Status of the bronchi in adolescents and young patients with tuberculosis of the respiratory organs

A comparative analysis is presented of the results of bronchoscopy carried out in 1976-1980 in 406 adolescents and young subjects with different forms of pulmonary tuberculosis and in 115 patients of the same age groups who were examined in 1987-1989. The last decade was marked by the incidence decrease of tuberculosis of bronchi in patients with tuberculosis of respiratory organs from 27.8 to 17.4% and by more benign course. At the same time, the incidence of nonspecific endobronchitis significantly increased (by 3 times). Among the causes of development and growth of the incidence of nonspecific endobronchitis in pulmonary tuberculosis patients the main role is assigned to the deterioration of ecological situation, occupational factors and bad habits. It is considered that nonspecific endobronchitis is not the consequence of pulmonary tuberculosis but are independent diseases having a negative influence on the course of pulmonary tuberculosis.     

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.     

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.     

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.     

X-ray semeiotics of functional changes of the respiratory organs in patients with tuberculosis of the lungs and the obstructive syndrome

Examination included 178 patients with active pulmonary tuberculosis and moderate obstruction (74 subjects) or severe obstructive syndrome (104 subjects). The dynamic morphofunctional X-ray examination along with a study of external respiratory function made it possible to study the pattern of functional disturbances in patients with tuberculosis of respiratory organs and concurrent bronchial obstruction. Roentgeno-pneumopolygraphy supplemented with physical exercise tests and berotec specified the localization, extent and the character of disorders of bronchial patency and enabled one to study the compensatory mechanisms of external respiratory function during antibacterial therapy. According to the data of roentgeno-pneumopolygraphy, the more serious air-filling disorders are, the more pronounced the bronchial obstructive changes are, while the degree of respiratory disorders depends on the type and extent of the process and on the duration of the disease and its genesis.     

Current aspects of bronchial tuberculosis

The authors report a retrospective study of 34 cases of bronchial tuberculosis observed between 1981 and 1985 with precise endoscopic and histological data. Analysis of the population showed a male predominance (71 p. 100) and a high incidence of black Africans (54 p. 100), much higher than that observed in the general population of tuberculosis in our department (20 p. 100 of black Africans). Three groups of patients were identified with respect to age: group I, 23 patients aged 18 to 32 years; 22 of these patients were black Africans (98 p. 100) with primary tuberculosis; group II, 4 patients aged between 44 and 56: all were immunocompromised; group III, 7 patients over 65 years of age with reinfections: 6 of these 7 patients were French nationals. Apart from the specific problem of immunodepression observed in group II, two distinct features were identified: the primary lympho-bronchial infection of the young African and tuberculous bronchial reinfection of European women over of the age of 65.     

The risk of reactivation of post-tuberculosis changes in patients with severe somatic diseases

To establish the risk of tuberculosis reactivation in subjects who had severe somatic conditions, 103 patients were observed in a multiprofile general hospital and followed-up for 1-3 years after their discharge. A potential and actual risk (estimated to be 78.0 +/- 6.5 and 7.3 +/- 4.0% of the cases, respectively) for recurrent tuberculosis was recorded as a result of the excretion of conditionally stable and unstable M. tuberculosis L-forms. The importance of the nature and the degree of residual tuberculous changes in view of a specific process reactivation risk for the patients was confirmed. It was indicated that the persons with severe somatic conditions and residual tuberculous changes in respiratory organs made up a tuberculosis risk group to be observed by a phthisiologist.     

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.     

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.     

Prevalence of chronic bronchitis and respiratory function in a group of dairy farmers in the French Doubs province

We used a questionnaire combined with medical history and spirometric studies to compare symptoms and respiratory function in two groups of subjects living in the French province of Doubs. A group of 250 dairy farmers was compared with 250 control subjects, matched with regard to sex, age, height, and smoking habits. The prevalence of acute bronchial infections and dyspnea was identical in the two groups. Among dairy farmers, 30 (12 percent) had chronic bronchitis vs 15 (6 percent) in the control group (p less than 0.05). Chronic bronchitis was more common in patients aged over 40 years (p less than 0.001) and in nonsmokers (p less than 0.001). All respiratory function parameters measured (expressed as a mean percentage of values measured in comparison with theoretic values) were lower in the dairy farmer group than in the control group. With regard to degree of bronchial obstruction, the difference between the two groups was more marked in patients aged 40 years and over and in nonsmokers. Dairy farmers' occupation is a risk factor of chronic bronchitis and bronchial obstruction, in particular in patients aged 40 years and over and in nonsmokers.     

阜阳地区呼吸系统疾病住院患者疾病构成及发病情况分析

目的分析阜阳地区呼吸系统疾病住院患者疾病构成及发病情况。方法收集2007—2012年安徽省阜阳市人民医院呼吸科住院病历资料9 012份,进行疾病分类统计和构成比分析,分析各年度各类疾病住院人数的变化。结果我院6年间呼吸系统疾病中以慢性阻塞性肺疾病、肺癌及肺炎为主,平均构成比分别为34.31%、23.44%及12.30%。慢性阻塞性肺疾病随年份有下降趋势,肺癌、肺结核、间质性肺疾病和肺栓塞随年份有上升趋势。慢性阻塞性肺疾病以老年患者为主,60~79岁为高发年龄段,发生率为40.25%;而支气管哮喘多发于年轻患者;肺癌高发于60~69岁年龄段,发生率为35.55%,但有年轻化趋势;呼吸系统疾病整体发病率以60~69岁为最高峰。结论慢性阻塞性肺疾病、肺癌、肺炎仍为阜阳地区主要呼吸系统疾病,肺癌发病率上升,有年轻化趋势,肺结核、间质性肺病及肺栓塞构成比提高。     

Characteristics of prevention of tuberculosis in the conditions of low prevalence of tuberculous infection]

Immunologic screening was used for examining children of five St. Petersburg regions (4155 subjects) and workers of two industrial enterprises (7700 subjects). Tuberculosis infection level in children living together with subjects of groups I, II, Va, Vb and VII dispensary record and tuberculin sensitivity in adults were determined. New risk groups of tuberculosis development have been suggested which include children from the families of subjects with residual changes of past respiratory tuberculosis with a high risk of its reactivation and adults having hyperergic tuberculin sensitivity. BCG revaccination postponement in adults aged 27-30 years is valid in conditions of low tuberculosis prevalence.     

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.     

Roentgenological symptoms of functional changes in the respiratory organs of patients with pulmonary tuberculosis

To study typical disorders in the external respiration function of patients with pulmonary tuberculosis without concurrent bronchial obstruction and to find out an information potential of the roentgeno-pneumo-polygraphic+ (RPPG) method in detecting local obstructive disturbances, 53 subjects aged from 23 to 52 years with respiratory tuberculosis, including 38 and 15 of them with a limited or disseminated process, respectively, were examined. X-ray functional examination conducted in dynamics and with the use of physical load and bronchodilators made in possible to discover both local and disseminated occult bronchial obstruction. Application of RPPG method and administration of such bronchodilator, as berotec, revealed a functional nature of the bronchial obstruction. According to RPPG data. In a lingering tuberculous process a costal component is predominant in the course of respiration.     

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.     

Diagnosis in the aged from the pathologic-anatomic viewpoint

The preciseness of clinical diagnostics for two different age groups was reviewed among 2033 unselected autopsies looking at eight single diagnoses. The younger age group was up to 59 years of age, the older one over 59 years. In the older age group myocardial infarction, hepatocirrhosis, bronchial and gastric carcinomas were less frequently diagnosed compared to the younger group. Pulmonary embolism, pulmonary tuberculosis, colon and breast carcinomas were almost evenly diagnosed before death in both groups. The multimorbidity in aged patients is discussed. Also in the geriatric diagnostic a high autopsy rate--86% in our collective--is important.     

Immunological reactivity in adolescents with different manifestations of tuberculosis infection

Immunological reactivity was investigated in 306 tuberculosis adolescents aged 13-18 years: 117 with a turn of the tuberculin reactions, 20 with tuberculosis running for more than 2 years in the presence of aggravating factors, 57 with active tuberculosis of the respiratory organs, 15 with attenuating active tuberculosis, 36 with clinically cured tuberculosis. 79 noninfected adolescents served control. Immunological reactivity was altered more appreciably and often (nonspecific declined but specific enhanced) in active tuberculosis, less significantly in cured tuberculosis. The least changes occurred in the turn of tuberculin reactions and in patients infected for more than 2 years. Cellular immunity underwent most pronounced changes.     

Study of the mucociliary transport rate in evaluating the effectiveness of the treatment of suppurative endobronchitis by CO2 laser

The rate of mucociliary transport (MCT) in dogs with an experimental pulmonary tuberculosis and concurrent suppurative endobronchitis (SEB) and just with the latter was measured. The treatment effect was achieved by an endobronchial radiation with a CO2-laser unfocused beam of 3.56 and 5.3 w/cm2 power density, and the dogs in the control group were subjected to an endobronchial introduction of furagin. A comparison of the endoscopic picture and MCT rate findings made it possible to believe that the latter index appeared to be more reliable than a visual inspection of the bronchial mucous membrane. An active specific process in the lungs brings about MCT rate inhibition while the concurrent SEB aggravates these changes to a great extent. The radiation of the bronchial mucous membrane with the CO2-laser unfocused beam produces an immediate positive effect on MCT rate normalization. Better results were observed at a power density of 3.56 w/cm2.     

Association of initial tuberculin sensitivity, age and sex with the incidence of tuberculosis in south India: a 15-year follow-up.

OBJECTIVE: To determine the association of initial tuberculin sensitivity, age and sex with the development of tuberculosis. METHODS: A 15-year follow-up of 280000 subjects in south India, where new cases of tuberculosis were detected mainly by periodic population surveys. Life-table technique was employed to estimate tuberculosis incidence and disease risk in survivors. The independent effect of tuberculin sensitivity, sex and age at intake was determined using Cox's proportional hazard model. RESULTS: Taking subjects with reaction size 0-7 mm to 3 IU PPD-S as reference group, the adjusted relative risk (RR) for developing culture-positive tuberculosis was 1.1, 1.9, 2.9, 3.6 and 3.3 for those with indurations of 8-11, 12-15, 16-19, 20-24 and > or = 25 mm (P < 0.01). Considering subjects aged 0-4 years as reference group, the adjusted RR for the other groups increased from 1.7 to 10.8 (P < 0.01). Males had a substantially higher incidence (adjusted RR 3.0, P < 0.001). The risk of culture-positive tuberculosis over 15 years in survivors was 3.3% (5.0% in males and 1.6% in females), and increased substantially with tuberculin sensitivity at intake. In those with > or = 12 mm at intake, the approximate lifetime risk was 6.1% (8.6% in males and 3.1% in females). CONCLUSION: The incidence of tuberculosis increased steadily with tuberculin sensitivity to PPD-S and age at intake. Males had a significantly higher risk than females in every PPD-S group and the overall risk was three-fold higher.