[Current aspects of teaching phthisiopulmonology to senior students of a medical university].
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Biomedical subjects
Publications and source records attributed to L B Khudzik.
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Young and middle-aged males with lower education levels, unemployed, poor and laborers are most susceptible to progressive pulmonary tuberculosis. The most severe forms of the disease are more common in single persons. The factors that promote its progression are as follows: poor living conditions, migration, chronic alcoholism, which shows these population groups to be at risk for poor prognosis forms. The disease is detected mainly on patients' referral. Pulmonary lesions were primarily bilateral and frequently primary. They are characterized by acute onset, marked intoxication, cathexis, excessive rale, scanty sputum, anemia, lymphopenia, drastically accelerated erythrocyte sedimentation rate. Sputum Mycobacteria tuberculosis are occasionally found. The outcomes of acute progressive tuberculosis are chiefly poor, which requires that effective methods of treatment and prevention should be developed for risk groups.
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The efficiency of treating patients with destructive tuberculosis by using different immune correctors was comparatively analyzed. Five hundred and fifty three patients were treated with thymalin, thymogen, human leukocytic interferon, and a combination of thymogen and interferon. The benefit from immunocorrector treatment was obtained early in the complex therapy and the best result was achieved by the use of thymogen plus interferon. However, the action of the two immunocorrectors increased when fibrous deformity of the lung was healed, followed by the development of pronounced residual changes.
In the past 5 years, the epidemiological situation associated with tuberculosis has greatly aggravated in the high ecological risk areas (the towns of Engels and Volsk) of the Saratov region. Morbidity has increased from 40 to 48 per 100,000 persons (to 79 in Engles). The proportion of destructive and acutely progressive types of pulmonary tuberculosis and the number of those died from tuberculosis among the followed up at the tuberculosis dispensary are on the increase.
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Cellular and humoral antiinfection defense, frequency and severity of microbial infection were evaluated in patients with chronic nonobstructive and obstructive bronchitis. Systemic approach and analysis demonstrated that in chronic bronchitis there appeared shifts in cellular and humoral defense, functional dissociation of the above parameters, defects in intra- and intersystem compensation. Thus, in chronic bronchitis antiinfection defense needs immunocorrective therapy which is especially appropriate in bronchial obstruction and persistent infection of peripheral blood.
When examined for immunological status, complement, basic endogenic protease blockers parameters, patients with infiltrative destructive tuberculosis of the lungs (IDTL) and IDTL combination with exacerbation of chronic pyo-inflammatory bronchitis, exhibited disturbances in cellular and humoral immunity, complement activity, content of alpha 1 protease inhibitor and alpha 2 macroglobulin which aggravated in combined respiratory pathology. Nonspecific aerosol treatment with native protease inhibitors (contrykal or gordox) and thymalin aroused the efficacy of etiotropic treatment and promoted normalization of the above defense systems.
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The electrophoretic mobility of peripheral blood lymphocytes was studied in 35 patients with pulmonary tuberculosis, 128 persons clinically cured of tuberculosis, and 30 healthy persons by using an Elphor-VaP-5 apparatus (Germany). This study revealed abnormal lymphocytic functional activity both in patients with tuberculosis and in patients with great residual changes after prior tuberculosis, which was the basis for using of thymic immunomodulators (thymalin or thymogen) in the latters. Immunomodulators improved the tolerance of antirecurrent chemotherapy in persons with IIIA dispensary register group and produced a marked stimulating effect on the functional activity of T and B lymphocytes.
Changes in hemostasis and basic serum antiproteases (alpha 1 protease inhibitor--alpha 1-PI and alpha 2-macroglobulin--alpha 2-MG) were followed up in patients with infiltrative pulmonary tuberculosis in the destruction phase. 65 patients received chemotherapy in combination with contrykal inhalations, 63 patients were given glucocorticoid hormones and prodectin. It was found that natural protease inhibitors produced a marked clinical response, abated more rapidly thrombohemorrhagic syndrome, promoted normalization of coagulation and fibrinolysis. Replacement aerosol therapy with antiprotease agents reestablished the concentration of alpha 1-PI, but had no effect on that of alpha 2-MG. This may contribute to reparative processes in pulmonary tissue which ran without significant signs of sclerosis. The results obtained may be used by clinicians choosing methods of pathogenetic therapy.
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Patients with infiltrative pulmonary tuberculosis at its degenerative stage were examined for parameters of hemostasis, serum proteolytic inhibitors, immunity status and complement. In doing so, the following changes were detected: simultaneous intensification of plasma coagulability and fibrinolytic properties, sputum-induced increase in fibrinolysis; disproportion in the content of the main protease blockers (higher alpha 1-protease inhibitor and lower alpha 2-macroglobulin); T-lymphocyte deficiency; stimulation of the immunity humoral link; rise in the count of O-lymphocytes and higher concentration of the complement component C3. The correlation between the indices of the examined systems was observed, thus indicating the interdependence of the body defensive factors. The findings can be used in the clinical practice when pathogenetic drugs are chosen.
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