Problemy tuberkuleza最新文献

The paper presents the epidemiological features of tuberculosis in children from West Siberia at the present stage. It covers the problems of primary its contamination and morbidity in children, including those at risk. An algorithm of a physician's efforts is proposed depending on the results of the Mantoux test with 2 TE (PPD-L) in children. The use of the algorithm is aimed at optimizing the joint activities of a pediatric service and a phthisiopediatric one.

Sixty children infected with Mycobacteria tuberculosis from two age groups (3-5 and 12-14 years) were followed up. The phagocytic activity and oxygen-dependent biocidicity of peripheral neutrophilic granulocytes were studied. The studies indicated dysfunctions of neutrophilic granulocytes in the children infected with Mycobacteria tuberculosis. This fact should be borne in mind in developing immunorehabilitative programmes in this category of patients. Moreover, the changes in the killing activity of neutrophilic turned out to be more pronounced in a young age group. In this connection, immunomodulating therapy should be strictly differentiated.

During treatment, 65.7% of the patients developed adverse reactions to antituberculosis drugs. Allergic reactions were most commonly associated with the use of streptomycin. The simultaneous inclusion of isoniazid, rifampicin, and pyrazinamide into the treatment regimens irrespective of the total number of drugs was found to increase the incidence of hepatotoxic reactions as compared with the regimens which do not contain a combination of these 3 drugs. Cycloserin may be given to adolescents with multidrug resistant tuberculosis. Glutaminic acid prevents the toxic effect of the drug on the CNS, therefore cycloserin may be prescribed for a long period (for as long as 9 months).

Eighty nine patients with alveolitis [60 with extrinsic allergic alveolitis (EAA) and 29 with idiopathic fibrosing alveolitis (IFA)] were followed up. Cytological and immunological studies of bronchoalveolar lavage revealed that the patients with EAA had elevated counts of lymphocytes, moderately increased neutrophils and eosinophils, decreased alveolar macrophages, elevated SIgA and T lymphocytes. In the patients with IFA, only higher counts of neutrophils were significant.

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 relationship between the efficiency of treatment and the nature of morphological changes in the lung was studied in 125 patients with pulmonary tuberculosis without X-ray signs of pneumoconiosis who worked at coniosis-risk enterprises (CRR). Despite adequate specific and pathogenetic therapy, tuberculomas formed and decay cavities preserved in the patients, in this connection they had surgical treatment. Three types of morphological changes were identified. Quartz-containing industrial dust was found to exert an adverse potentiating effect on the course of tuberculosis in most CRE patients: increases in the delimiting a specific process of respiratory disorders and postoperative complications. These specific features should be borne in mind in drawing up a treatment protocol for patients working exposed to industrial dust.

Clinical testing of the forced oscillation test (FOT) yielded criteria for bronchial obstruction: an increase in viscous respiratory resistance (VRR) (Rfo, Rin, Rex); the frequency dependence of VRR; and a decrease in a phase angle. The study of VRR promoted detection of bronchial malpatency in additional 20.7% of the individuals who had no bronchial obstruction, as evidenced by spirography (SG) and forced expiration volume-current curve (FEV-CC) recording. To improve the diagnosis of bronchial patency impairments, it is expedient to use FOT of VRR along with the routine methods (SG and FEV-CC recording). A relationship has been established between the values of VRR and the clinical signs of chronic bronchitis and the degree of bronchial obstruction.