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.     

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.     

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.     

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.     

Ability for physical work of patients with newly-diagnosed destructive pulmonary tuberculosis

To find a relationship between a decrease in physical working capacity and the nature of bronchial tree lesions and the degree of bronchial obstruction, 124 patients with newly diagnosed destructive pulmonary tuberculosis were examined. The studies demonstrated that the physical capacity for work depended on the extent of bronchial tree lesions, the severity and extent of bronchial obstruction. A maximum decrease in the physical capacity for work is observed in bilateral diffuse endobronchitis and the most severe bronchial obstruction. A decrease in the physical capacity for work of the 2-nd and 3-rd degrees is, as a rule, significantly observed with minor bronchial and generalized obstructions.     

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.     

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.     

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.     

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.     

Mechanisms of development of antiproteolytic deficiency in tuberculosis and in nonspecific lung diseases]

In the course of 3 series of experiments on CBA mice intravenously infected with tuberculosis and the use of bronchoalveolar washings (BAW) as a test material, it was revealed that the period of developed tuberculosis is accompanied by a simultaneous rise in antitryptic activity (ATA) and that of neutrophilic elastase (NE). The treatment of the affected animals with alpha-tocopherol, a liposoluble antioxidant, failed to prevent the loss of antielastase activity in pulmonary antiproteinases. In vitro incubation of BAW with 0.01M of ascorbic acid water-soluble antioxidant completely recovered the antielastase activity in pulmonary antiproteinases and provided a three-fold increase of their ATA. As a result of clinical experience gained in the management of 30 patients with different types of chronic pulmonary pathology, ATA, NE and NE complexes with alpha 1-proteinase inhibitor were defined both in blood serum and in BAW. Concentration of these complexes and the NE indices in BAW were seen to be directly related to the content of neutrophils. In blood serum, a direct correlation of the above complexes with NE and a reverse one with ATA were traced. It is concluded that in the development of antiproteolytic deficiency in patients with tuberculosis and other types of chronic pulmonary pathology, an oxidizing inactivation of antiproteinases and their consumption during conjugation with the surplus of proteolytic enzymes have an important role to play.     

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.     

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.     

支气管结核的CT征象分析

目的分析支气管结核的CT影像表现和诊断价值。方法分析65例气管支气管结核的胸部CT影像表现。结果局部CT影像特点为：1病变范围较广,常见多个支段受累。本组病例中有50例累及2叶段以上;2病变支气管范围长,多为主支气管、叶支气管、段支气管连续或间断受累;3管腔多为不规则狭窄;4管壁多为不规则增厚,但其管壁外径未见增大,即中心性增厚,内径缩小。本组有32例管壁有增厚,伴管壁密度增高,鲜有钙化;5肺部多见结核并发灶。本组约有13例肺部合并病灶,其中8例有相应部位的肺不张;6肺门纵隔一般无肿块影,本组仅有肺门增大2例。结论 CT对显示气管、支气管结核的累及范围有一定的优势,对临床早期确诊气管、支气管结核有着重要作用。     

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.     

Serum adenosine deaminase activity in pulmonary tuberculosis

Adenosine deaminase (ADA) activity has been helpful for the diagnosis of tuberculous pleurisy. However, there are few studies about the role of ADA in the diagnosis and follow-up of pulmonary tuberculosis. In our study, serum ADA activity was determined in order to investigate the role of the enzyme in the diagnosis of pulmonary tuberculosis and monitoring the efficiency of therapy. The ADA activity was (mean +/- SD) 21.77 +/- 8.51 U/L in pulmonary tuberculosis patients (n= 44), 6.24 +/- 3.25 U/L in old tuberculosis patients (n= 24), 8.58 +/- 4.38 U/L in healthy control subjects (n= 20), whereas the mean for the patients with bronchial cancer (n= 20) was 18.51 +/- 7.85 U/L. There was no statistical difference between the results of pulmonary tuberculosis patients and the patients with bronchial cancer. On the contrary, the result of these two group were significantly different from both old tuberculosis patients and healthy control subjects (p< 0.001 for both). In 10 pulmonary tuberculosis patients, ADA activities were determined both before and after treatment and a significant decrease was observed in ADA activities after treatment (p< 0.001). In conclusion, serum ADA activity is increased in pulmonary tuberculosis patients, therefore it may be a helpful parameter for monitoring therapy.     

Endoscopic bronchial care in patients with chronic bronchitis

Endoscopic bronchial sanitation was made in 194 patients with an exacerbation of chronic bronchitis. Catarrhal and purulent endobronchitis was endoscopically diagnosed in 121 and 73 patients, respectively. For endoscopic sanitation, therapeutical lavage was used at fiber bronchoscopy. Ringer's solution added by methyluracil and dioxidine was used as a wash liquid. In patients with staphylococcal or streptococcal infection, the bronchial washing was completed by the administration of specific phage preparations. Good and fair effects could be achieved in 97.7 of the treated patients.     

The value of flexible bronchoscopy in childhood pulmonary tuberculosis

The value of 121 flexible bronchoscopy (FB) procedures was evaluated in 54 children, aged three months to 14 years, suspected of having pulmonary tuberculosis. Specimens from FB were culture-positive for Mycobacterium tuberculosis in seven of the 13 bacteriologically confirmed cases. Bronchial abnormalities consistent with the diagnosis were found in 31 of 54 cases. Separate or coexistent findings at initial FB included airway compression (20 cases), granulation tissue (ten cases), and obstructive caseum (four cases). Chest roentgenograms underestimated bronchial involvement in 14 children. Further FB monitoring documented disease evolution. The FB was important in the management of patients, as it (1) guided the use of prednisone therapy, especially in the children with a chest roentgenogram not suggestive of bronchial involvement; (2) indicated a need for resection of granulation tissue by rigid bronchoscopy (three cases); and (3) guided the surgical decision (two children with persistent bronchial obstruction). Thus, FB is a safe and valuable procedure in the management of childhood pulmonary 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.     

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.