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Tuberculosis of intrathoracic lymph nodes in part of patients is complicated by the break of molten caseous node in the lumen of the bronchus lumen and obstruct it with thick caseous masses and granulation tissue. The severity of state in children is determined by the caliber of the affected ones. Recovery of the right primary bronchus patency in 10-month child succeeds in rigid bronchoscopy.

Therapy for pulmonary tuberculosis in patients is complicated by their negative psychoemotional state frequently deteriorated by long inpatient stay. Enhancing the efficiency of rehabilitative measures in phthisiology requires active optimization of the patients' mental state. This problem can be solved by a package of correction measures involving psychological correction with reflex therapeutic normalization of the functional state of the cortical regions of the central nervous system in patients with pulmonary tuberculosis. One hundred tuberculosis patients with decompensated mind, including 60 with OG and 40 with KG, were examined. A noticeable psychoemotional improvement was reliably detected 5 months after complex correction psychological and neuropsychological accompaniments of standard chemotherapy in the OG study.

One hundred and thirteen patients with pulmonary tuberculosis and mental disease and 127 tuberculosis patients without mental diseases were studied. Patients with mental diseases were observed to have asymptomatic pulmonary tuberculosis with insignificant expectoration, which made the microbiological diagnosis of tuberculosis difficult. The basic method for detection of tuberculosis is to make a fluorographic study every 6 months, which enables active detection of more than 92% of new cases of tuberculosis as minor forms. The efficiency of treatment for tuberculosis concurrent with mental diseases was high: bacterial discharge ceased in 93.3% of cases, decay cavities closed in 80%, which was associated with the possibility of performing long-term continuous treatment in the inpatient setting.

Enzyme immunoassay (EIA) was used to study the diagnostic value of PTAT circulating in the free and attached state as part of serum circulating immune complexes (CIC) in 34 patients with tuberculosis (TB), 38 with concomitant HIV/TB infection, and 92 with HIV infection without active tuberculosis. A humoral immunological response as circulating PTAT and PTAT conjugated in specific CIC depends on both the form and degree of pulmonary tuberculosis and may be employed to diagnose a disease running as both an independent entity and in the concomitant HIV/TB infection. The use of specific CIC yields additional information on the presence and circulation of mycobacterial antigenic components, which should be borne in mind at the early stages of the disease. EIA diagnosis of pulmonary tuberculosis from the significant titer of PTAT is relatively effective at the stages with infiltration and it ascertains destructive changes before their detection on X-ray and tomographic films.

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.

Data on 104 patients with pneumonia treated at Moscow multidisciplinary hospitals for suspected respiratory tuberculosis (RT) show that general practitioners have lost tuberculosis-diagnosing skills and phthisiological alertness. This is suggested by frequent failures to collect medical historical data, neglect of risk factors for RT, poor orientation in the differential diagnosis of pneumonia and tuberculosis, violation of diagnostic standards of pulmonary tuberculosis, specifically a paucity of sputum microscopic studies and lateral lung X-ray studies. Upgrading the recognition quality of tuberculosis makes it necessary to observe the propedeutic rules for examining and studying a patient, to reveal important anamnestic and clinical data, and to follow instructions. At the same time, there is no need for new equipment and technologies, but it is critically important to increase the level of tuberculosis knowledge in physicians of all specialties and to create motivation for qualitative diagnostic work.

The impact of disease and treatment on the mental status of patients with infiltrative pulmonary tuberculosis was studied. The study included 39 patients, chemotherapy in whom was complicated by the development of adverse reactions and 33 patients who had no adverse reactions. In new cases of tuberculosis, anxiety and personality disorders before chemotherapy were ascertained to be a response to first diagnosed tuberculosis and forced long-term in the inpatient setting. The development of adverse reactions caused by antituberculous agents during therapy was accompanied by impairments in psychological adaptation processes, the preservation and worsening of anxiety and personality disorders, which determines it necessary to include additional drug and psychotherapeutic correction methods into a package of therapeutic measures in tuberculosis.

The study was undertaken to reveal the clinical and epidemiological features of development diabetes mellitus (DM) and pulmonary tuberculosis (PT) in comorbidity. The material of the study was 143 case histories and outpatient cards of patients with DM and PT who were registered in 2001-2006. A total of 11,702 cases of tuberculosis were notified in 1999-2005. The significance ofa difference between the extensive indices was assessed by Student's test preceded by the Fisher angular transformation. Thus, the specific features of development of DM and PT are: 1) type 1 DM frequently occurs in youth while type 2 DM does at mature age; 2) tuberculosis in DM patients occurs at mature and old ages; 3) there is a male preponderance among patients with type 1 DM and a female predominance among those with type 2 DM; 4) comorbidity is more common in town-dwellers; 5) severe PT was prevalent in type 1 DM; mild PT is rarely observed in type 2 DM; 6) in comorbidity, fibro-cavernous, cirrhotic tuberculosis, caseous pneumonia, and tuberculoma are encountered by several times more frequently and focal tuberculosis and tuberculous pleurisy are less frequently in patients without DM.

The authors determined the state of the hemostatic system, the duration of fibrinolysis, intravascular coagulation (IVC) markers, and anticoagulation system activity by the values of antithrombin III (AIII), protein C (PC) and protein S (PS), as well as the depth of systemic inflammation by the values of acute phase reagents. Patients with pulmonary tuberculosis were found to have a hypercoagulation shift associated with prolonged fibrinolysis and accompanied by IVC. There was concurrently a decrease in the activity of the prothrombin complex and the D-dimers arising from IVC began to act as secondary anticoagulants. The hypercoagulation shift is attended by a moderate rise in the activity of AIII and PC with a simultaneous decrease in PS. As systemic inflammation and hypercoagulation syndrome progress, there is a gradual decompensation of the anticoagulation system. The changes in the values of prothrombin index, AIII, and PC are directly and inversely related to the degree of the hypercoagulation syndrome and systemic inflammation. PS showed no correlations.

To study the immunological features in chronic bronchitis (CB) patients with great residual changes (GRC) after prior pulmonary tuberculosis, the authors examined two groups: 1) 40 CB patients with GRC after prior pulmonary tuberculosis (a study group) and 2) 30 CB patients without a history of pulmonary tuberculosis. The examination revealed that CB patients with GRC after prior pulmonary tuberculosis were found to have higher T lymphocytes, lower B lymphocytes on an exacerbation of the disease. The phagocytic properties of neutrophils were altered as their high phagocytic activity, decreased oxygen-dependent microbicidal activity of phagocytes with their stimulation. The humoral response remained to be slightly pronounced in CB bronchitis with GRC. The low serum levels of TBC active products may suggest the low activity of lipid peroxidation processes in the study group patients. After prior pulmonary tuberculosis, antioxidative activity preserves to be high in CB patients with GRC.

The development of an acutely progressing process of varying extent to the point of total damage to both lungs is typical of a patient with tuberculosis concurrent with HIV infection due to progressive immunodeficiency. There is an apparent need for dividing patients with comorbidity into 2 groups: (1) HIV/TB, in patients HIV infection is a primary disease; (2) TB/HIV, in whom tuberculosis is accordingly primary. These groups differ in clinical manifestations, forms of tuberculosis, and pathomorphological changes. Group 1 patients are mostly typified by the primary forms of tuberculosis with involvement of lymph nodes of all groups and by miliary processes at the sites of multiple organs (the lung, abdomen, and central nervous system). Most patients from Group 1 are observed to have fever, progressive intoxication, and morphologically necrotic foci without signs of differentiation and in the absence of typical granulomas. Multiple drug resistance is noted in more than 20% of the patients; in these patients, the efficiency of an intensive therapy phase in arresting bacterial discharge is 26.9%. In Group 2 patients, comorbidity takes a less acute course, pulmonary symptoms are less marked; there is a preponderance of infiltrative, disseminated, firocavernous pulmonary tuberculosis, and caseous pneumonia. In this group, the signs of a prior tuberculous process with phenomena of a slight or moderate productive reaction and with resolution elements are morphologically detectable. In late-stage HIV infection--AIDS, the patients from both groups develop a generalized tuerculous process. Both patient groups are typified by the severe progressive course with identical clinical and pathomorphological manifestations, which results in death.

The authors determined acute-phase protein spectrum, monocytic and neutrophilic functions by the values of spontaneous and stimulated HCT-tests, platelet function under basal conditions and their varying stimulation, the state of the hemostatic system, and the parameters of intravascular blood coagulation in 66 patients with torpid pulmonary tuberculosis and 84 patients with respiratory sarcoidosis (RS). The changes found in both diseases were fundamentally unilateral; however, they were more frequently detected in RS and they were more pronounced. In tuberculosis, all detected changes may give the impression that they are secondary to tuberculous infection and, in RS, act as primary triggers in the development ofgranulomatous inflammation.

The clinical manifestations of spontaneous pneumothorax were determined in patients with respiratory tuberculosis and nonspecific lung diseases. Spontaneous pneumothorax was shown to be a group of complications of lung disease, which is heterogenic in the clinical course and outcomes. Moreover, its morphological basis was pulmonary emphysema, a destructive specific process, or a concomitance of these diseases. In patients with spontaneous pneumothorax, its severity was determined by the continuosly functioning bronchopleural fistula.

The paper describes the influence of socially significant factors, such as a family, children, interpersonal attitudes, and relatives' support, on the course of a tuberculous process in the mentally ill patients long receiving hospital treatment. Positive changes in a tuberculous process are favored by frequent visits of patients, a personal contact of relatives with them, a warm kind attitude of patients towards their relatives and people. The paper shows it necessary to implement educational programs among relatives and rehabilitative and psychocorrective measures with patients, the objective of which is to make and maintain the close and interacting contact - physician-relative-patient, which causes positive changes in the course of pulmonary tuberculosis in mentally ill patients.

The study covered 56 patients (aged 6-14 years) having hyperergic tuberculin sensitivity, including 28 patients with pulmonary tuberculosis (Group 1) and 28 patients infected with Mycobacterium tuberculosis (MBT) (Group 2). All tuberculous processes were asymptomatic and limited. Minor forms of tuberculosis, diagnosed by computed tomography, were found in 71.4% of cases. The signs of incomplete calcification were detectable in 93% of cases. In the past year, tuberculin sensitivity has progressed to hyperergic one in 75% of Group 2 patients. The patients with tuberculosis were treated with 3 drugs; those infected with M BT received 2 agents. In the patients with minor forms of tuberculosis, the level of specific IgG antibodies was equal to those in healthy MBT-infected individuals with hyperergic tuberculin sensitivity, the levels of immunoglobulins of subclasses G1 and G4 were lower, that of IgE antibodies were higher than in the MTB-infected. These data may suggest the stability of the immune system in patients with minor forms of tuberculosis, detected in the phase of calcification, and its instability in the MBT-infected with tuberculin sensitivity increasing up to hyperergic one.

A relationship was studied between the response of mononuclear cells (MNC) to fetoproteins (FP) and the bronchial changes in patients with pulmonary tuberculosis. The response was evaluated by the change in the relative count of CD8+ lymphocytes after MNC incubation with FP as compared with the controls. The value of the response (in scores) was compared with the pathohistological pattern of the bronchial epithelium and interstitial tissue. The studies show that the values of a MNC response to FP are criteria for the presence and absence of dysplasia as one of the types of bronchial epithelial atypia. It is not improbable that patients with chronic inflammatory processes in the lung in the presence of a positive MNC response to FP should be regarded as persons at risk for malignancies.

The present views of pathophysiological processes in tuberculosis make it necessary not only to suppress the vital activity of Mycobacterium tuberculosis, but also to restore biophysical immune and other protective functions of an organism. The acutely progressive forms of tuberculosis isolating drug-resistant mycobacteria require that the exposure techniques improving circulation and metabolic and bioenergetic processes in the cellular and tissue structures at the site of a specific tuberculous process be compulsorily included. Rehabilitative measures considerably accelerate reparative processes, enhance the efficiency of standard chemotherapy regimens, and attend respiratory function recovery in tuberculosis and associated bronchopulmonary diseases. When in a day hospital, as many as 50% of the patients first registered may be examined and receive efficient standard chemotherapy in combination with rehabilitative measures.

Wearisome mental stress arising from experiencing aggressive sensations in the subjectively and objectively unbearable situation may be a significant contributor to the development of a psychosomatic disorder. A hundred and twenty patients with new-onset pulmonary tuberculosis underwent a psychological study. The steady-state personality trait in these patients is hostility as overpretentiousness, susceptibility to offence, and suspiciousness. The development of hostility in patients with pulmonary tuberculosis is associated with masterful upbringing in their parental families, which promotes the development of a sense of guilt, sensitivity to their criticism, restrained actions, and inattention. The inclination of these patients to feel themselves attacked victims forces them to mobilize their energy to repulse the aggressive reality as they perceive, maintaining the abnormally high level of affective tension that impairs autonomic balance in the body and makes the treatment of tuberculosis ineffective. It is expedient to take into account the revealed psychological characteristics of patients with pulmonary tuberculosis in the mentally corrective constituent of a therapeutic process in order to achieve the optimal cooperation in the physician-patient-family system.

Concomitance of infiltrative tuberculosis and lung cancer cannot be considered to be rare and sporadic. Thirty-seven patients with concomitance of these two diseases were followed up at the phthisiosurgical department of the Kostroma regional tuberculosis dispensary in 1979 to August 2005. Uni- and bilateral tuberculosis affliction occurred in 14 and 23 patients, respectively. Thirty-four cases developed cancer in the lung that exhibited tuberculous changes. In this group of patients, the central form of cancer prevailed over the peripheral one (33 versus 4 patients). Stages I, II, III, and IV cancer were established in 1, 3, 22, and 11 patients, respectively. Eleven patients were operated on.

The paper deals with the important problem of pulmonary surgery--the capacities of surgical treatment in concomitance of pulmonary tuberculosis and lung cancer. In 1990 to 2002, the Santarishkes Republican Tuberculosis and Lung Diseases Hospital and the Department of Thoracic Surgery and Oncology, Vilnius University Cancer Institute operated on 2218 patients with lung cancer, of them 46 (2.1%) were diagnosed as having concomitance of lung cancer and tuberculosis. The diagnosis of central and peripheral lung cancer was established in 37 (80.4%) and 9 (19.6%) patients, respectively. Histology revealed squamous-cell tumors in 24 (52.2%) patients, adenocarcinoma in 10 (21.7%), and adenosquamous-cell carcinomas in 12 (26.1%) patients. Stages I, II, and III were established in 12 (26.1%), 11 (23.9%), and 23 (50%) patients, respectively. Pulmonectomy was performed in 18 (39.2%) patients; 10 (21.7%), 10 (21.7%), and 8 (17.4%) patients underwent lobectomy, bilobectomy, and segmentectomy, respectively. Postoperative complications were observed in 28 (60.8%) patients. There were 6 (13%) cases of death. Twenty-three (50%) patients received complex treatment. Surgery is the method of choice in the treatment of concomitance of pulmonary tuberculosis and lung cancer. In such patients, survival averaged 28 +/- 2 months.

The results of treatment are analyzed in 102 patients with disseminated pulmonary tuberculosis complicated by pulmonary hemorrhage. The authors have developed and clinically tested a procedure for arresting pulmonary hemorrhage by creating therapeutic hypoventilation and atelectasis of a lung portion, in which there is a source of bleeding, by using valvular bronchoblocation of the draining bronchus. The application of valvular bronchoblocation to patients with pulmonary bleeding enhances the efficiency of complex treatment and reduces mortality by 4.9 times and a need for emergency and urgent surgical interventions by 7.4 times.

The efficiency of treatment has been studied in 100 patients with pulmonary tuberculosis caused by drug-resistant (DR) Mycobacterium tuberculosis (MBT) strains and complicated by bronchial diseases, treated at the units of the Clinic of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy, in 2004 to 2006. Several forms of specific and/or nonspecific bronchial diseases are shown to be detected in patients with drug resistance in MBT. Pulmonary tuberculosis caused by DR MBT strains and complicated by bronchial diseases is characterized by the lower interferon-producing capacity of bronchoalveolar lavage (BAL) cells and by more significant impairments in the mechanisms of local lung protection. Inclusion of the immunomodulator leukinferon into the combined therapy of patients with pulmonary tuberculosis complicated by bronchial diseases contributes to the elevation of BAL cell production of alpha and gamma-interferons, reduces the generation of active oxygen forms in the BAL phagocytes and brush biopsy specimens, and increases the levels of immunoglobulins in BAL. The local administration of leukinferon reduces the time of cure of specific and nonspecific bronchial diseases in patients with pulmonary tuberculosis who isolate DR MBT strains, thus promoting the enhanced efficiency of treatment in reducing the times of bacterial isolation and decay cavity closure and the length of hospital stay.

The specific features of essential arterial hypertension (AH) were studied in patients with active pulmonary tuberculosis (PT) and in those with residual changes (RC) after prior PT. The prevalence of AH was defined in patients with PT in relation to age, gender, and clinical form of a tuberculous process. The study indicated that the prevalence of AH among patients with an active tuberculous process was less than in the general population and it amounted to 18.2%. It was more common in males aged less than 60 years and in females aged above 60 years. The prevalence of AH in fibrocavernous tuberculosis was less than that in other forms, which was associated with the impact of intoxication on blood vessels. The patients with RC after prior PT had more frequently AH than those with an active tuberculous process, as well as target organ changes and a severer course of AH.

The specific intravascular and central hemodynamic features were studied in 42 patients with pronounced posttuberculous changes in the lung in comparison to a group of healthy individuals without a history of tuberculosis. Along with clinical, functional, and electrocardiographic studies, the authors used echocardiography. End ventricular and atrial systolic and diastolic areas, end left ventricular systolic and diastolic volume, ejection fraction, stroke and cardiac indices were determined. Dilation of the right ventricle and right atrium and their increased specific contractility were ascertained in patients with pronounced posttuberculous changes. At the same time hypertrophy of the right ventricular wall was rarely observed. This gives grounds to regard dilatation of the right ventricle as an earlier sign of evolving chronic cor pulmonale that its hypertrophy. There were no changes in the left ventricle, left atrium, ejection fraction, stroke and cardiac indices, which was explained by the absence of intoxication and toxic infective action in the persons clinically recovered from tuberculosis.

The fact that there is an association of alcohol abuse with pulmonary tuberculosis is well documented. The effect of alcohol sales per capita on tuberculosis mortality rates is considerably less known. The aim of the study was to evaluate the beverage-specific effect of alcohol on pulmonary tuberculosis mortality rates. Trends in pulmonary tuberculosis mortality rates in Belarus from 1981 to 2001 were analyzed in relation to those in the level of sales of various alcoholic beverages per capita, by applying the time series analysis. The analysis demonstrated a positive and statistically significant effect of changes in per capita alcohol sale levels on pulmonary tuberculosis mortality rates. It suggests that a 1% increase in alcohol sales per capita might cause 0.49 and 0.36% increases in pulmonary tuberculosis mortality rates in males and females, respectively. This study also indicates that tuberculosis prevention programs should place more emphasis on alcohol problems.

The data of clinical, X-ray, and radioisotopic pulmonary scintigraphic studies were analyzed in 119 patients with tuberculosis. In patients with pulmonary tuberculosis concurrent with nonspecific infection, impaired pulmonary capillary blood flow may occur in the area of lesion in 60.8% of cases. Concomitant chronic bronchitis observed in half of the patients of this group is an important pathogenetic point of this unfavorable tendency resulting in increased fibrosis in the lung. Less effective treatment of the underlying diseases is another factor contributing to a reduction in pulmonary capillaries during therapy.

Examination was made in 155 patients, including 60 patients were diagnosed as having hepatitis, hepatic lesion being first detected by a screening survey for markers of hepatitis. The antipyrine test was carried out. Patients with slow and rapid hydroxylation were identified. No changes were found in the biotransformation functions of the liver in patients with pulmonary tuberculosis 6 months after intravenous intermittent chemotherapy twice a week from the beginning of therapy; however, there was inhibition of the activity of monooxygenases and a two-fold increase in the number of patients with slow hydroxylation among patients with concomitant chronic hepatitis B and/or C. The best results of chemotherapy were found in tuberculous patients with slow hydroxylation: they less frequently underwent surgical interventions since decay cavities were therapeutically closed.

Clinical trials of the forced oscillation (FO) technique could identify criteria for bronchial obstruction: viscosity airway resistance (VAR) (R(fo), R(in), R(ex)), and its frequency dependence. VAR studies promoted detection of bronchial patency in further 21.9% of the patients who had no bronchial obstruction, as evidenced by spirography (SG) and F-FEV curve recording. To improve the diagnosis of impaired bronchial patency, it is expedient to explore VAR by the FO technique along with the routine methods (SG and F-FEV curve recording).

The incidence of spontaneous pneumothorax and pleural empyema and the outcomes of their medical and surgical treatments in 1982 to 2003 were studied in 541 patients with destructive pulmonary tuberculosis. In the past decade, the incidence of spontaneous pneumothorax and pleural pneumonia has increased from 2.6 to 12.1% due to the aggravated epidemic situation and the worse structure of pulmonary tuberculosis. The clinical severity of the disease and the extent of a pulmonary-and-pleural process did not allow radical reparative operations to be performed in 11.3%. Complex medical and surgical treatment for pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema could yield good and fair results in 71.5% of patients with severe pulmonary-and-pleural comorbidity despite high hospital mortality (17.2%).

To treat hemodynamic disorders, preductal was used in combination with antibacterial therapy in 30 patients with disseminated destructive pulmonary tuberculosis for a month. A control group comprising 31 patients was in parallel observed. Clinical, electrocardiographic, and echocardiographic studies were performed to evaluate the efficacy of preductal. The drug was found to promote improvements in left ventricular function and central hemodynamics as a decrease in end-systolic volume and increases in ejection fraction and stroke and minute volumes. Preductal exerted no significant effect on right ventricular dysfunction associated with chronic cor pulmonale.

The paper describes the results of a clinical trial of itraconasole as suspension in the treatment of Candida-induced lower respiratory tract lesions in patients with pulmonary tuberculosis. The first course of the therapy stopped the growth of fungal culture in 34 (68%) patients; after its repeated course, there were 42 (84%) recovered patients out of 50. After the first course of orangul therapy, there was a decrease in the titer of fungal growth in 15 (30%) patients. The repeated course of the therapy resulted in fungal eradication in 8 of the 15 patients, a further decrease in the baseline titer of the fungi was observed in 4 patients. The treatment was ineffective only in 1 (2%) patient, which was associated with the progression of disseminated pulmonary tuberculosisand with the presence of the dose-dependent fungal strain C. glabrata.

Hemorrhage is one of the most pressing problems in lung diseases. The paper analyzes the results of medical and surgical treatments for pulmonary hemorrhages. A total of 724 patients with hemoptysis and bleedings of various etiology were treated at the Thoracic Unit in 1985-2003. Pulmonary hemorrhages occurred in 442 (61%) patients with pulmonary tuberculosis and in 282 (39%) patients with nonspecific lung diseases. X-ray study revealed right-sided lung lesions in 268 (37%) patients; left-sided lung lesions in 203 (28%), bilateral lesions in 170 (23.5%). The visible X-ray changes were not found in 83 (11.5%) patients. Destructive pulmonary parenchymal changes were detected in 366 (50.5%) patients. Bronchological study was conducted in 703 patients with pulmonary hemorrhage: 377 (53.7%) and 214 (30.4%) patients were found to have its direct and indirect signs, respectively. Neither changes nor hemorrhagic traces were detected in 112 (15.9%) patients since they underwent bronchoscopy in a later period when bleeding had already stopped. Foam rubber sponge tamponade of the main and lobar bronchi was made in 75 (10.4%) patients with profuse bleeding; a positive effect was achieved in 61 (81.3%) patients. The treatment policy for pulmonary hemorrhage is determined by its severity and etiology and the health status of the patient. A major role was assigned to medical hemostatic therapy in the treatment of pulmonary hemorrhages. If it was ineffective, surgical treatment was used. The use of hypotension controlled by ganglionic blockers (more commonly pentamine): bleedings were suppressed in 359 (74%) of 485 patients with second- and third-degree hemorrhages yielded good results. They were medically stopped in 558 (77%) patients; death occurred in 14 (2.4%) cases. A hundred and fifty two (20.9%) were operated on; of them 8 patients underwent segmentectomy; 85 had lobectomy. Pulmonectomy, cavernostomy, and thoracoplasty were performed in 48, 4, and 7 patients, respectively. Twenty-six patients were operated on at the peak of hemorrhage. Bleedings were suppressed in 140 (92%) patients (they recovered; 12 (7.9%) patients died. In the postoperative period different complications were noted in 30 (19.7%) patients. The final results of medical and surgical treatment were as follows: bleedings were stopped in 698 (96.4%) patients (they recovered) and 26 (3.6%) died.

The authors made an attempt to evaluate the efficiency of different means of protecting the healthy lung section against hemo-aspiration in TB surgical patients with pulmonary hemorrhages applied at the stages of surgery and narcosis administration. A total of 70 patients with different pulmonary TB variations were examined within the case study. On the basis of a conducted analysis, the author concluded that the preoperative hemorrhage arrest is the most rational tactic in the described cases. It delays the surgical intervention and cuts the number of postoperative hemo-aspiration complications.

Bone mineral density (BMD) was studied in 93 patients, including 24 patients with nonspecific lung diseases (NLD), 20 with sarcoidosis, 23 with cancer, and 26 with tuberculosis. Among the patients from different groups, the most profound BMD changes were recorded in those with lung cancer. As compared with other groups, the patients of this group were elder and accordingly had many concomitant diseases, which was likely to affect the status of BMD. BMD changes were more marked in patients with tuberculosis than in those of the same age who had NLD and sarcoidosis. All the patients were found to risk factors of osteoporosis, such as alcohol abuse and smoking. The patients with sarcoidosis displayed less pronounced BMD changes, although they did not differ in age from patients with tuberculosis and NLD. Furthermore, women at the highest risk of osteoporosis were prevalent.

A hundred and fifty-six patients with first detected destructive pulmonary tuberculosis were examined. 43.6% of the patients were found to have various complications: bronchial tuberculosis and exudative pleurisy were more common. All the patients received conventional chemotherapy. The studies have demonstrated that the efficiency of chemotherapy during the complicated course was less than in the uncomplicated one: closure of decay cavities was observed in 69.4% of the patients with specific lesion of the bronchial system, in 78.8% of those with a complication, such as exudative pleurisy (in 81.8% with uncomplicated course). In these groups of patients, cessation of bacterial isolation, as verified both bacterioscopically and culturally, was slower.

The specific features of diagnosis were studied in 209 patients with tuberculosis at 9 phthisiological stations of the Yaroslavl Region in 1998-2002. In 96.2% of the patients, tuberculosis was found to have been newly diagnosed in general polyclinics and polyclinics. Only in 3.8% of the patients, the diagnosis of tuberculosis was made at prophylactic fluorography performed on the patients' initiative. A retrospective assessment of outpatient records indicated a significant delay in establishing tuberculosis, by using adequate diagnostic criteria if a physician had professional skills. The authors arrive at the conclusion that dispensary should assume the functions of phthisiopulmonological centers that will secure the continuity of early diagnosis of tuberculosis and its early treatment.

Regional lymphotropic therapy involving 10% isoniazid administration was included into multimodality treatment in 250 patients with pulmonary tuberculosis and comorbidity. The findings have indicated that the lymphotropic therapy during the use of rifampicin, streptomycin, ethambutol enhances the efficiency of chemotherapy in different forms of pulmonary tuberculosis, including the latter concurrent with hepatic lesion or diabetes mellitus. Lymphotropic therapy is particularly beneficial to patients with poor drug tolerability. The use of lymphotropic isoniazid in the multimodality treatment of pulmonary tuberculosis leads to the earlier disappearance of the symptoms of tuberculous intoxication (by 1-1.5 months) in 80-92% of the patients, to abacillation in the same periods, to the increased frequency of decay cavity closure by an average of 15% as compared to the conventional treatment, and, in most cases, to the normalization of the biochemical parameters of hepatic function.