[Osteal scintigraphy in the evaluation of the course of reparative processes after surgical treatment for tuberculous and nonspecific arthritis, by using constrained bone grafting].

Osteal scintigraphy was used to study the course of reparative processes after surgical treatment in 106 patients with large joint lesions, including 76 patients with tuberculous arthritis and their sequels and 30 with nonspecific and dystrophicones before and 2-3 weeks after operations (those with and without articular tissue revascularization (n = 43 and n = 63); mobilizing (n = 64) and stabilizing (n = 42) operations), of them 22 being performed in late periods (1-3 years (n = 16)). It was established that after mobilizing operations with revascularization, the early postoperative period was marked by a significant increase in radionuclide accumulation (by 1.52 times) and after those without revascularization, there was a less significant rise (by 1.34 times); following stabilizing operations with revascularization, hyperfixation was similar before and after surgery whereas following those without revascularization it significantly reduced (by 1.53% in 70% of patients). The late postoperative period was characterized by reduced hyperfixation, which was more evident after mobilizing operations with revascularization. Osteal scintigraphy quantifies the course of reparative processes and determines the efficiency of different operations.

[Bone tissue metabolic features in tuberculous and nonspecific large joint lesions as evidenced by osteoscintigraphy].

Osteoscintigraphy was employed to study the bone tissue in 405 patients referred for tuberculous arthritis and its sequels or suspected tuberculosis. Tuberculous lesion was identified in 228 patients; there were nonspecific arthritides (n = 69), dystrophic diseases (n = 88), tumors (n = 8), and no bone involvement (n = 12). In active tuberculous ostitis, radiotracer hyperfixation (HF) was found to be marked and it was normal when the disease subsided. In tuberculous arthritis in the arthritic phase (synovitis and in full swing) HF was higher than that in arthrosis; in complicated forms (fistulas and abscesses) HF showed 5-to 15-fold increases in 19.5%. An insignificant HF was observed at the stage of subsidence. In nonspecific arthritis and dystrophic arthrosis, HF depended on the activity and stage of involvement. This procedure could provide an objective assessment of bone tissue changes, by substantially supplementing the basic X-ray study in both the examination of patients and the determination of further treatment policy.

[Suboccipital tuberculosis: the clinical and radiation and potentialities of current surgical treatment].

The clinical and radiological manifestations of suboccipital tuberculosis have been analyzed in 7 patients aged 7 to 35 years. A case of this condition accompanied by extensive vertebral destruction, abscesses, and basilar impression is described in a 7.5-year-old child. A radical stabilizing operation was successfully performed using the currently available technologies.

[Current radiotherapy for extrapulmonary tuberculosis].

Radiation studies are prominent in the diagnosis of extrapulmonary tuberculosis. X-ray study preserves its basic value. Its-based concepts of the pathology of osteoarticular, urogenital, lymphabdominal tuberculosis largely allow for analyzing the images obtained by new medical visualization techniques, such as X-ray tomography, computed tomography, magnetic resonance imaging, ultrasonography, and radionuclide studies. Each method has its merits and demerits and is used by a certain algorithm at different sites of extrapulmonary tuberculosis.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.

[Osseous-perichondral autoplasty in surgery for tuberculosis of the joints]. / Kostno-peikhondrial'naia autoplastika v khirurgii tuberkuleza sustavov.

The results of 68 reconstruction surgeries made in the hip and knee joints in tuberculosis and concomitant diseases were studied. Advantages of operations involving the component plasty of joint ends (osseous autoplasty, as well as auto-perichondral plasty and their variations), including under the conditions of revascularization of the osseous bed, were proven on the basis of the results of a comparative analysis of clinical-and-functional data and X-ray examinations. The use of the method ensuring additional sources for vascularizing the joint tissues improves the conditions of autograft assimilation; the application of perichondral grafting preserves or expands the joint split, which provides an increased mobility amplitude in a damaged joint. The use of perichondral plasty and of its combination with revascularization of the joint osseous joint tissues secured more favorable results as compared to the implementation of osseous-plasty interventions alone.

[Computed tomography in the diagnosis of tuberculous spondylitis complicated by neurological disorders]. / Komp'iuternaia tomografiia v diagnostike tuberkuleznogo spondilita, oslozhnennogo nevrologicheskimi rasstroistvami.

Computed tomographic data were studied in 50 patients with evolutional forms of tuberculous spondylitis and 3 patients with its sequels. 95% of the patients were operated on. Cross sections displayed 3 variants of vertebral body destruction in tuberculous spondylitis. The vertebral canal was evaluated in 28 patients with neurological disorders and in 22 patients without them. Epidural abscess was revealed in all the patients with neurological disorders and in 12 patients without them. There was a relationship of the severity of neurological disorders as classified by Frankel et al. to the degree of stenosis of the vertebral canal, to the presence of its reserve space, and to the extent of vertebral and spinal lesion. The informative value of computed tomography in detecting spinal cord compression was 98.1 +/- 1.8%.

[Ultrasound diagnosis of retroperitoneal abscesses in spinal tuberculosis]. / Ul'trazvukovaia diagnostika zabriushinnykh abstsessov pri tuberkuleze pozvonochnika.

Sixty four patients were examined to elucidate the capacities and accuracy of ultrasonography (USG) in the diagnosis of retroperitoneal abscesses by ultrasound and X-ray studies. They were all operated on. Retroperitoneal abscesses were detected in patients (58 observations). X-ray retroperitoneal abscesses aroused doubts in 23% of cases. Ultrasonographic evidence was erroneous in 4.9% of cases. USG may reveal accumulation or absence of liquid pus, define the extent and number of chambers of retroperitoneal abscesses, which is helpful in answering questions as what surgical access should be chosen and what scope of a surgical intervention made. The safety and cost-effectiveness of the procedure allows a follow-up to be made.

[Clinical and radiographic manifestations of tuberculous spondylitis in adults]. / Kliniko-rentgenologicheskie proiavleniia tuberkuleznogo spondilita vzroslykh.

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.

[Magnetic resonance imaging in the complex radiation diagnosis of tuberculous spondylitis in adults]. / Magnitno-rezonansnaia tomografiia v kompleksnoi luchevoi diagnostike tuberkuleznogo spondilita u vzroslykh.

The paper analyzes X-ray study and MR imaging of 36 adult patients with tuberculosis spondylosis having an active process developed in maturity (n = 20) and sequelae of childhood spondylitis (n = 16). X-ray study is shown to retain its basic value in the diagnosis of spondylitis. MRI is the optimum technique for early diagnosis of inflammatory changes in the spine and soft tissues, the method of choice in neurological disorders.

[Efficiency of plastic surgery for osteoarticular tuberculosis by using revascularization of osseous tissue bed and graft]. / Effektivnost' plasticheskikh operatsii pri kostno-sustavnom tuberkuleze s primeneniem revaskuliarizatsii kostnoi tkani lozha i transplantanta.

The paper provides the results of using original procedures for revascularization of the osseous bed and free bony grafts by transplanting osteovascular complexes in patients with tuberculosis of the hip joint and spine. A total of 20 patients with tuberculous coxitis and 14 with spondylitis were operated on. These interventions were found to have advantages over plastic surgery with bony grafts and mobilizing operations without plasty in similar skeletal lesions, appeared as a great scope of movements in the operated joints is achieved, less time for grafts to adhere with the bed and bony block of vertebrae, and enhanced accumulation of a radioopaque agent in the area to be replaced.

[Experimental rationale and clinical evaluation of perichondroplasty used in surgery for tuberculosis and nonspecific joint diseases]. / Eksperimental'noe obosnovanie i klinicheskaia otsenka primeneniia perikhondroplastiki v khirurgii tuberkuleza i nespetsificheskikh zabolevanii sustavov.

Experiments on 77 rabbits studied the specific features of chondrogenesis during different grafting modifications for the perichondrium. The latter was found to have a high chondroplastic potential. The factors predisposing to cartilaginification and inhibiting this process were identified. Experimental positive results of perichondrial arthroplasty, in tuberculous arthritis as well, were achieved. By taking into account the experimental data, original methods for reparative operations used in patients with tuberculosis and nonspecific diseases of the joints were developed in the clinical setting. Their use in 12 patients yielded positive results, suggesting that the above methods are promising and their further study is advisable.

[Radiologic signs of aseptic necrosis of the femoral head in adults and their pathomorphologic substrate]. / Rentgenologicheskie proiavleniia asepticheskogo nekroza golovki bedrennoi kosti u vzroslykh i ikh patomorfologicheskii substrat.

The examination of 284 patients with aseptic necrosis of the head of the femoral bone (ANHFB) has revealed that tuberculosis coxitis in adults erroneously diagnosed in 74.6%. Four X-ray stages of ANHFB which meet the requirements of diagnosis, differentiation, surgical treatment have been identified. The average periods of their development have been defined. A pathomorphological substrate of X-ray film and variants of the disease course are described in the paper. It is stated that to make a X-ray diagnosis of ANHRB should include indications of a process stage, which facilitates its correct diagnosis.

[Roentgenological manifestations of metatuberculous coxarthrosis in adults]. / Rentgenologicheskie proiavleniia metatuberkuleznykh koksartrozov u vzroslykh.

The author has studied the clinical and roentgenologic findings of 68 patients (33 males and 35 females) aged 19 to 60 who had tuberculosis of the hip joint or of the greater trochanter and were cured by conservative means or with palliative and late surgical interventions. The disturbances in the trophics and in the formation of the joint acquired during the process of inflammation as well as the anatomic losses of destructive character became the basis for the development of metatuberculous coxarthroses at stages II and III in these patients, which occurred under the influence of statodynamic loads in pathologic conditions. The roentgenologic picture of metatuberculous coxarthroses is polymorphic; it depends to a certain extent on the age of the beginning of the tuberculous process and is accompanied by pronounced productive reactions of the bone tissue. In essence it corresponds to the manifestations of coxarthroses of other origins, but it also has some peculiarities consisting mainly in the presence of traces of trophic changes in the bone tissue and in the residual signs of the destruction that had taken place which are characteristic of tuberculosis of bones and joints.

[Biochemical criteria of the activity of osteoarticular tuberculosis]. / Biokhimicheskie kriterii aktivnosti kostno-sustavnogo tuberkuleza.

A correlation between the informativeness of the proteinogram, blood ceruloplasmin and haptoglobin levels and connective tissue metabolism indices used to characterize the inflammatory process activity was performed in 55 patients with different stages of tuberculosis of bones and joints. Among the acute phase proteins examined, the most sensitive indices include ceruloplasmin and haptoglobin found in their combination. A higher urinary oxyproline and glycosaminoglycan excretion in different forms of osteoarticular tuberculosis (both of an inflammatory and a degenerative type) should not be interpreted as an indication of activity of the specific process.