Search

The purposeof this study was to determine detection rate and clinical and morphological characteristics of mediastinal lymphadenopathy (ML) in patients with respiratory system sarcoidosis (RSS), disseminated pulmonary tuberculosis (DPT) and exogenic allergic alveolitis (EAA).Materials and Methods.Patients (n= 278) with established diagnosis RSS, DPT, EAA were investigated. The cumulative index parameters were determined, hematology test, assessments of pulmonary function, diffuse lung capacity, diffusion coefficient were performed in all patients. Computed tomography of chest organs and morphologic examination of mediastinal lymph node (LN) biopsy were performed.Results.Subjects with newly diagnosed (n= 72) and recurrent (n= 104) disease were observed among patients with RSS (n= 176). ML was observed in 95% of cases, involved bronchopulmonary, bifurcation, paratracheal and paraaortal groups; dimensions of intrathoracic LN (ITLN) were 20.0 ± 1.9 mm. Epitheliocellular granulomas (EG) without necrosis, not fusing with each other, were established morphologically; they were determined in recurrent disease course in association with background fibrosis. In patients with DPT (n= 41), subacute (n= 28) and chronic (n= 13) disease course was noted. With subacute course of DPT in 28.6% of cases, ML of paratracheal and bifurcation groups (dimensions of ITLN – 13.1 ± 0.3 mm) was observed, with chronic course – the enlargement of paratracheal and bronchopulmonary LN (7.7% of cases). EG with necrosis and tendency to fusion was verified histologically; inflammatory process involved LN capsule and could be spread to fatty tissue. In patients with EAA (n= 76), acute (n= 10), subacute (n= 38) and chronic (n= 28) disease courses were observed. With acute EAA course, hyperplasia of ITLN of bifurcation and tracheo-bronchial groups up to 13.5 ± 0.6 mm was observed in 20% of cases. Follicular hyperplasia with widening and edema of hermintative centers was observed at morphological investigation. With subacute EAA course, increased ITLN in bifurcation and broncho-pulmonary groups up to 13.6 ± 0.6 mm were observed in 46% of cases. Formation of histiocytic-macrophagal granulomas without epithelioid cells and deposit precipitation in the plasma cell aggregation areas was found at morphological evaluation. With chronic EAA, ML in broncho-pulmonary and paratracheal groups was detected in 17.8% of cases (enlargement of LN up to 11 ± 0.9 mm). The formation of diffuse and focal fibrosis and hyalinosis was noted morphologically.Conclusion.ML is observed in all granulomatous pulmonary diseases studied, however its rate and severity, composition of involved ITLN groups and character of morphological changes is different which is possible to use in diagnostics.

Introduction: An important role in treatment of fibro-cavernous XDR tuberculosis is played by the surgical methods. Aim: The study of the effects of the intravenous laser blood irradiation (IV LBI) on the efficiency of preoperative preparation and surgical treatment of patients with XDR TB. Methods: We studied 147 patients with fibro-cavernous pulmonary XDR TB. 1 group – 68 patients, who underwent a course of treatment with IV LBI (630 nm). 2 group – 80 patients, who were not treated with IV LBI. Results: All patients were operated. The patients treated with using IV LBI more often noted resorption of infiltration (17%) and сlosure of the cavities was more frequent (8%). In 1 group the increase of blood circulation around the cavity more often by 32%. Histological examination after surgery showed that in 2 group tuberculosis process has characteristic signs of pronounced progression with predominance of caseous-necrotic and exudative components. In group 1 small pockets of compacted caseous surrounded by a thin layer of granulation tissue and well-formed fibrous capsule. Large caverns have a wide fibrous wall, often with focal infiltration of lymphoid and macrophage elements, the presence of different areas of compacted caseosis, sometimes with calcification. On the periphery of the thick fibrous capsule can be seen glandular structures formed cubic epithelium without signs of atypia and reflecting the regeneration of alveolar tissue in this area. Fresh foci of dissemination and epithelial cell granulomas are not determined or isolated. Conclusion: The use of VLBI in preoperative preparation promotes healing processes and leads to effective surgical treatment.

One of the key requirements for the diagnosis of pulmonary tuberculosis is the identification of M. tuberculosis in tissue. In this paper, we present the advantages of specific fluorescent antibody labelling, combined with laser scanning confocal microscopy (LSCM), for the detection of M. tuberculosis in histological specimens of lung tissues. We demonstrate that the application of LSCM allows: (i) The automatic acquisition of images of the whole slice and, hence, the determination of regions for subsequent analysis, (ii) the acquisition of images of thick (20&ndash, 40 &mu, m) slices at high resolution, (iii) single bacteria identification, and (iv) 3D reconstruction, in order to obtain additional information about the distribution, size, and morphology of solitary M. tuberculosis, as well as their aggregates and colonies, in various regions of tuberculosis inflammation. LSCM allows for the discrimination of the non-specific fluorescence of bacteria-like particles and their aggregates presented in histological lung samples, from the specific fluorescence of labelled M. tuberculosis, using spectrum emission analysis. The applied method was effective in the identification of M. tuberculosis in lung histological samples with weak Ziehl&ndash, Neelsen staining. Altogether, combining immunofluorescent labelling with the application of LSCM visualization significantly increases the effectiveness of M. tuberculosis detection.

Goal of the study: to investigate structural and functional specific features of macrophages and cytokine profiles of bronchoalveolar lavage in new and relapsing respiratory sarcoidosis (RS). Materials and methods. The study included comparative light optical and electronic microscopic examinations of macrophages, macrophage formula and cytokine profile of bronchoalveolar lavage in 120 patients suffering from different forms of RS. It was found that in case of new RS mostly macrophages of M1 phenotype were detected in the lavage. They had high level of IL-8, IL-2, IL-1β production and ultrastructural signs of hypersecretion which was especially typical of platycytes. High level of IL-4, IL-5 content is typical of relapsing sarcoidosis: additionally to macrophages of M1 phenotype, there are macrophages of M2 phenotype with ultrastructural signs of phagocytic function which can be used for diagnostics of this form of RS.

Cells of the host containing special proteins-transporters, so-called proteins of multiple drug resistance (MDR proteins) can contribute to the drug resistance formation. Goal of the study: to define specific expression of gene and distribution of main MDR proteins (MDR1/Pgp, MRP1, lRP, BCRP) in the pulmonary cells in case of active tuberculosis. Materials and methods. Expression of MDR protein genes was evaluated by RT-PCR for mRNA isolated from the surgical specimen of fibrous cavernous tuberculosis patients. Localization of MDR proteins was performed by immunohistochemical staining and confocal laser microscopy. Main results. Intensity of MDR protein genes expression varies in different zones of tuberculous lesions: MDR1 and BCRP are characterized by the highest level and MRP1 gene is characterized by the minimum level. The level of lRP gene expression depends on the inflammation zone and it is maximum in perifocal zone where protein is detected in the cells of alveolar epithelium and macrophages. High expression of MDR protein genes in various parts of tuberculous lesions witnesses about the potential involvement of these proteins in the development of drug resistance to anti-tuberculosis drugs.

Introduction: Errors in diagnosis of pulmonary granulomatoses reach 75%. Treatment effectiveness depends on timely diagnosis, course and activity of the disease. Aim: To perform differential diagnosis of disseminated pulmonary TB (DPT), hypersensitivity pneumonitis (HP), pulmonary sarcoidosis (PS) and pulmonary non-tuberculous mycobacterioses (NTM) by MSCT and SPECT scanning with 99m Tc-technetril. Methods: The analysis of MSCT and SPECT with 99m Tc-technetril data on 130 cases: DPT – 40; PS, HP and NTM – 30 in each group. We used the Siemens MSCT scanner “Somatom Emotion 16”; the gamma camera "Nucline Spirit” in the planar and SPECT mode. Results: We established that granulomas mainly localized in the peribronchovascular interstitium. In 55.2% of DPT cases peribronchovascular localization was accompanied by septal and intrabronchial foci. In 63.7% of HP cases – by centrilobular foci. In 68.3% of PS cases – by septal and centrilobular foci. In 90.4% of NTM cases there were also subpleural and intrabronchial foci (p Conclusions: 1. MSCT findings demonstrate the diagnostic value of predominant sites of granulomas in the structure of the bronchopulmonary system. 2. Use of SPECT scanning with technetril enables to establish activity, phase and stage of the pathological process.

Materials and methods: 105 patients with EAA underwent CT, bronchoscopy with lung biopsy and BAL with calculation of percentage of young and mature macrophages with different phenotypes, levels of necrosis and apoptosis of lymphocytes, CD4/CD8 indices, DNA of mycelial and yeast-like fungi using PCR. Levels of immunoglobulins A, M, G, and precipitating antibodies to different allergens in blood were determined. Results: In 36.6% of cases acute EAA was caused by fungi Aspergillus and Candida , subacute disease – by proteins of animal origin (72.1%), chronic disease – by inorganic dust (58.2%). HRCT revealed 100% of acute EAA cases as ground-glass opacity, subacute – as microfocal dissemination (79.1%), chronic – as honeycomb lung with traction bronchiectases (70.8%). The macrophage formula of BAL might have an independent meaning for verification of the EAA variant. In acute disease we observed inflow of young non-activated mononuclears into the lungs (31.81±3.08%), in subacute – young activated (19.18±2.1%) and mature (66.05±3.82%) macrophages. In chronic EAA the concentration of non-activated macrophages was normal, but elevated in relapse cases (25.81±5.09%). Use of the endopulmonary cytogram to determine an EAA variant was limited, as typical changes of BAL were observed only in the acute variant (63.86±3.23% of lymphocytes, 8.79±2.44% of neutrophils). More sensitive was the CD4/CD8 index, which value was determined for acute (1.15±0.45), subacute (0.61±0.13) and chronic (0.4±0.02) variants. In subacute EAA apoptosis of lymphocytes was expressed in 49%; in acute EAA necrosis was observed in 20%.