[Implication of specialized sanatoria in the improvement of care to patients with ocular tuberculosis at the present stage].

A total of 6230 case histories and the data of annual reports over the past 7 years were examined. A therapeutic-and-diagnostic process continues to be improved under the present-day conditions. Patients admitted to the sanatorium for the inadequately substantiated etiology of ocular tuberculosis underwent an additional differential diagnostic study. The diagnosis of tuberculosis was verified only in 31.29% of cases. The optimized procedure for etiotropic chemotherapy for patients with new-onset ocular tuberculosis has been introduced. A scheme for intensifying the treatment of recurrent ocular tuberculosis, which permits high therapeutic results to be achieved, has been proposed. It is expedient to reorganize the sanatorium "Red Bank" as one of the sanatorium centers of therapeutic-and-rehabilitative and differential diagnostic care to patients with ocular tuberculosis.

[Epithelio-myoepithelial carcinoma of the salivary glands]. / épitelial'no-mioépitelial'naia kartsinoma sliunnykh zhelez.

Epithelio-myoepithelial carcinoma was singled out as a separate nosological unit in the second revision of the International Histological Classification of Tumors of the Salivary glands (WHO, 1991). For the first time in domestic literature the article describes morphological evidence obtained at investigation of epithelial-myoepithelial carcinoma of the parotid gland using modern technologies.

[Criteria for the clinical cure of tuberculosis of the eye]. / O kriteriiakh klinicheskogo izlecheniia tuberkuleza glaz.

The results of examination were analyzed in 314 patients with tuberculosis of the eye, including 120 patients having its inactive phase. Tuberculin skin tests were performed in 31 patients; fluorescence angiography and photostress tests were conducted in 122 patients, and 120 patients underwent lacrimal fluid crystallography. To define the cure rate in tuberculosis of the eye, it is necessary to have a complex of criteria: no clinical signs of active tuberculous inflammation in the ocular tunics and environments; no clinical, X-ray, and laboratory manifestations of tuberculosis of other organs; no focal and significant overall reaction to tuberculin injected in doses of 2 and 50 TU. If there are contraindications to tuberculin skin tests to conclude whether the disease is cured, it is necessary to use fluorescence angiography of the fundus of the eye, lacrimal fluid crystallography, and/or photostress tests in combination with biochemical and immunological blood studies.

[Effectiveness of treating peripapillary geographic choriopathy]. / Effektivnost' lecheniia peripapilliarnoi geograficheskoi khoriopatii.

The results of treatment of 77 patients (127 eyes) with peripapillary geographic choriopathy (PGC) were generalized. The drug therapy gave positive results in 45.4% of cases, relative stabilization was noted in 54.6% of cases. In patients with stages I-II PGC in comparison with stage III the efficacy of treatment was significantly higher. Improvement in the exudative phase of PGC was achieved 2.6 times frequently than in the cicatricial phase. In the patients who received 2-3 courses of therapy annually the likelihood of persistence of the stabilization of the disease is 91.2%, while without treatment it descends to 29.7%. In argon laser coagulation (ALC) the positive result was obtained in 17 out of 26 eyes and retained more than 2 years in 15 out of 23 eyes. After choreoid revascularization (CR) in patients with stages II-III PGC (with visual that in those untreated functions disorders) improvement continued for 17(10 months in all 6 eyes. Operative treatment of retinal detachment in patients with PGC is effective. The findings suggest the higher likelihood of persistence of stabilization in cases of treatment in patients treatment.

[Fundamental principles of diagnosis, differential diagnosis and treatment of ocular tuberculosis]. / Osnovnye printsipy diagnostiki, differentsial'noi diagnostiki i lecheniia tuberkuleza glaz.

Results of author's many-year studies of ophthalmic tuberculosis are presented. A method for verification of tuberculous origin and a system of diagnosis and differential diagnosis have been developed, which ensure a universal approach to diagnosis of ophthalmic tuberculosis and essentially reduce the incidence of erroneous diagnoses. Schemes for optimizing etiotropic drug therapy are proposed, decreasing the duration of the basic course to 6 months due to increase in the number of effective drugs during the initial phase of therapy to 3-4 and obligatory combination of systemic and local treatment. The incidence of tuberculosis in risk group is analyzed. Tasks of phthisioophthalmologists and ophthalmologists of outpatient health centers in detection and treatment of patients with ophthalmic tuberculosis are formulated.

[Criteria for clinical recovery in ocular tuberculosis]. / Kriterii klinicheskogo islecheniia tuberkuleza glaz.

The paper analyzes the results of examination of 314 patients with ocular tuberculosis, 120 of them had quiescent tuberculosis. Thirty one patients underwent tuberculin tests; 122 had fluorescence angiography and photo stress test; 120, lacrimal crystallography. To determine the degree of recovery requires a complex of criteria: neither clinical signs of active tuberculous inflammation in the retina and medium of the eye, no clinical, X-ray, and laboratory manifestations of tuberculosis of other sites, or a focal and much significant overall response to tuberculin in doses of 2 TE and 50 TE. If there are contraindications to tuberculin tests, a conclusion on recovery should be made by using fluorescence angiography of the fundus of the eye, crystallography of the tear and/or photo stress test in combination with blood biochemical and immunological studies.

[A clinico-pathogenetic classification of tuberculosis of the eye]. / Kliniko-patogeneticheskaia klassifikatsiia tuberkuleza organa zreniia.

Clinical pathogenetic classification is based on the results of many-year observation of a large group of patients in whom the tuberculous etiology of ocular disease was confirmed by a universal approach based on reliable informative diagnostic criteria. Three pathogenetic and 4 clinical forms of ocular tuberculosis were distinguished. The classification for the first time includes ocular involvement in tuberculosis of the central nervous system and tuberculosis of defense system of the eye. Tuberculous diseases of the cornea, sclera, and retinal vessels are presented in combination with uveitis of this or that localization, because they are secondary towards uveitis. The classification includes 4 sections. The diagnosis based on this classification reflects the clinical features of disease and the time course of the process. The classification is diagnostically and therapeutically oriented. It suggests a rational choice of etiological diagnosis and therapy, which is determined by the pathogenetic and clinical forms of ocular tuberculosis.

[On the Kraup-Posner-Schlossmann syndrome]. / K voprosu o sindrome Kraupa-Poznera-Shlossmana.

Five patients with the Kraup-Posner-Schlossmann syndrome are described. The disease has been erroneously taken for chronic serous iridocyclitis of tuberculous origin with hypertension. One patients later developed a true glaucomatous process. The authors believe that the complex of characteristic symptoms of glaucomatous crisis in general can be considered pathognomonic for this disease. No differential diagnosis for ruling out tuberculous or other (endogenous) iridocyclitis is needed in cases when this complex is present. Patients with symptomatic ophthalmic hypertension are in need of regular check-ups.

[Specific features of therapeutical and diagnostic process at the Vyborg-3 sanatorium under present day socioeconomic conditions]. / Osobennosti lechebno-diagnosticheskogo protsessa v sanatorii "Vyborg-3" v sovremennykh sotsial'no-ékonomicheskikh usloviiakh.

The Vyborg-3 republican sanatorium is intended to serve 210 patients with ocular tuberculosis. A total of 2521 histories of patients admitted to the sanatorium from different regions of the country were examined. A fourth of the patients needed differential diagnostic studies. In 9% of patients, the tuberculous etiology of eye diseases was excluded. Patients with hematogenic severe and complicated ocular tuberculosis are prevalent every year. The proportion of complicated forms of ocular tuberculosis (cataract, retinal lesions, uveal glaucoma, fibrosis of the vitreous body) is 28%. Therapeutical efficiency in the underlying disease is 92%.

[Peripapillary geographic choriopathy]. / Peripapilliarnaia geograficheskaia khoriopatiia.

Examinations of 179 patients with peripapillary geographic choriopathy (PGC) revealed that peripapillary landscape-like foci often involving the macula and periphery of the fundus oculi are the pathognomonic symptom of PGC which permits the diagnosis of the condition without additional examinations in more than 90% of patients. The incidence and types of complications are assessed. The possibility of a unilateral disease is proven. Previous data on the nontuberculous origin of PGC have been confirmed.

[Treatment effectiveness of patients with ocular tuberculosis at specialized sanatoria]. / Effektivnost' lecheniia bol'nykh tuberkulezom glaz v spetsializirovannykh sanatoriiakh.

The outcomes of treatment of 2908 patients with ocular tuberculosis who were treated at the Vyborg-3, Krasnyi Val, and Plyos sanatoria in 1993 - 1995 are analyzed. These sanatoria used the common guide in evaluating the efficacy of treatment, namely a separate assessment of the outcomes of treatment of the underlying and concurrent diseases. There were no statistical significant differences in therapeutical efficiency at these sanatoria. Therapeutical benefits were obtained in 99.8% of patients in the active phase of the disease.

[Ways of optimizing the diagnosis and differential diagnosis of ocular tuberculosis]. / Puti optimizatsii diagnostiki i differentsial'noí diagnostiki tuberkuleza glaz.

The results of differential diagnostic study of 1035 patients with actual or suspected ocular tuberculosis in different aspects are analyzed. To define the diagnostic value of different signs, their comparative assessment was made via determination of the validity and informative value. Comparison of the findings with the efficiency of antituberculous therapy. In late posttherapeutical periods in particular was a reference for verification of the tuberculous etiology of eye diseases. There was strong evidence for the use of higher doses of tuberculin for diagnostic purposes due to its lower sensitivity. Focal tuberculin reactions were ascertained to be of no strict specificity and, if they were slightly pronounced, low informative value. The signs of the body's infection to tuberculin and of its sensitization were shown to suggest that the eye diseases might be of tuberculous etiology. A procedure for its verification was developed, based on the detection of specific ophthalmological picture, moderate or great focal tuberculin reactions by the type of inflammation and positive testing therapy with antituberculous agents. A programme (a system) of differentially diagnostic examination and an algorithm scheme aiding a physician to make a diagnosis and substantially reducing the frequency of misdiagnoses were proposed.

[Differential diagnosis of tuberculous and herpetic uveitis]. / K differentsial'noi diagnostike tuberkuleznykh i gerpeticheskikh uveitov.

A total of 158 inpatients with ophthalmic tuberculosis or with this condition suspected were examined at the St. Petersburg Research Institute of Phthisiopulmonology. Tuberculous etiology of iridocyclitis and chorioretinitis was confirmed in 39 patients, herpesvirus etiology was recognized in 35 patients. In the rest patients endogenous uveitis or dystrophic involvement of the eye of other origin were diagnosed. An algorithm of differential diagnosis tuberculous and herpetic uveitis of different localization has been developed, which is based on the clinical findings and results of tuberculin tests, allergic test with herpetic polyvaccine, relevant test therapies, and cytologic investigations of the conjunctival epithelium. The results confirm the differential diagnostic significance of this scheme and a high specificity of focal reactions in allergic tests after A. A. Kasparov in patients with herpesvirus uveitis.