Problemy tuberkuleza最新文献

A comparative study of morphological reaction in the foci of tuberculous inflammation in decreased patients with caseous pneumonia (n = 2), fibrocavernous pulmonary tuberculosis (n = 19), disseminated tuberculosis (n = 5) and on the material of resected parts of the lung (infiltrate in a phase of separation (n = 2), tuberculomas (n = 22), caverns (n = 5)) has shown that exudative and necrotic reactions with minimum discriminating signs and no epitheliocytes, by accompanying by atrophy of the paracortical area of intrathoracic lymph nodes reflect immediate hypersensitivity. The decrease in the rate of exudative necrotic reactions, the increase in fibroplastic processes, and the appearance of epitheliocytes suggest that immediate hypersensitivity is added by delayed hypersensitivity. Pronounced fibroplastic reactions around the foci of caseosis and on the walls of tuberculous caverns, involvement of epitheliocytes in cellular reactions point to the fact that a tuberculous process develops in delayed hypersensitivity.

The paper summarizes the results of studies into the pathological anatomy and pathomorphism of pulmonary tuberculosis in Yakutia, which have been conducted by the Department of Anatomy, Yakutsk State University Medical Institute, over 36 years. A morphological comparative analysis of autopsies of individuals who died from different forms in the pre-antibacterial and antibacterial periods and surgical materials were used as a major source of data. More than 1,000 autopsies made it possible to define a wide range of behavioral patterns and the morphological features of pulmonary tuberculosis under the extreme climatic conditions of the Far North. These findings have made a significant contribution to the development of the new scientific school Northern Phthisiology.

The processes of organization and fibrosing were investigated in the tuberculosis-involved and non tuberculosis-involved lung tissue of the lungs and their parts resected in 307 patients with different forms of tuberculosis by histological, histochemical, luminescence microscopic, biochemical, and morphometric studies. When tuberculous lesions develop and begin fibrosing, there was impairment of final formation of collagenous fibers in their inner area due the low proliferative capacity of epithelioid and giant cells, shortage of fibrogenic cells and precipitation on the argyrophilic fibrillary network of tissue degradation products. Etiologically, pathogenetically, and histogenetically, the development of tuberculous lesions gives rise to posttuberculous fibrosis while that of extratuberculosis lesions leads to metatuberculous fibrosis due to the modification and coarsening of preformed connective tissue. The formation of fibrosis is caused by a combination of definite factors: clinicomorphological forms of tuberculosis, long-term history of the disease, the extent of lung tissue decay, old age, the pattern of antituberculous treatment (regular or regular), the extent of the impaired capillary network, the type of arbitrarily fibrogenic cells functioning inside and outside the area of inflammation.

Three hundred and seventy patients operated on at the Institute Surgical Clinic underwent 638 surgical interventions: 356 and 282 in Groups 1 and 2 patients, respectively. Intraoperative complications occurred in 24 (3.8%) cases, in 6.5% of the patients operated on. Twenty-two complications were successfully eliminated, 2 patients died. Postoperative complications were established in 25 (14.8%) of the 169 patients of Group 1 and in 12 (6.0%) of the 201 patients of Group 2. The incidence of complications largely depended on the type of an operation. Complications were observed in 8 (36.4%) of the 22 patients undergone pulmonectomy. The active phase of a specific process as a surgical risk factor is prime consideration. In patients operated for emergency indications in the phase of an non-arrested exacerbation of tuberculosis, pleuropulmonary complications occur 2.5 times as frequently as those in patients with relative process stabilization.

Three hundred and seventy neonatal infants born by mothers with pulmonary tuberculosis were examined. A control group comprised 121 neonatal babies born by apparently healthy women. The infants born by ill mothers weighed less. In the study group, 142 (38.4%) babies with asphyxia were born. In infants born by mothers with active tuberculosis, birth asphyxia was observed 1.5 times as frequently as in those born by healthy mothers. In the control group, only 11 (9.1%) children with mild asphyxia were born. Neonatal compilations were noted in 137 (37.1%) infants of the study group, moreover almost equally frequently in babies born by mothers with both active and inactive tuberculosis, they were in 12 (9.9%) babies in the control group. In the latter group, malformations were detected only in 2 (1.7%) newborn babies, in the study one, they were in 46 (12.4%) infants, the mothers of these 15 (32.6%) infants had received specific therapy for tuberculosis in early pregnancy.

Among lymphadenopathies of different etiology, tuberculosis of peripheral lymph nodes was detected in 28% of cases in children and adolescents, as shown by our data. In its diagnosis in the children, the most informative methods include a morphological study of lymph node biopsy specimens and the results of experimental treatment. History data, clinical findings, and tuberculin diagnosis were also of great importance in verifying the disease. Lymphotropic administration of antituberculosis agents in patients with tuberculosis of peripheral lymph nodes enhances the efficiency of chemotherapy.

The paper proposes the standards of combined treatment involving intermittent intravenous bactericidal chemotherapy for different groups of patients. It describes treatment regimens at the inpatient stage, defines the scope and time of control examination and correction of a treatment protocol by taking into account the pattern, phase, and dissemination of a process and the duration of the disease.

When multifactorial processes are analyzed, it is most rational to use the methods of multidimensional statistical analysis, including the major components methods. This method is rather new in epidemiological surveys. Its advantage is that it may be used to get information that is difficult derived by other ways. Noteworthy is the versatility of the method, which lies in that the problems of analysis, prediction, and classification (stratification) of temporal series are solved by using actually the same techniques. How to apply the major components method are considered by using an example of investigating the general trends in the development of an epidemic tuberculous process in a specific area. Statistical data on tuberculosis morbidity in the areas of the Novosibirsk Region were employed as the initial material.

The impact of exogenous infection on the course of an epidemic process was considered. The spread of tuberculosis infection from an ill patient to children and adolescents within a territorial focus was observed. A mapping study allowed the authors to make a goal-oriented search for patients with tuberculosis, as well as primarily infected children and adolescents.