Biomedical subjects
Publications and source records attributed to B E Knoring.
Immunological testing of surgical patients with specific pulmonary tuberculosis revealed specific immunodeficiency in 68% of cases which appeared at higher risk of postoperative complications. A scheme of a simple immunological testing by 2 reactions is provided.
Immunological and morphological findings were compared for 85 patients with lung cancer. Tuberculin sensitization was found to reflect the activity of antitumor immunity. The proportion humoral to cellular response to tuberculin and the intensity of these responses in lung cancer patients provide significant information on tumor histology and stage.
Immune characteristics available for 225 patients with active pulmonary tuberculosis were considered with reference to the process severity and progression. Some combinations of immunological parameters reflecting T- and B- cell function proved to provide sufficient information on the disease severity and trends in its progress. Immunological criteria of negative or positive course of tuberculosis vary with prevailing inflammation: productive or exudative. An individual approach should be practiced in reading immunograms which require due regard for immunopathological changes in the lungs.
Genetic relationships with tuberculous process and immunity were investigated within immunogenetic study of 178 patients with active pulmonary tuberculosis. Tuberculosis occurrence seemed to be associated with phenotypical antigen Cw2. Unfavorable outcome of the disease was observed in the presence of HLA A9, A11, B14, B40, B41 antigens. A pronounced specific humoral and cellular responses more frequently arise in carriers of antigens Cw2 and B13, while high proliferative activity of T-cells in carriers of A10, B7 and Cw2. Production of IgA, IgG and IgM is determined by different genetic factors. The results obtained are essential for prognosis of tuberculosis course and choice of individual therapy.
The data on immunological and morphological examinations of 85 lung cancer patients have been compared. Tuberculin sensitization indexes were shown to indicate the strength of antitumor immunity. Relationships between indexes of humoral and cellular immunologic response to tuberculin, on the one hand, and their actual levels in lung cancer patients, on the other, serve as fairly reliable indications of histological pattern of tumor and its extension.
Immunological examination performed in 292 patients with pulmonary diseases which presented difficulties for differential diagnosis has shown essential differences in immunological status of tuberculous, pneumonia and cancer patients. The fact that immunological abnormalities were related to X-ray characteristics of the lesion made it possible to develop each X-ray syndrome-specific criteria of distinguishing tuberculosis from other pulmonary lesions. The advance of the disease caused unidirectional changes in immunograms for various pulmonary lesions. There is evidence of enhanced cell response to tuberculin in patients suffering from nontuberculous pulmonary lesions.
The immunological survey of 1,688 patients with tuberculosis and 486 with non-specific pulmonary diseases was made. Criteria were identified for immunodiagnosis. The use of current mathematical methods of analysis allowed the development of high performance immunodiagnostic systems for pulmonary abnormalities, which included diagnostic tables and discriminant analysis by employing a computer. The major immunological disorders were determined, which in agreement with the definite direction of a tuberculous process with the subsequent use of data for monitoring the patient's status and correcting the treatment. The most potent immunocorrective drugs were studied, indications for their use were specified, proceeding from the immunological characterization of a specific patient. It was shown that the comprehensive assessment of various links of the immune system is of undoubtful value for the diagnosis and prediction of diseases, and prescription of immunocorrective therapy for pulmonary tuberculosis.
A clinicoimmunological examination of 312 new-onset cases of tuberculosis was performed to investigate the relationships between factors of humoral and cellular immunity and tuberculous process. Specific immune response (SIR) and the trends in the disease progress showed some interdependences. The forms of SIR reported can serve criteria for alterations in the lungs and prognosis of the process outcome.
Tuberculosis, cancer or abscessed pneumonia were diagnosed in 141 (84%) of the 168 patients who had solitary cavities in the lungs in the absence of M. tuberculosis or cancer cells isolation. The most informative diagnostic signs in these cases are provided by sex, age, special features of the onset and course of the disease in the period between diagnosis establishment and patients' hospitalization, data obtained when fluorograms taken from archives were compared with the X-ray picture at the moment of disease detection as well as by the results of serological reactions such as tuberculous antigen detection and Mantoux test, and blood level fibrinogen determination. On the second stage of examination the supplementary signs were obtained in bronchoscopy, cytologic examination of the bronchial contents after prescription of irritating inhalations and prednisolone test and immunologic study. Correct diagnosis can be established in 99% of the cases in the presence of simultaneously five and more significant signs.
A combined immunologic examination included 67 patients with concurrent lung pathology (tuberculosis with pneumonia), 64 with tuberculosis and 71 with pneumonia. The relation of the immune status to the pattern of the process was demonstrated proceeding from the findings. Pneumonia in the abatement phase had no influence on the immunologic parameters of a tuberculosis patient. Acute pneumonia combined with tuberculosis was marked by suppressed T-lymphocyte functional and specific activity, increased counts of T-suppressors and the presence of antituberculous antibodies. It was found that the newly developed diagnostic tables can be used effectively for differentiating the combined pathology from the uncomplicated tuberculosis and pneumonia.
Immunologic screening was used for examining children of five St. Petersburg regions (4155 subjects) and workers of two industrial enterprises (7700 subjects). Tuberculosis infection level in children living together with subjects of groups I, II, Va, Vb and VII dispensary record and tuberculin sensitivity in adults were determined. New risk groups of tuberculosis development have been suggested which include children from the families of subjects with residual changes of past respiratory tuberculosis with a high risk of its reactivation and adults having hyperergic tuberculin sensitivity. BCG revaccination postponement in adults aged 27-30 years is valid in conditions of low tuberculosis prevalence.
Stemming from the results of a complex immunologic examination of 653 patients with lung diseases, 4 immunologic reactions of highly diagnostic value were identified, i. e. specific antibody formation, blast transformation with PPD and PHA and spontaneous rosette formation. The most valuable combinations of these reactions were defined for each type of the pathology. For tuberculosis, 16 such combinations were found, including 5 without specific antibody formation; 5 in cancer; 3 in nonspecific inflammation; and 1 in sarcoidosis. Diagnostically important combinations of the above immunologic reactions are summarized in the Table whose use in differential diagnosis of doubtful cases of tuberculosis, cancer, nonspecific pneumonia and sarcoidosis can increase their diagnostic probability up to 0.95-0.99 in 30 per cent of the patients without employing invasive methods.
The results of a computer analysis of immunograms for the differential diagnosis of tuberculosis, cancer, pneumonia and sarcoidosis are presented. The findings indicate that computer immunodiagnosis may be used as a supplementary tool that increases the effectiveness of diagnosis in difficult cases. The advantage of the elaborated system is to rapidly apply a systemic approach to the assessment of the patient's immune status and to objective diagnosis by using computer algorithms.
The results of ++clinico-serological examination of 81 subjects with meningeal diseases are given; among them 53 had tuberculous meningitis. The authors applied complement fixation (CFT) and indirect hemagglutination tests (IHT) with tuberculin. The high diagnostic significance of CFT and low efficiency of IHT were established in tuberculous meningitis detection. It is expedient to determine simultaneously the antituberculous antibodies in the blood serum and cerebrospinal fluid of the examined patients. Simultaneous performance of CFT during the follow-up increases its diagnostic potentialities to 88.6%. Detection of complement-binding antibodies only in CFT is, in most cases, a sign of isolated tuberculous meningitis. Detection of specific antibodies only in the blood serum of tuberculous meningitis patients is an indirect evidence of generalized process.
Study of a combination of immunologic parameters in 29 adolescents with pulmonary tuberculosis who were subject to a combined treatment with the use of tuberculin demonstrated a decline in heightened specific cellular sensitivity, enhancement of antituberculous antibodies synthesis, normalization of the content and functional activity of T- and B-lymphocytes and rise of the level of class G and M immunoglobulins. It has been concluded that tuberculin has a desensitizing action combined with simultaneous stimulation of humoral response and the normalizing action on the T-lymphocyte system.
Analysis of the clinical course of acute pneumonia in pulmonary tuberculosis patients is presented. The lowest rate of acute pneumonia morbidity was found in patients with active tuberculosis during antituberculosis therapy. As soon as the specific process subsides and its activity diminishes acute pneumonia morbidity grows. Specific features of the course of acute pneumonia in patients with different phases of tuberculosis development are shown. Data on the study of liquid-crystal thermography are presented as well as the assessment of the capillary blood flow and the results of immunologic study in the presence of combined pathology. The terms of alleviation of acute pneumonia in tuberculosis patients are delayed, especially in inflammation development in the zones of post-tuberculosis changes.
Different models of algorithms for the immunologic diagnosis of pulmonary tuberculosis, cancer, nonspecific inflammation and sarcoidosis were developed. A comparative assessment of the effectiveness of 3 versions of Diagnostic Tables was made. A significant advantage of these Diagnostic Tables based on the analysis of immunologic indices characterizing groups of patients with different forms of the process was defined, as they are seen in the X-ray pictures (3d version). A differential diagnosis of tuberculosis and nonspecific lung diseases made by the 3d version of the tables showed that correct and incorrect answers made up 87.6 and 6.8%, respectively. The developed method of immunodiagnosis can be of great help in the differential diagnosis of lung diseases.
Explore the source record for details and available documents.