Vol 77, No 2 (1996)

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 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.

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 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 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.

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.

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 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.

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 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%.

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.

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.

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.

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.