Biomedical subjects
Publications and source records attributed to M V Shesterina.
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Analyzing the duration and efficiency of treatment of 95 inpatients with first detected pulmonary tuberculosis indicated that the mean hospital stay of patients without and with decay was 205 and 291 days, respectively. Medical and social aspects should be considered while defining indications and hospital stay periods in patients with tuberculosis. Long-term hospitalization of the patients is justifiable only in complicated tuberculosis and special circumstances which require direct continuous follow-up.
In bronchial asthma alone and combined with active pulmonary tuberculosis there are marked shifts in immune system (diminished mature T-cell and suppressor subpopulation of T-lymphocytes) resulting in disordered immunoregulatory subpopulation relationships. Also, B-system immunity responded with hyperfunctional activity (increased count of B-lymphocytes and polyclonal gammaglobulinemia). As conventional methods fail to normalize the shifts, an adjuvant laser immunocorrection was tried. Laser radiation displayed a good immunocorrecting action and therefore is recommended for patients with bronchial asthma and associated diseases.
Local temperature reactions were studied in 72 patients with intrathoracic tuberculosis (64 of them had active tuberculosis and 8 residual pulmonary changes after prior tuberculosis). Endobronchial thermometry in the dynamics of a specific process was conducted in 7 patients with pulmonary tuberculosis. Bronchial temperature was measured during fibrobronchoscopy under local anesthesia by a device of an original design. Marked thermoregulatory disturbances were found in the bronchi which were caused by a specific active process in the lungs and were manifested in a significant decline of endobronchial temperature as compared to normal values. Clinical recovery of pulmonary tuberculosis with the development of posttuberculous fibrous changes does not cause any disturbances in local temperature reactions. The temperature level in the bronchi is significantly affected by the nature and degree of the inflammatory process in the bronchi.
The paper gives the results of helium-neon laser irradiation of the endobronchus used in the combined treatment of 30 patients with newly-diagnosed pulmonary tuberculosis complicated by nonspecific endobronchitis. Inclusion of endobronchial phototherapy and helium-neon laser radiation in the complex treatment of patients with newly diagnosed pulmonary tuberculosis complicated by nonspecific endobronchitis makes it possible to achieve clinical cure of an inflammatory bronchial process by 35% more frequently and over 2-3 times more rapidly than in its absence and to increase treatment efficiency of the main process; the terms of bacillary excretion decrease by 1 month, on the average, closure of destruction cavities (with an increase in the parameter by 17%) by 1.2 months and hospital treatment by 1.2 months, as compared with the respective parameters obtained by the traditional treatment of the similar patients.
The results of a dynamic examination with the use of an electron microscope of semi- and ultrathin sections of the epithelial lining of the respiratory tract in the experimental dogs under endobronchial treatment of nonspecific endobronchitis with varying doses of low-energy radiation from helium-neon laser are presented. It was proved that the outcomes of regeneration of the bronchial mucosal membrane epithelium under endobronchial treatment of purulent endobronchitis with low-energy radiation of the helium-neon laser much depend both on exposure time (single doses of energy), and multiplicity (cumulative dose of energy), and the period after the laser therapy. The most favourable regeneration takes place under 5-minute (single dose of 4.5 J) radiation with 8 to 9 sessions (cumulative dose of 23.1 +/- 1.5 J). A regeneration most close to the normal condition of the bronchial mucous membrane epithelium is achieved at 2.5-3d months after the onset of the experiment (or a month after the laser therapy).
The rate of mucociliary transport (MCT) in dogs with an experimental pulmonary tuberculosis and concurrent suppurative endobronchitis (SEB) and just with the latter was measured. The treatment effect was achieved by an endobronchial radiation with a CO2-laser unfocused beam of 3.56 and 5.3 w/cm2 power density, and the dogs in the control group were subjected to an endobronchial introduction of furagin. A comparison of the endoscopic picture and MCT rate findings made it possible to believe that the latter index appeared to be more reliable than a visual inspection of the bronchial mucous membrane. An active specific process in the lungs brings about MCT rate inhibition while the concurrent SEB aggravates these changes to a great extent. The radiation of the bronchial mucous membrane with the CO2-laser unfocused beam produces an immediate positive effect on MCT rate normalization. Better results were observed at a power density of 3.56 w/cm2.
A total of 68 children and adolescents suffering from tuberculosis, chronic pneumonia in the phase of exacerbation, pulmonary cysts and hamartochondroma were examined for the phagocytic activity of alveolar macrophages. In pulmonary tuberculosis, the low absorption properties of alveolar macrophages were established in all the phases of a specific process. The patients afflicted with chronic pneumonia were characterized in the phase of exacerbation by discreteness of the parameters of the activity of alveolar macrophages in the bronchoalveolar lavage fluid withdrawn from the focus of inflammation: the absorption activity increased whereas bactericidal one reduced.
Local protection in patients with complicated tuberculosis was investigated. The bronchoalveolar lavage fluid (BALF) was tested for the levels of IgA, sIgA, IgM, IgG, lysozyme, activity of granulocyte proteinases (elastase and trypsin-like proteinases) and their acid-fast inhibitors, ability to produce interferons by the BALF cells, the BALF cell composition and functional activity of alveolar macrophages. The local protection was shown to be decreased in the patients with nonspecific inflammatory processes in the bronchi. The decrease was especially pronounced in the patients with purulent endobronchitis. The data indicated the necessity of using immunocorrectors in combined therapy of such patients.
To study the cellular component of local immune defence, bronchoalveolar lavage fluid (BALF) was examined in 69 patients: 24 children and adolescents with primary tuberculosis and 45 patients with secondary patterns of tuberculosis complicated by catarrhal and purulent endobronchitis. With no appreciable lesions in the bronchial mucosa the cellular composition of BALF and functions of alveolar macrophages (AM) in patients with primary tuberculosis are determined by the phase of specific process. In secondary tuberculosis associated with endobronchitis, the cellular composition of BALF is mainly determined by the character of bronchial pathology whereas AM function by the patterns of both specific and nonspecific processes.
Clinical trials aimed at decreasing the terms of treatment and temporary disability in various categories of new cases of tuberculosis of the respiratory organs were conducted. It was shown to be possible at the account of decreasing the hospitalization period and increasing the role of controlled outpatient therapy.
The function of the lung macrophagal system was estimated in patients with pulmonary tuberculosis complicated by nonspecific inflammatory processes. A decrease in the absolute and relative contents of alveolar macrophages (AM) in bronchoalveolar lavage fluid (BALF) and their lower absorbing activity were revealed. Autologic macrophages from blood monocytes had higher functional activity than AM. Introduction of autologic macrophages into the bronchial tree in the patients with tuberculosis associated with catarrhal and purulent endobronchitis promoted normalization of the BALF cytograms, increasing AM activity and involution of the specific and nonspecific processes.
Results of endobronchial treatment of experimental purulent endobronchitis (PE) in dogs with low intensity He-Ne laser are presented. The endobronchial use of the laser energy in treatment of PE was shown expedient and valid. Comparison of the visual endoscopic picture with the findings of the histochemical and electron microscopic examination of the bronchial mucosa bioptates in the time course of the treatment provided establishment of the optimal regimen for the treatment of nonspecific PE with He-Ne laser.
Characteristics of chronic nonspecific diseases of the respiratory organs in persons registered in group VII of dispensary observation and the results of their treatment with an account of the bronchoscopic findings were studied. It was shown that the frequency of association of nonspecific endobronchitis and other bronchial affections was 2.9 times higher in the persons of group VII than that in the patients with the same pathological processes observed in polyclinics. Differential treatment in regard to the nature of the nonspecific endobronchitis was 2.8 times more efficient as compared to the routine treatment.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.