The comparative analysis of the basic medical statistical indices of tuberculosis for 2 five-years is given. The investigation results show the sharp change for the worse of the epidemiologic situation, and the revealed tendencies are indicative of the real possibility of the subsequent worsening up to the tuberculosis epidemic. The real way out of the established situation is the centralixed interdepartmental program directed to the realization of urgent measures against tuberculosis.
The annual growth of TB incidence in the Republic of Tatarstan is 5.5%, the same is the annual increase in the contingents; the mortality rate grows faster - 14-16% per year. Worsening of living conditions, increase of migration activity of population, reduction of TB measures intensity have a negative impact. In conditions of deteriorating nutrition, high infectiousness of population and increased risk of tuberculosis, the incidence rate may increase due to endogenous reactivation from old tuberculosis foci. The current situation is also characterized by the mechanism of superinfection through contact with a bacillus in the nidus.
The analysis of the general sickness rate of tuberculosis and its destructive forms for one hundred thousand people in Kazan for 30 years is performed, and the number of deads in the first observation year in percent for the general number of persons with tuberculosis and for the number of persons with destructive pulmonary tuberculosis is determined. The epidemiologic situation can be judged from the sickness rate index of destructive forms of the disease and from the number of deads in the first observation year in percent for the persons fell ill for the first time.
With the development of a network of health institutions in the Mari Republic, a tuberculosis department with 15 beds and one doctor was opened in 1926. Later, with the arrival of phthisiatricians, the number of beds gradually increased. By the end of 1961 there were 1,265 beds and 75 TB doctors working in the republic. Great attention was paid to improving doctors' qualifications, especially in the period when Kazan State Medical Institute, with Prof. B.L. Mazur as the Head of Tuberculosis Department, provided consultative assistance in organizing TB service in the republic. In 1962, the Moscow Research Institute of Tuberculosis of M3 RSFSR took over the management of tuberculosis service in the republic.
The data for social and economic state of the health protection of Tatarstan Republic in the transition to market economy are presented. The reform conception of the health protection financial and budget policy, management bodies, price formation system of personnel training, initial medico sanitary service, improvement of treatment-and-diagnostic process and widespread diseases prevention is outlined.
The description of the basic current functional diagnosis methods is presented. Peculiar attention is given to the clinical interpretation of the data obtained by these methods. The possibility of the morphological changes interpretation of bronchopulmonary system on the basis of not only roentgenologic observation data but functional observation data is shown.
The fluctuations during the day of the ventilation function indices such as VC, FEV05, FEV1 PEF, FEF25, FEF50, FEF75 FEF25-75, FEF75-85 are examined in 52 patients with pulmonary tuberculosis. It is found that VC, FEV05 and PEF increased but FEF75, FEF25-75 and FEF75-85 decreased during the day, and fluctuations of different ventilation indices are in connection with other clinical indices.
The immune status of patients with infiltrative pulmonary tuberculosis and healthy donors is investigated, and the possible mechanisms of the disease development are studied. The revealed regularities of the changes of immunogram indices can have practical significance for phthisiologists and physicians in the general practice.
The state of tuberculosis bacteriologic diagnosis for 1985—1994 in conditions of the inter-district antituberculosis centre is studied. It is shown that the number of inoculations to one patient with active tuberculosis as well as microbacteria inoculation depend on the volume of bacteriologic investigations and the quality of pathologic material. The growth of bacillar patient number is stated showing the change for the worse of tuberculosis epidemiologic situation. The high efficacy of the cultural diagnosis method particularly of pulmonary tuberculosis among persons of heightened risk of the disease in comparison with fluorographic examination is noted.
The clinical picture of lobar, caseous pneumonia, peculiarities of its roentgenologic picture and laboratory data are analyzed. The differences in the tactics of treatment and outcomes of the disease that can have concrete practical importance are shown.
The results of the combined early surgical treatment of patients over 55 years of age with tuberculous spondylitis are analyzed. The conservative therapy tactics and surgical treatment method —the combination of the radical operation in the tuberculous focus with external fixation of vertebrae by Byrov’s apparatus are described. The method applied allows to reduce the terms of the bed postoperative period.
We have experience with longitudinal median sternotomy in 21 patients aged 20 to 59 years. In 19 of them we performed lung resections for various forms of bilateral tuberculosis, in one - for a unilateral process, and in another one we performed transsternal transpericardial occlusion of the right main bronchus stump for fistula after pulmonectomy.
Symptomatic lesions of the stomach in patients with chronic inspecific pulmonary diseases depend on the respiratory insufficiency gravity and blood gas composition changes. Hypoxemia promotes stomach mucous membrane atrophy, and hypercapnia reduces stomach mucous membrane resistance to the tion of different ulcerogenic factors including Неlicobacter pylori. The infection of the stomach mucous membrane with Helicobacter pylori is retained in the treatment of patients with chronic inspecific pulmonary diseases by antibiotics.
Diaphragm contractility is studied by the measurement method of transdiaphragm pressure and its components in 154 patients suffering from chronic obstructive pulmonary diseases with clinical signs of respiratory muscle deficiency. The investigations show the considerable fall of power characteristics, stability to fatigue of diaphragm in conditions of high bronchial resistance and pulmonary emphysema.
The pathogenetic role of hemostasis system disorders in the urogenital mycoplasmas infection (M. hominis, M. fermentans, M. genitalium and M. urealiticum) is studied. It is stated that the urogenital mycopeasmas a systemic lesion accompanied by infection is not a local process but chronic syndrome signs of disseminated intravascular blood coagulability. The increase of the indices of Villebrandt’s factor and 5’-nucleotidase allows to judge of the functional state of vessels endothelium and infection activity.
The investigation of oxygenous metabolism of polymorphonuclear leukocytes is performed by luminol-dependent chemoluminescence method in 22 women in III term of physiological course of pregnancy, labor and postnatal period and in 41 women with pregnancy complicated by hestosis of various gravity before labor, on days 2—5 after it. The correlation between clinical course of the disease and some oxygenous metabolism hyperactivation of polymorphonuclear leukocytes of peripheric blood is revealed.
The interrelation between the air pollution extent and immunologic indices complex in children with allergic diseases is studied. The changes of immunologic indices manifested in the oppression of the cellular link and activation of the humoral one, more noticeable in the regions with increased aerohenic load are revealed. The importance of the realization of air protection measures directed to the decrease of not only the concentration of substances exerting allergenic action but the air pollution combined index is stressed.
Many issues of the organization of pulmonary tuberculosis detection, diagnosis and treatment in general phthisiology have been largely solved, but they have not been fully developed in relation to contingents of patients suffering from psychiatric diseases. Literature data on this topic are quite contradictory and do not allow physicians to make correct conclusions. In recent years, research in this direction is practically nonexistent. In this connection, we have tried to summarize the data of the domestic literature.
In addition to the well-known role of purine compounds in cell metabolism, growth, and reproduction, extensive factual material has been accumulated over the past two decades, demonstrating the important role of purines in intercellular interactions. It has been established that a number of physiological and pathophysiological reactions lead to the release of purine compounds (mainly adenosine and adenosine-5'-triphosphoric acid-ATP) by cells, which can interact with special receptors for them, purine receptors. The latter are subdivided into two main classes: PPpurinoreceptors and P2-purinoreceptors, whose main endogenous ligands are adenosine and ATP, respectively.
In the mid-1970s, there was an increase in the number of newly diagnosed patients with tuberculosis, who were admitted to the hospital in a very serious condition and often died within a short time after admission. We counted the number of deaths in Kazan city in the first year of follow-up from 1969 to 1992 for 24 years, dividing them into 3-year periods. In 1969-1971 there were 0.55% of those who died in the first year of observation to the total number of first-time pulmonary tuberculosis patients, in 1972-1974 - 0.98%, in 1975-1977 -1.6%, in 1978-1980 - 1.7%, in 1981-1983 - 0.27%, in 1984-1986 - 0.57%, in 1987-1989 - 0.7%, in 1990-1992 - 1.3%.
The importance of fluorography as a preventive method of group X-ray examination of large contingents of population is quite obvious. The main advantages of fluorography are good resolution capacity, sufficient throughput capacity with low examination time, relative cost-effectiveness, preservation of objective documentation and high mobility of the newest fluorographic units.
Lifetime detection rate of opisthorchiasis cancer even in the areas of endemic foci is only 10-30%. This variant of cancer occurs as an acute disease with duration not more than 4 months with metastasis in 53% of cases. The following forms of tumor occur: 1) hepatomegaly; 2) cirrhotic; 3) latent masked. The latter proceeds in the form of abdominal catastrophe, fever, brain, heart and lung failure with the predominance of the corresponding metastases.
Chondromatosis of joints is relatively rare. Over five years, six patients were operated on at the trauma department of Bugulma Central Regional Hospital.
The analysis of peculiarities of the epidemiologic sitiation of childish tuberculosis in Tatarstan Republic for the last twenty years is performed. The negative tendencies are revealed. The sickness rate in 1994—1995 increased by a factor of two in comparison with the sickness rate in 1993 (9.0 to 100 thousand). The reasons of this situation are considered and the recommendations on the directions of combined work of phthisiothric and general pediatric system are given.
More detailed inspection of intrahospital pyo-in- flammatory diseases is proposed. The additional methods of sanitation of pathogenes carriers of pyo-inflammatory diseases by the local use of lifuzol, chlorhexidine, metacid and propolis are suggested.
In 1965, X-ray fluorography department was organized under the City TB Dispensary, which conducts routine examinations in all districts of Kazan. Centralization of fluorography service allowed to maneuver equipment and personnel for the benefit of the whole city, to keep a single record of all the fluorographic work by districts, contingents and facilities, to achieve high-quality processing of all fluorographic films, to perform double independent assessment of fluorograms.
On the basis of Kazan University and its medical faculty, opened in 1814, important scientific researches were carried out, the results of which were included in the golden fund of medical science. In 1835-1836 G. I. Sokolsky, the founder of the national phthisiology, had read a course on private pathology and therapy to the students. In 1836 he published a manual "Teaching on difficult diseases". Anticipating the foundations of the modern clinical classification of tuberculosis, G.I. Sokolsky distinguished between disseminated, infiltrative and cavernous forms of pulmonary tuberculosis, described the pathanatomy of tuberculosis tubercle and caverns, the phenomenon of pleural rubbing noise and noise of falling drops.
The Department of Phthisiology at the Kazan Institute for Advanced Training of Physicians was organized in 1932 by Professor M.I. Mastbaum, a prominent therapist and phthisiologist, on the basis of the Kazan Tuberculosis Institute. Professor. M. I. Mastbaum headed the department till 1939. At that time the leading teachers were M. I. Oyfebakh, N. M. Zakharov, N. K. Sokolova, B. N. Agricolyansky, F. Z. Eisenberg. In subsequent years, M. I. Oyfebakh, having become a professor, became one of the leading phthisiatricians in the country. For more than 20 years he headed the dispensary sector of the Tuberculosis Institute of the USSR Academy of Medical Sciences.
Another session of KRC RAMS began with a Russian-French symposium devoted to the use of the new ß-blocker lokren (betaxololol) in the treatment of arterial hypertension (AH). As the chairman of the symposium prof. Y.N. Belenkov (Moscow) noted, the continuing interest to the search of new tools for AH treatment is caused primarily by the fact that our country annually loses over 500 thousand people from AH and its complications. The available arsenal of hypotensive drugs is thoroughly reconsidered from the position of modern views on the pathogenesis of AH and the influence of these drugs on the quality of life.
The monograph develops the ideas of A.L. Chizhevsky, who discovered in 1919 the beneficial effects on health of negative air ions (AEs) of oxygen, which have an increased biological activity.