Helium-neon laser in the complex treatment of patients with pulmonary tuberculosis

The paper gives the results of helium-neon laser irradiation of the endobronchus used in the combined treatment of 30 patients with newly-diagnosed pulmonary tuberculosis complicated by nonspecific endobronchitis. Inclusion of endobronchial phototherapy and helium-neon laser radiation in the complex treatment of patients with newly diagnosed pulmonary tuberculosis complicated by nonspecific endobronchitis makes it possible to achieve clinical cure of an inflammatory bronchial process by 35% more frequently and over 2-3 times more rapidly than in its absence and to increase treatment efficiency of the main process; the terms of bacillary excretion decrease by 1 month, on the average, closure of destruction cavities (with an increase in the parameter by 17%) by 1.2 months and hospital treatment by 1.2 months, as compared with the respective parameters obtained by the traditional treatment of the similar patients.     

Dynamics of the indices of the immune system as affected by endobronchial laser therapy in patients with complicated tuberculosis of the lungs]

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.     

The dynamics of the bronchial system lesions in patients with pulmonary tuberculosis

The state of the bronchial system was examined in 1066 patients within the period of 1964 to 1984. Infiltrative tuberculosis of the lungs predominated in the patients. There was a high incidence (30.1 per cent) of specific affections of the bronchial system complicating infiltrative tuberculosis. Within the last decade the incidence of tuberculosis of the bronchi complicating disseminated tuberculosis has markedly lowered. The incidence of newly detected inactive posttuberculous lesions on the bronchial mucosa and nonspecific endobronchitis increased.     

Autologous macrophages in combined therapy of patients with tuberculosis complicated by nonspecific bronchitis

The function of the lung macrophagal system was estimated in patients with pulmonary tuberculosis complicated by nonspecific inflammatory processes. A decrease in the absolute and relative contents of alveolar macrophages (AM) in bronchoalveolar lavage fluid (BALF) and their lower absorbing activity were revealed. Autologic macrophages from blood monocytes had higher functional activity than AM. Introduction of autologic macrophages into the bronchial tree in the patients with tuberculosis associated with catarrhal and purulent endobronchitis promoted normalization of the BALF cytograms, increasing AM activity and involution of the specific and nonspecific processes.     

Treatment of patients with destructive pulmonary tuberculosis and nonspecific purulent endobronchitis

Imozymase treatment should be started from the first hospital days in patients with destructive pulmonary tuberculosis concurrent with nonspecific purulent endobronchitis. Two-week ultrasound inhalations with imozymase in a dose of 1 ml (60 PU) may rapidly abolish not only the nonspecific inflammatory bronchial process, but also accelerate the attenuation of symptoms of intoxication, the time of abacillation, cavernous closure, and preparation for surgical interventions.     

The endoscopic bronchial picture of patients with pulmonary tuberculosis of various age groups

Endoscopic pictures of the bronchi were studied in 509 new cases of pulmonary tuberculosis. Tuberculosis of the bronchi and its aftereffects such as cicatricial lesions were detected in 31.1 per cent of the children and adolescents, 7.9 per cent of the adults at the age of 18 to 29 years, 9.0 per cent of the adults at the age of 30 to 55 years and 14.7 per cent of the adults at the age of 56 to 75 years. Nonspecific endobronchitis was diagnosed in 27.9 per cent of the children and adolescents, 44.9 per cent of the adults at the age of 18 to 29 years, 46.3 per cent at the age of 30 to 55 years and 44.1 per cent at the age of 56 to 75 years. The incidence and nature of tuberculosis of the bronchi and nonspecific endobronchitis were not related to the patients' age.     

Bronchoscopic diagnosis of pulmonary tuberculosis in miners

Two hundred and thirty nine records of bronchoscopic examination of miners from iron ore mines, including 114 patients with active pulmonary tuberculosis were studied and the frequency of specific and nonspecific endobronchitis and functional, anatomical and hemocirculatory disorders was determined. Qualitative estimation of the endoscopic symptoms and computer-assisted analysis enabled one to validate the direct and probabilistic bronchoscopically evident signs of active tuberculosis. The data on the mature, frequency and diagnostic value of some endoscopic signs should be considered in differentiation of tuberculosis in miners (without pneumoconiosis).     

Methodology and effectiveness of bronchoscopy with polychromatic analysis in patients with pulmonary tuberculosis and sarcoidosis

A procedure of polychromatic analysis (PA) was improved by using light filter occular attachments. In 154 patients, including those with pulmonary tuberculosis (101) and sarcoidosis (53), a diagnostic effectiveness of a traditional bronchoscopy is compared to that with PA, including morphoendoscopic comparison. As against traditional bronchoscopy, PA made it possible to find out in 34.8% an additional number of non-specific endobronchitis cases accompanying pulmonary tuberculosis, and at the same time to approach in 90.2% an endoscopic diagnosis to a pathomorphologic one. In several patients the authors managed to additionally distinguish by means of PA infiltrative bronchial tuberculosis of tuberous type. In pulmonary sarcoidosis the use of PA also allowed to increase a diagnostic effectiveness of the traditional bronchoscopy.     

Status of the bronchi in patients with pulmonary tuberculosis and different haptoglobin phenotype]

External respiration function test and bronchologic examination were conducted in 206 pulmonary tuberculosis patients with different haptoglobin (Hp) phenotypes. It was found that obstructive changes in peripheral portions of the bronchial tree were most common and marked among the revealed disorders of pulmonary ventilation function. These changes promote a decrease in the ventilation reserve to a great extent. As compared to Hp 2-1 carriers, specific endobronchitis and bronchial obstruction symptoms were significantly more frequent in patients with Hp 2-2. Bronchial obstruction symptoms alone were twice as frequent as in patients with Hp 1-1 than in Hp 2-1 carriers. The findings indicate that there is a close relationship between the status of the bronchi in pulmonary tuberculosis patients and the genetically determined Hp phenotype.     

Lesions of the bronchial system in patients of different age groups with tuberculosis of the respiratory organs]

The results of bronchological examinations were analysed in 650 patients (between the ages of 1 and 89 years) with tuberculosis of respiratory organs. Three age groups were specified: group I included children and adolescents to 17 years (152 subjects); group II-adults aged 18 to 59 years (408 subjects), and group III--those aged 60 to 89 years (90 subjects). In group I active bronchial tuberculosis was diagnosed in 14.3% of the cases, residual changes after past tuberculosis in 11.1%, nonspecific endobronchitis in 33.3%; the respective figures for group II were 7.1%, 11% and 43.3% and those for group III 20%, 31.1% and 24.4% of the cases. Isolated froms of bronchial tuberculosis account for 0.9% among all clinical froms of tuberculosis of respiratory organs. Nonspecific endobronchitis in cases with tuberculosis of respiratory organs occur in the form of bilateral catarrhal processes. With age catarrhal changes decline from 92.2% to 54.7% and atrophic and hypertrophic bronchial changes increase and amount to 9.2% and 22.3%, respectively. The character of bronchial pathology is determined by the initial forms of tuberculosis.     

Chronic nonspecific diseases of the respiratory organs in persons observed in Group VII of ambulatory follow-up

Characteristics of chronic nonspecific diseases of the respiratory organs in persons registered in group VII of dispensary observation and the results of their treatment with an account of the bronchoscopic findings were studied. It was shown that the frequency of association of nonspecific endobronchitis and other bronchial affections was 2.9 times higher in the persons of group VII than that in the patients with the same pathological processes observed in polyclinics. Differential treatment in regard to the nature of the nonspecific endobronchitis was 2.8 times more efficient as compared to the routine treatment.     

Acute pneumonia in persons with residual tuberculous lesions

To elucidate the role of pneumonia in pathogenesis of reactivation of residual tuberculous lesions, time courses of clinicoroentgenological and immunological indices for a period of 3 to 5 years before detection of active tuberculosis were studied. Nonspecific bronchopulmonary aggravations progressing by the type of acute, persisting or abscessing pneumonia have many features providing their consideration as nonspecific "masks" of the specific process progression. The features are: localization, clinical picture, disease process, time course increasing of the host specific sensitization, hyperergic character of reactions to intracutaneous tests with tuberculin and BCG vaccine, signs of specific endobronchitis, no effect of nonspecific treatment and favourable time course of the process under the effect of specific antibacterial therapy.     

Mucociliary transport in patients with pulmonary tuberculosis complicated by bronchial obstruction]

The examination of 98 patients with newly diagnosed destructive pulmonary tuberculosis was undertaken to find the relation between the condition of the bronchial tree, level of obstruction and degree of mucociliary insufficiency. The latter was shown to depend on the condition of the bronchial free and was most manifest in diffuse endobronchitis. At the same time, the degree and level of obstruction of the bronchial tree also had influence on the rate of mucociliary transport.     

Tarivid in the combination therapy of patients with pulmonary tuberculosis]

The effectiveness of tarivid, a new drug having a broad spectrum of antimicrobial action and antituberculous effect, was studied. The drug was given to 29 patients with newly detected destructive pulmonary tuberculosis and bacillary excretion. Eight patients had microbacterial resistance to streptomycin, rifampicin and isoniazid, 12 had tolerance to them, in 9 patients tuberculosis was complicated by a nonspecific inflammatory process. The course of treatment ranged from 3 weeks to 3 months. The drug was well tolerated. Its effect was manifested by reduction of intoxication, resolution of the inflammatory and pericavitary pulmonary lesions and bacilli absence. Tarivid can be considered an efficacious drug in the multimodality therapy of tuberculosis patients.     

High incidence of pulmonary tuberculosis in the non-HIV infected immunocompromised patients in Hong Kong

In areas where tuberculosis is endemic, clinicians managing immunocompromised patients (ICP) are confronted with the possibility of Mycobacterium tuberculosis as a pathogen. To determine the incidence and clinical pattern of, the diagnostic approach to, and potential therapeutic implications of pulmonary tuberculosis in this patient population, we reviewed 62 non-HIV infected ICP in Hong Kong who had bronchoscopy because of pulmonary infiltrates. Pulmonary tuberculosis was the second most common cause after bacterial infections. Clinical and radiographic presentations of 12 patients with tuberculosis were nonspecific. Flexible bronchoscopy for tuberculosis carried a diagnostic sensitivity of 91.7 percent. We conclude that for the non-HIV infected ICP from areas where tuberculosis is endemic: M tuberculosis should be suspected as the pathogen; radiographic findings are diagnostically not helpful; FB is a sensitive diagnostic test for tuberculosis and in smear-negative cases where tuberculosis is suspected, initiation of empiric anti-tuberculosis therapy should be considered while awaiting culture results.     

Bronchopulmonary local defense in nonspecific endobronchitis in patients with tuberculosis

Local protection in patients with complicated tuberculosis was investigated. The bronchoalveolar lavage fluid (BALF) was tested for the levels of IgA, sIgA, IgM, IgG, lysozyme, activity of granulocyte proteinases (elastase and trypsin-like proteinases) and their acid-fast inhibitors, ability to produce interferons by the BALF cells, the BALF cell composition and functional activity of alveolar macrophages. The local protection was shown to be decreased in the patients with nonspecific inflammatory processes in the bronchi. The decrease was especially pronounced in the patients with purulent endobronchitis. The data indicated the necessity of using immunocorrectors in combined therapy of such patients.     

Spinal and pulmonary tuberculosis

The paper presents the results of a study of the clinical course of tuberculous spondylitis of combined pulmonary tuberculosis in 86 patients admitted from different areas of the Republic of Uzbekistan. Patients with tuberculosis of the spine and lung have been shown to have a more unfavourable course of a specific process in the bony tissue and lung. The tuberculous process is accompanied by severe intoxication, pain syndromes. The severity of the process is aggravated if there are extensive suppurative processes around an osseous focus. These patients have varying severe cerebrospinal disorders. Moreover, patients with combined forms of the process more frequently exhibit concomitant nonspecific visceral diseases.     

Change in the content of serum immunoglobulins A, G, M in patients with pulmonary tuberculosis and alcoholism during antibacterial and anti-alcoholism therapy]

Serum immunoglobulins A, G, M in 93 patients with pulmonary tuberculosis and suffering from alcoholism at the same time (a core group) were investigated in the course of a combined therapy. A control group consisted of 44 pulmonary tuberculosis patients who were nonalcoholics. Examinations were carried out on their admission to a hospital and 3, 6 and 9-12 months after treatment. The findings proved that the patients of the core group had hyperproduction of main serum immunoglobulins. In the course of a complex antibacterial and antialcoholic therapy the IgA values remained high. A disturbed functional activity of B-lymphocytes is likely to be one of the causes leading to a low efficacy of the tuberculosis treatment among alcoholics.     

Effectiveness of intratracheal administration of contrykal in combined treatment of children with intrathoracic tuberculosis complicated by endobronchial pathology

Local balance in the system of proteinases-inhibitors in bronchial secretion was studied in 97 children with intrathoracic tuberculosis involving the bronchial tree by activity of trypsin-like proteinases (TLP), free antitryptic activity (ATA) and total content of locally synthesized low molecular acid resisting proteinase inhibitors (ARI). In the children with endobronchial pathology there was observed imbalance in the system evident from increasing activity of TLP and simultaneous decreasing of ATA and the content of ARI. The maximum inhibition of ARI local secretion and increasing of the TLP activity were stated in the patients with purulent and specific endobronchitis. In the children with catarrhal endobronchitis the shifts were moderate. Local use of contrykal in the form of ultrasonic inhalations in complex therapy of tuberculosis promoted in short periods reduction of the inhibitory potential, a 2-fold decrease in the terms of clinical recovery from endobronchitis and a decrease in the frequency of marked fibrous lesions in the bronchi and lungs as compared to analogous patients in the control group treated without the use of the proteinase inhibitor.     

Clinico-immunological studies of pulmonary tuberculosis in the elderly

We studied tuberculin reactivity and clinical course after starting chemotherapy in patients with active pulmonary tuberculosis divided by four age-groups less than 29, 30-49, 50-69 and 70 years and more. The skin test to tuberculin purified protein derivative (PPD) was examined in 178 cases of active pulmonary tuberculosis, 120 cases of lung cancer, 25 cases of atypical mycobacteriosis and 466 cases of the other respiratory diseases. The average size of tuberculin reaction in pulmonary tuberculosis decreased with age, but significantly higher than that in patients with other nontuberculous pulmonary diseases of the same age-group. The size of PPD skin test in the group of 70 years and more was significantly lower than other age-groups in pulmonary tuberculosis. We compared the time required for negative conversion of sputum by culture after primary chemotherapy among the different age-groups in pulmonary tuberculosis. It revealed that the time for negative conversion tended to be longer with age, and the time in the group 70 years and more was significantly longer than that of the group less than 29 years of age, although no significant differences in the radiographic severity and conditions of chemotherapy were observed. Finally, the PPD-induced lymphocyte proliferation test in vitro was done in newly diagnosed patients with pulmonary tuberculosis. The patients were divided into two groups by the size of PPD skin test (high responder more than 16 mm and low responder less than 15 mm of erythema induced by PPD).(ABSTRACT TRUNCATED AT 250 WORDS)