[Periodicity and quality of clinical diagnostics of protracted pneumonia in a tuberculosis clinic].

Analysis of the quality and modes of clinical diagnostics of protracted pneumonia in a tuberculosis clinic revealed the most frequent causes of this condition responsible for hyperdiagnostics of tuberculosis. These are concomitant diseases, pneumosclerosis, chronic bronchitis, fibrous transformation of the bronchial tree, complicated clinical course of pneumonia, age above 60 years, history of tuberculosis, inadequate or short-term antibiotic therapy at the initial stages of diagnostics. Motivational prerequisites for high-quality diagnostic work include compliance with standards and guidelines for the examination and management of patients suspected of having pneumonia with a view to detecting tuberculosis. Such approach would decrease the frequency of ungrounded hospitalization of patients at tuberculosis clinics.

[Linear tomographic scan filtration in the diagnosis of pulmonary globular and cavitary masses].

To enhance the informative value and validity of X-ray study in detecting destructive changes in infiltrates, tuberculomas, and blocked caverns, the authors treated their computed tomographic scans by linear spatial filtration and identification of equidensite fields. In this case, after treatment of an image, the phase of decay in the presence of filtrates was 14.2% and increased up to 36.1%. Cavernous processes are detectable when the scans of blocked caverns that are frequently taken as infiltrates are treated.

[Causes of negative x-ray changes in the lungs of patients with tuberculosis]. / Prichiny otritsatel'noi rentgenologicheskoi dinamiki v legkikh u bol'nykh tuberkulezodm.

The study examines various manifestations and causes of negative X-ray changes (NXC) in the lung of patients with tuberculosis, which were observed by the authors in 7% of cases. Among the causes of NXC, there was a predominance (64.7%) of progressive tuberculosis caused 7 leading predisposing factors, whereas in other cases (35.3%). NXC were due to the addition (exacerbation) of concomitant abnormalities, to the occurrence of adverse reactions to antituberculous drugs, etc. The establishment of these causes facilitates the verification of a diagnosis and promotes the rational use of the bed fund of specialized hospitals.

[Disseminated pulmonary tuberculosis: significance of high-resolution computerized tomography]. / Disseminirovannyi tuberkulez legkikh: znachenie vysokorazteshiushchei KT.

Clinical and X-Ray studies were performed in 85 patients with disseminated pulmonary tuberculosis. All the patients underwent routine computerized tomography (CT) and high-resolution CT. According to the pathogenetic process, the authors identified hematogenic (n = 38), lymphogenic (n = 19), bronchogenic (n = 18) and mixed (n = 10) disseminations. High-resolution CT was found to have great advantages in detecting various types of tuberculous disseminations and in assessing the pattern of pulmonary abnormalities. Disseminated tuberculosis was revealed in 7 patients who had no pathological changes on routine lung X-ray films. The specific signs of hematogenic, lymphogenic disseminations and bronchgenic inoculations were identified in other forms of pulmonary tuberculosis. CT symptomatology is shown to be determined by the pathogenetic variant of its development and the stage of the process. Small focal changes in the lung were prevalent in patients with acute and subacute hematogenic forms of the disease. Infiltrates with decay cavities, thin-wall caverns, emphysema and bronchoectases were detected over the chronic course. Lymphogenic disseminations were characterized by the predominance of interstitial changes along with multiple minor foci. High-resolution CT had advantages in identifying decay cavities, signs of fibrosis and in evaluating mediastinal lymph nodes. CT data are of great significance for differential diagnosis of disseminated tuberculosis with lung metastases and diffuse interstitial diseases.

[Centralized control of the quality of diagnosis and detection of tuberculosis without pulmonary destruction and bacterial discharge]. / Tsentralizovannyi kontrol' kachestva diagnostiki i vyiavleniia tuberkuleza bez destruktsii legkikh i bakteriovydeleniia.

The City Supervision Committee (CSC) has been set up in St. Petersburg to control detection, quality of diagnosis and treatment of new-onset cases of tuberculosis without destruction and bacterial discharge. The CSC members contributed to unification of diagnostic and activity status techniques, helped introduce retrospective survey of fluorograms, raise responsibility of practitioners. The CSC activity was found beneficial for antituberculosis institutions of a large city.

[Effectiveness of fluorography in the prevention and diagnosis of pulmonary tuberculosis and cancer]. / Effektivnost proverochnoi fliuorografii v vyiavlenii tuberkulëza i raka lëgkikh.

Annual fluorographic examinations, involving about 80% of adult population, helped detect 81.6 +/- 0.6% of patients with pulmonary tuberculosis and 37 +/- 0.5% of those with pulmonary carcinoma. Unjustified reduction of the number of prophylactic phorofluorographies resulted in a reduction of the level of diagnosis of these conditions: the share of detected tuberculosis patients reduced to 62.3%. The incidence of bacterial discharge in newly detected cases increased by 19.7%, the disintegration phase increased by 16%. Decrease of the bacillary nucleus parallelled by an almost twofold growth in the number of lethal cases of tuberculosis evidence poor detection of the patients. Reduction in the number of cases of pulmonary carcinoma detected by prophylactic photofluorography resulted in the reduction of operable patients with this condition from 23.5 to 18%. A retrospective analysis of photofluorograms of newly detected patients with destructive tuberculous processes demonstrated the necessity of annual photofluorographic check-ups of the adult population aimed at the detection of pulmonary tuberculosis. The authors emphasize that the intervals between prophylactic check-ups of subjects at risk of developing pulmonary tuberculosis should by no means be prolonged.

[An economic assessment of check-up fluorographic studies in detecting lung cancer]. / Ekonomicheskaia otsenka proverochnykh fliuorograficheskikh issledovanii pri vyiavlenmii raka legkogo.

The diagnostic value and cost-effectiveness of photoroentgenography were assessed on the basis of the data for 1977-1986 provided by 41 health care establishments of Leningrad. The mean overall cost of a single examination including the procedure and analysis was 0.29 +/- 0.01 rubles. Identification of a lesion in the lung, mediastinum or thoracic wall, whatever its nature, costed 18.8 rubles.

[Organization of fluorographic examinations of the population in large cities]. / Ob organizatsii fliuorograficheskikh obsledovanii naseleniia v usloviiakh bol'shogo goroda.

A 5-year experience with fluorographic examination of the population of Leningrad is described. The data show that it is untimely to prolong the intervals between check fluorographic examinations. Difficulties in forming the risk groups are also indicated. Ways for improving organization of fluorographic examinations by using the available reserves are defined. On the whole, the present arrangement of prophylactic fluorographic examinations is rather efficient in regard to early detection of many pulmonary diseases including tuberculosis and peripheral cancer of the lungs.