Place of digital X-ray fluorography in improving the diagnosis of pulmonary tuberculosis,lung cancer and mediastinal pathology

The prime objective of this paper is an effort to make a comprehensive assessment of a place of current digital X-ray fluorography in the diagnosis of various diseases of the lung, primarily its tuberculosis and cancer, and abnormalities of the mediastinum. The investigation used a principle of obligatory examination of the diagnostic potentialities of film X-ray study and digital X-ray fluorographic findings. Assessment of digital X-ray fluorography showed its potentialities of identifying an abnormality just on the monitor screen and through printer (paper) image reproduction. A total of 2,500 cases from different patient groups (those registered at a dispensary or identified at screening, those with a previously verified pathology). In addition to a particularly diagnostic section, the authors state their ideas on a multiplicity of organizational and methodological problems in the introduction of digital X-ray fluorography into practical public health of Russia. By defining "a diagnostic field" of application of the method, the authors restrict it only to the diagnosis of lung and mediastinal diseases.     

A place of digital X-ray fluorography in the detection of lung diseases in the public health facilities of the Russian Federation

The paper shows the authors' opinion as to the use of digital X-ray fluorography (DXF) to detect pathology of the lung, primarily its tuberculosis and cancer from organizational-and-methodological and purely diagnostic standpoints. Based on a great body of data pooling 21,295 studies of patients, which comprised two (screening and routine clinical) groups, they authors state their views on the place and role of lung DXF in the work of public health facilities in the Russian Federation (RF). The objectivity of the authors' opinion is confirmed by the different nature of a lung abnormality detected by DXF at both the municipal and regional levels of the RF public health system and by a comparative analysis of the findings with those of film fluorography, routine X-ray study, linear tomography, X-ray computed tomography (XCT), and surgical evidence. The study has allowed the authors to express their opinion by recommending DXF as a method for primary diagnosis of lung diseases instead of film fluorography and routine X-ray study and to appreciate it in screenings. The authors' data indicate that XCT in its simplest variant rather than linear tomography should become the optimum method that specifies the diagnosis of lung diseases detected by DXT.     

Organizational and methodological approaches to using digital X-ray fluorography in the diagnosis of lung diseases in practical public health care of the Russian Federation

On the basis of a great body of information, the authors propose the most reasonable and effective organizational and methodological approaches to further actively introducing digital lung fluography into Russia's practical public health care. The paper discusses a diversity of topical problems associated with the practical use of digital X-ray fluorography (DXF), such as the assessment of its use depending on the level (municipal or regional) of public health care, methodological issues of its performance, current relationships of DXF and film fluorography; a place of DXF in the screening and routine clinical diagnosis of lung diseases. Great emphasis is laid on the role of DXF in the diagnosis of tuberculosis and cancer of the lung. The place and role of Russian manufacturers of digital lung fluorographs in the further development of SXF in practical public health care of Russia are also touched upon. The authors emphasize that replacement of film fluorography by digital one will present difficulties if regional and municipal health administrators do not take an active part in this matter.     

Disseminated pulmonary tuberculosis: significance of high-resolution computerized tomography]

Clinical and X-Ray studies were performed in 85 patients with disseminated pulmonary tuberculosis. All the patients underwent routine computerized tomography (CT) and high-resolution CT. According to the pathogenetic process, the authors identified hematogenic (n = 38), lymphogenic (n = 19), bronchogenic (n = 18) and mixed (n = 10) disseminations. High-resolution CT was found to have great advantages in detecting various types of tuberculous disseminations and in assessing the pattern of pulmonary abnormalities. Disseminated tuberculosis was revealed in 7 patients who had no pathological changes on routine lung X-ray films. The specific signs of hematogenic, lymphogenic disseminations and bronchgenic inoculations were identified in other forms of pulmonary tuberculosis. CT symptomatology is shown to be determined by the pathogenetic variant of its development and the stage of the process. Small focal changes in the lung were prevalent in patients with acute and subacute hematogenic forms of the disease. Infiltrates with decay cavities, thin-wall caverns, emphysema and bronchoectases were detected over the chronic course. Lymphogenic disseminations were characterized by the predominance of interstitial changes along with multiple minor foci. High-resolution CT had advantages in identifying decay cavities, signs of fibrosis and in evaluating mediastinal lymph nodes. CT data are of great significance for differential diagnosis of disseminated tuberculosis with lung metastases and diffuse interstitial diseases.     

Radiation diagnosis of diffuse lung diseases: Part I

Based on the data on 150 patients with diffuse lung diseases, the authors present the X-ray and computed topographic semiotics of changes in lung tissue in a number of diseases from this group. The differential diagnosis of diffuse lung diseases has certain difficulties whose solution is association with the application of complex radiation studies (digital fluorography, classical X-ray study, X-ray computed tomography, and magnetic resonance imaging). These techniques not only assess the status of the parenchyma of the lung and the extent of a process, but also permit a follow-up monitoring and evaluation of the efficiency of the therapy performed.     

肺结核合并肺癌患者的临床分析

目的：探讨肺结核合并肺癌的临床特点,提高临床医师诊断肺结核合并肺癌的警惕性。方法：对2000年1月至2009年12月在我院诊断为肺结核、肺结核合并肺癌、肺癌患者各40例进行回顾性分析。结果：三组之间的临床表现与实验室检查进行相互比较,发现其临床表现并无统计学差异,影像学与支气管镜检查有明显统计学差异外,其他实验室检查无差异。结论：结核合并肺癌与肺结核、肺癌等临床表现、实验室检查近似,易造成漏诊、误诊,临床医师应提高警惕,及时行影像学及支气管镜等检查。     

Comparative evaluation of the diagnostic efficiency of interactive digital radiography and routine fluorography in screening examinations of the chest

The current trend for decreased exposure to medical ionizing radiation sources contributes to the introduction of novel technologies into radiation diagnosis. The aim of this study was to compare the informative value of interactive digital X-ray study and routine enlargement fluorography. The study covered 316 individual without the complaints typical of lung diseases. Three roentgenologists assessed X-ray images by 7 major signs. The sensitivity, specificity, and accuracy of the methods in question were defined. The final stage was the construction of routine operating curves (ROC). When there were diffuse changes in the lung, the sensitivity of interactive digital X-ray study was 14% higher. The higher informative value of interactive digital X-ray study is also attested by the higher position of a respective ROC. The fact that lung tissue function in combination with low radiation load may be estimated assumes the use of interactive digital X-ray study in patients with pneumosclerosis and emphysema.     

To the role of computed tomography in the algorithm of diagnosis of lung cancer

The paper summarizes the results of examination of 100 patients with malignant tumors of the lung. The results of X-ray study, linear tomography, and computed tomography (CT) used in the examination of patients with lung cancer were compared by using as an indicator the following parameters: to make diagnosis of lung cancer, to reveal mediastinal intergrowths, to detect enlarged lymph nodes, pulmonary metastases, and pleural lesions, to obtain information on tumor spread into the chest, to reveal growths into the vascular walls. To evaluate the efficiency of the techniques in solving the above diagnostic tasks, a statistical analysis including the estimation of their accuracy, specificity, and sensitivity was made. Recommendations for examination of patients with lung cancer were drawn up for therapeutic institutions of different types.     

A computer-assisted study of the effect of gravitation on the functional state of the lungs

Gravitation influence on lung function was investigated in 115 patients and 21 healthy persons. Changing of an examinee's position from vertical into a horizontal one causes changes in lung function in health and disease. Characteristic features of lung function were determined for each group of examinees in order to improve the diagnosis and differential diagnosis of bronchial cancer and nonspecific chronic pulmonary diseases with a similar x-ray picture. A study of pulmonary ventilation and blood supply of the lungs in vertical and horizontal postures in Hodgkin's disease patients led to a conclusion that irradiation of patients seemed more effective in a phase of deep breath. It made it possible to reduce radiation exposure of healthy parts in a zone to be irradiated.     

自噬与肺部疾病研究进展

自噬(autophagy)是广泛存在于真核细胞中的基本生命现象,是细胞适应环境变化、防御病原微生物侵袭、维持内环境稳定的重要机制．多种肺部疾病中存在自噬活性的变化,自噬与肺部疾病的发生、发展密切相关．自噬在慢性阻塞性肺病、肺气肿、肺癌、肺结核等许多肺部疾病中发生,且发挥重要作用．现从自噬与多种肺部疾病的关系角度进行综述,有助于了解自噬在肺部疾病中发挥的作用,以便进一步研究自噬的调节,为肺部疾病的治疗提供新思路．     

Presentation of Sporothrix schenkii in pulmonary cytology specimens

Macrophages containing small ovoid intracytoplasmic yeast cells, surrounded by a slight "halo," were observed in Papanicolaou-stained smears of sputum submitted for cytologic examination from two patients with culture-confirmed pulmonary sporotrichosis. The cytologic findings are presented and discussed in relation to other pulmonary fungal infections and the appropriate stains to be used for their cytologic detection. The clinical symptoms of pulmonary sporotrichosis are nonspecific and may mimic those of tuberculosis or other diseases; the causative organism, Sporothrix schenkii, may remain undetected by routine microbiologic procedures unless there is cause to suspect the diagnosis. Sporotrichosis should be considered in the differential diagnosis when small ovoid intracellular yeast cells (2 microns to 4 microns in length) with an apparent "halo" are observed within macrophages in pulmonary cytology specimens; the recognition of these findings may aid in the diagnosis of this relatively rare disease.     

多层螺旋CT对肺结核合并肺癌患者的诊断价值

目的:研究多层螺旋CT对肺结核合并肺癌的鉴别诊断价值。方法:选择2013年3月至2015年9月在我院确诊的肺结核合并肺癌患者32例和单纯肺结核患者39例应用多层螺旋CT扫描患者肺部病变情况。结果:肺结核合并肺癌组:陈旧性肺结核28例、活动性肺结核4例;病灶位置经典部位29例、非经典部位3例,合并鳞癌11例、腺癌13例、小细胞癌5例、未分化癌3例;10例结核病灶与肺癌病灶不同侧、13例结核病灶与肺癌病灶同侧不同叶、9例结核病灶于肺癌病灶同侧同叶。单纯性肺结核组胨旧性肺结核36例、活动性肺结核3例;病灶位置经典部位34例(上叶尖段11例、后段9例、下叶背段14例)、非经典部位5例。肺结核合并肺癌组患者分叶征、毛刺征、胸膜凹陷征、阻塞性肺炎及肺不张以及棘状突起比例高于单纯肺结核组,而空泡影比例低于单纯肺结核组,差异具有统计学意义(P0.05);两组钙化、斑片条索影、结节影以及空洞或空腔比较,差异无统计学意义(P0.05)。结论:多层螺旋CT对肺结核合并肺癌具有较高的临床鉴别诊断价值。     

Evaluation of the findings of computed tomography of the lungs in patients with nonspecific pneumothorax in late periods after surgical treatment

By using the results of examination of 54 patients operated on for nonspecific spontaneous pneumothorax (NSP), the authors conclude that X-ray computed tomography (CT) is of high value. In addition to external respiratory function that identifies pulmonary functional changes, it is recommended that a comprehensive examination should include X-ray CT with parenchymal densitometry of the upper, middle and lower lung to reveal lung tissue structural changes. The examination of patients should be performed as soon as possible when the disease is detected and in the late postoperative period for early surgical correction of an emphysematous process in the lung.     

High prevalence of latent tuberculosis infection in autoimmune disorders such as psoriasis and in chronic respiratory diseases, including lung cancer

The early diagnosis and treatment of individuals harboring M. tuberculosis is key to ensuring the effectiveness of health programs aimed at the elimination of tuberculosis (TB). Monitoring for TB also has other important health care implications for the related immune pathology caused by the chronic inflammatory response to M. tuberculosis. Moreover, the recent introduction of biologic therapies for the treatment of several immune-mediated inflammatory diseases has shown unexpected high frequencies of reactivation of latent TB. The present cross-sectional study is aimed at estimating the prevalence of latent tuberculosis infection (LTBI) in different groups of subjects, either undergoing a routine program of screening for TB or a clinical monitoring of autoimmune or lung disorders, by analyzing their immune response in vitro to a pool of different M. tuberculosis antigens through an IFN-gamma-release assay (IGRA). We consecutively tested 1,644 subjects including health care workers (931), healthy immigrants from different countries (93), patients with a diagnosis of psoriasis (405), patients with lung inflammatory disease (60) or lung neoplasia (32) and a group of HIV-1 infected Italian subjects (120). The prevalence of IGRAs positive responses among health care workers was 8.9 percent. In comparison, significantly higher frequencies were found in healthy immigrant subjects (33.3%), similar to those found in inflammatory broncho-pneumopathies (34.5%) or lung cancer (29.6%). Interestingly, an unexpected high prevalence was also found in patients affected by psoriasis (18.0%), while HIV-infected subjects had values comparable to those of health care workers (10.8%). An age cut-off was determined and applied for each group by receiver operating characteristic (ROC) curves in order to perform the statistical analysis among age-comparable groups. Multivariate analysis showed that the age and clinical conditions such as having a diagnosis of psoriasis or a lung inflammatory disease were independent risk factors for developing an IGRA positive response. This study highlights an unprecedented high prevalence of IGRA positive responses among patients affected by psoriasis and emphasizes the need for a preliminary assessment of LTBI before the administration of any biologic therapy based on cytokine antagonists such as anti-TNF-alpha. Moreover, screening for LTBI should be routinely performed in the presence of a chronic pulmonary disease.     

Increased levels of free circulating DNA in patients with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is difficult to diagnose because of numerous interstitial lung diseases with similar symptoms. As serum DNA has proven useful for early lung cancer detection, we aimed to define the relevance of this marker in discriminating IPF from other fibrotic and nonfibrotic/nonmalignant lung diseases. DNA was quantified in 191 subjects: 64 healthy individuals, 58 patients with IPF, 17 patients with nonspecific pulmonary fibrosis (13 idiopathic nonspecific interstitial pneumonia, 4 chronic hypersensitivity pneumonitis), and 52 patients with other diffuse/nonmalignant lung diseases. The median value of free DNA in IPF patients was 61.1 ng/mL (range 7.1-405), which was significantly higher than that of healthy donors (median 6.8, range 2.2-184) (p<0.001) and that of patients with other diffuse/nonmalignant lung diseases (median 28.0, range 4.2-281) (p=0.004). The area under the ROC curve was 0.926 (95% CI 0.879-0.973) when IPF patients were compared with healthy donors, and 0.702 (95% CI 0.609-0.796) when a comparison was made with non-IPF pulmonary diseases. In conclusion, we observed significantly higher levels of free circulating DNA in patients with IPF than in those with other fibrotic or diffuse/nonmalignant lung diseases.     

Current radiation diagnosis of pyelonephritis

The paper deals with the current diagnosis of nonspecific and specific (tuberculosis) acute and chronic pyelonephritis. Having rather ample materials (308 patients with different forms of acute and chronic pyelonephritis), the authors compared different introscopic techniques (plain X-ray study, excretory urography, retrograde pyelography, ultrasonography, computed tomography and angiography) used in the diagnosis and monitoring of patients with pyelonephritis. Based on their own findings and on the data available in the literature, the authors described the symptomatology of pyelonephritis in detail by using a great variety of diagnostic techniques. The paper shows the place and potentialities of conventional X-ray in a variety of current diagnostic studies and the potentialities of imaging techniques in recognizing pyelonephritis, assessing their extent and the reserve potentialities of the diseased kidney. The authors show that the rational use of routine and current radiographic techniques is of great diagnostic and prognostic value, enhances the efficiency of therapy for pyelonephritis, shortens treatment periods, reduces the number of radical nephrectomies by using organ-sparing operations more widely, and decreases mortality rates.     

Impediment in upper airway stabilizing forces assessed by phrenic nerve stimulation in sleep apnea patients

Research into respiratory diseases has reached a critical stage and the introduction of novel therapies is essential in combating these debilitating conditions. With the discovery of the peroxisome proliferator-activated receptor and its involvement in inflammatory responses of cardiovascular disease and diabetes, attention has turned to lung diseases and whether knowledge of this receptor can be applied to therapy of the human airways. In this article, we explore the prospect of peroxisome proliferator-activated receptor-γ as a marker and treatment focal point of lung diseases such as asthma, chronic obstructive pulmonary disorder, lung cancer and cystic fibrosis. It is anticipated that peroxisome proliferator-activated receptor-γ ligands will provide not only useful mechanistic pathway information but also a possible new wave of therapies for sufferers of chronic respiratory diseases.     

早期周围型肺癌的X线动态观察和分析

目的探讨X线动态观察对周围型肺癌进行早期诊断的价值。方法对有X线随访资料的早期周围型肺癌14例资料进行回顾性分析。结果病灶直径≤2cm,无局部、远处、肺门及纵隔淋巴结等转移者归为早期征象;病灶直径〉2cm以上,有或无肺门,纵隔淋巴结、骨及胸膜转移者归为进展期征象。鉴别诊断中,除考虑形态学改变外,还要注意观察肿瘤的生长速度。结论X线平片发现类似病灶,应进行动态观察,查看有无恶性征象,再结合临床资料进行鉴别诊断。     

The coexistence of tuberculosis infection and lung cancer in patients treated in pulmonary department of Medical Academy in Lublin during last ten years (1990-2000)

The coexistance of tuberculous infection (TB-infection) and lung cancer in patients treated in Pulmonary Department of Medical Academy in Lublin during last ten years (1990-2000) has been evaluated. Inclusion criteria involved: aging from 50 to 80 years, tobacco smoking, tuberculous infection in present or in past, lung cancer. All analyzed patients (32 males, 13 females) were heavy smokers (from 10 to 70 cigarettes per day, during at least 5 years). 27 patients were suffered from lung tuberculosis in past, the rest of them had active tuberculous infection. In 19 cases we detected carcinoma planoepitheliale, in 13 cases carcinoma macrocellulare, in 7 cases carcinoma microcellulare and in 6 cases adenocarcinoma. We concluded, that increased occurrence of lung cancer in TB reinfected patients may be connected with immunodepression caused by chronic TB infection. In patients with new active TB-infection in whom the clinical status and chest X-ray were getting worse in spite of antituberculotic treatment recommended procedures for cancer diagnosis were performed. We suggest that bad results of anti-tuberculotic treatment in TB-infected patients are not always caused by bactericidal resistance. In these cases, the proper diagnosis of lung cancer should be considered.     

The pathophysiological function of peroxisome proliferator-activated receptor-γ in lung-related diseases

Research into respiratory diseases has reached a critical stage and the introduction of novel therapies is essential in combating these debilitating conditions. With the discovery of the peroxisome proliferator-activated receptor and its involvement in inflammatory responses of cardiovascular disease and diabetes, attention has turned to lung diseases and whether knowledge of this receptor can be applied to therapy of the human airways. In this article, we explore the prospect of peroxisome proliferator-activated receptor-γ as a marker and treatment focal point of lung diseases such as asthma, chronic obstructive pulmonary disorder, lung cancer and cystic fibrosis. It is anticipated that peroxisome proliferator-activated receptor-γ ligands will provide not only useful mechanistic pathway information but also a possible new wave of therapies for sufferers of chronic respiratory diseases.