the evaluation not only of the predicted limits of efficacy but also of a probable rate of improvement in a raised TFD.

[Radiotherapy, using metronidazole, of regional lymph node metastases of cancer of the oral mucosa]. / Luchevaia terapiia s metronidazolom metastazov v regionarnye limfaticheskie uzly raka slizistoi obolochki polosti rta.

Altogether 67 patients with oral mucosa cancer metastases to the regional lymph nodes were given a split course of gamma-beam therapy with traditional dose fractionation and dynamic fractionation. Radiotherapy in the presence of metronidazole radiosensitization was given to 40 patients. Metronidazole was administered per os 3 = 4 h before irradiation with fractions I, III and V of each phase of a split course. A single dose of metronidazole was 5 g/m2, a summary dose 30 g/m2. Radiotherapy with metronidazole resulted in a 2-year cure of 17.5 +/- 6% of the patients. The therapy was the most effective in patients with metastases of diameter up to 2 cm. The results of therapy of oral mucosa cancer metastases to the regional lymph nodes were better in the use of the dynamic fractionation regimen.

[Radiation treatment with metronidazole in patients with oral mucosa cancer in the late stages]. / Luchevoe lechenie s primeneniem metronidazola bol'nykh rakom slizistoi obolochki polosti rta v pozdnikh stadiiakh.

Eighty patients with cancer of the oral mucosa at late stages were treated by a split course of gamma-beam therapy in two variants of dose fractionation as an independent therapeutic method. Metronidazole (at a summary dose of 30 g/m2) was given to 40 patients 3-4 h before irradiation. Short-term results of a 6-month-follow up have shown that radiation therapy with metronidazole improves the results. Six months after termination of gamma-beam therapy 30 patients have been alive, after radiation therapy with metronidazole 38 patients.