The article presents modern approaches to training on ТВ of ТВ specialists and other doctors involved in ТВ diagnosis (therapeutists, pulmonologists, pediatricians, family doctors, etc.). General sections, capacity and types of postgraduate training on ТВ are given according with the State educational standard of postgraduate training of a specialist with high medical education.

The aim of the study was to define a role of endothelial dysfunction and neoangiogenesis in development of lung fibrosis and pulmonary hypertension in usual interstitial pneumonia.

We examined 42 patients with different variants of pulmonary fibrosis: idiopathic pulmonary fibrosis (IPF) and fibrosing alveolitis in diffuse connective tissue diseases (FA-DCTD). The patients' age was 24 to 74 yrs, 50.6 ± 18.8 yrs in average, females predominated (87 %).

We used thrombin-antithrombin III complex (TAT) to evaluate disorders of the plasmatic part of the haemostasis and thrombocyte factor 4 (TF-4), which is a low-weight protein characterized the thrombocyte activity, to assess thrombocyte part of the haemostasis. TAT and TF-4 plasma concentrations were measured with the ELISA. Control values were gained from 16 healthy volunteers. Our study reliably showed activation of the coagulation and thrombocyte aggregation in patients with pulmonary fibrosis proved by the significant growth of the TF-4 and TAT levels, which are early stable and highly sensitive markers of thrombophilia, in 1.58 and 1.6 times respectively compared with the controls. The TAT maximal concentration was found in the IPF patients and the TF-4 maximal level was displayed in the FA-DCTD patients (p < 0.007 and p < 0.05 correspondingly compared with the controls). So, the revealed features of the haemostasis evidence a great role of the thrombophilia in lung sclerotic processes in interstitial lung diseases. The high TAT and TF-4 activities correlate with severe remodeling of the lung interstitial tissue and can be used as early markers of lesions of the pulmonary vessels and of possible thromboembolic complications in interstitial lung diseases.

Forty-six medical histories and autopsy protocols of died elderly and senile patients with chronic respiratory diseases treated in a pulmonology department of Saint-Petersburg War Veterans' hospital in 1997 were analyzed. Their average age was 76.76 yrs. There were 39 (84.78 %) males and 7 (15.22 %) females. COPD as basic, co-existing or underlying pathology was found during the autopsy in 43 of 46 died patients (93.48 %). The postmortem examination revealed 21 pneumonia cases considering as complications. Pneumonia complicating the basic COPD were registered in 14 patients (66.67 %), pneumonia complicating carcinoma in underlying COPD were detected in 7 (33.33 %) of the patients. Most pneumonias were community-acquired (85.71 %) and only 3 ones were nosocomial (14.29%). Pneumonic foci in COPD patients was prevalently smallsized (38.10%) or local (33.33 %) and situated in lower lung fields (85.72 %), mostly in the right lung (42.86 %). COPD and pneumonia combined in elderly and senile patients should be considered as mutually aggravating diseases. Pneumonia in elderly as a threatening complication can cause a poor outcome and, on the other hand, it often results in COPD exacerbation and death.

The purpose of our investigation was clinical and immunological analysis of effectiveness of recombinant human interleukine-2 (Roncoleukin) in complex treatment of pneumonias caused by Mycoplasma and Chlamydia. There were 60 people under investigation, 44 of them had pneumonia caused by Mycoplasma and 16 had pneumonia caused by Chlamydia. They were divided into 2 groups. The patients received typical treatment (macrolides, detoxicating and antioxidant therapy, bronchodilators, mucolytics) and the 2-nd group patients also received immunity-modulating therapy: intravenous infusion of Roncoleukin 500 000 IU twice with the 72 h interval. The patients with pneumonias caused by Mycoplasma and Chlamydia were revealed to have T-cell immunity depression and compensatory activation of humoral response. The typical therapy resulted in stimulation of the T-cell response. The treatment with Roncoleukin led to the normalization of principal quantitative and functional parameters of T-cell immunity and stability of the humoral response. The elimination of the immunity disorders correlated with a considerable clinical effect.

We studied 94,182 patients treated in 9 specialized departments of the Barnaul Railway hospital from 1994 to 2002 to detect the incidence and causes of nosocomial respiratory infections (NRI) and to evaluate the NRI clinical manifestations and outcomes. The NRI were found in 1,871 (1.99 %) patients. The NRI were presented mainly by acute respiratory infections of the upper airways (1.92 %) and rarer by nosocomial pneumonia (0.06 %). They had different etiology, clinical features and outcomes. The acute NRI were established to occur twice more frequently in winter (from October to March) depending on epidemiologic situation at the region, social and occupational status of the patients (frequently among the railway transport service staff). Chronic obstructive bronchitis background and violation of epidemiologic regimen (bringing the infection with newly admitted patients) were predisposing factors. Nosocomial pneumonia was mostly observed in patients of a resuscitation unit (more than 2/3 of the patients), predisposing factors were severe concomitant illnesses, repeated surgical intervention, elderly and senile age. Mycoplasma as an etiological factor of the nosocomial acute respiratory infection (ARI) was observed rarer (in 17.0 % of the patients) than in community-acquired ARI and much more rarer in nosocomial pneumonia (9.1 %) as compared with community-acquired pneumonia (21.6 %).

According to official medical statistic data pulmonary diseases are the most frequent pathology in polyclinics. Near 25,000 hospitalisations and more than 7,000 calls for the ambulance care regard to the pulmonary diseases at Kostroma region. The organisation of medical care for these patients in polyclinics and at home using long-term oxygen therapy and nebulized therapy provides good effect with less expenses.

Environmental impact on immune and interferon status of residents at industrial cities and the morbidity of the upper airway infections were studied in regions with various anthropogenic characteristics. High total intensity of the anthropogenic influence correlated with increased morbidity of acute respiratory viral infections (ARVI). The epidemiology of the ARVI is autonomic at every city. Close correlations were found between the ARVI morbidity and total air pollution level, S0₂ air concentration, as well as groups of pollutants: S0₂ + N0₂, S0₂+ H₂S, S0₂ + N0₂ + CO + phenol, S0₂ + phenol. The increase in the ARVI morbidity at Orenburg was facilitated by the irritating effect of the air pollutants on the upper airway mucous membrane with inhibition of the local and general non-specific defense followed by secondary immune deficiency and interferon inhibition. The increase in the ARVI morbidity in Novotroitsk was associated with a high allergic morbidity provided by compounds of nickel, chrome, cobalt and manganese. A growth of morbidity for rhinosinusitis and chronic tonsillitis correlated with air concentrations of H₂S and groups of pollutants S0₂ + H₂S + phenol and S0₂ + N0₂.

The article presents the "EDIFAR" computed system created to detect the most frequent, at first respiratory, childhood pathology. Screening with this system allowed rapid imaging of child health in primary health care service. This study was performed in a child outpatient department of Blagoveshchensk. The results demonstrated the real spread of respiratory diseases in children 0 to 7 years old and considerably exceeded official statistic data. The indisputable advantages of the "EDIFAR" system are abilities of early detection of the diseases, to diagnose co-existing pathology, to schedule surveillance resulting in timely adequate therapy which can improve prognosis in children with respiratory diseases. Besides of the clinical applications of this technique, it is of great healthcare and social importance. The information gained with this system is necessary not only to care of children but is useful under conditions of insurance medicine and marketing economic principles. This technique rationalizes pediatric and specialized medical work as long as it is an effective system for automatic questioning the medical history. It may be used for screening which allows to form high risk groups for development of certain diseases quite quickly.

Pleural effusion in patients with clotting haemothorax is characterized by high coagulant potential and low fibrinolytic activity. Streptokinase is an effective drug for pharmacological lung decortication in patients with high pleural concentration of plasminogen.

Intrapleural administration of streptokinase-activated fresh frozen plasma increased efficacy of conservative therapy and provided better outcome in clotting haemothorax.

A comparative analysis of medication in chronic bronchitis exacerbation was performed based on medical histories during 1998 to 2001. Positive shifts were found regarding to rarer administration of obsolete antimicrobials with insufficient activity against common pathogens and high toxity and to rarer application of drugs with not proven clinical efficacy in this disease. Current problems were quite total antibacterial therapy, choice of antibiotics not considering sensitivity of the pathogen, underestimation of a role of bronchodilating therapy.

Pulmonary artery pressure (PAP) was assessed using echocardiography and diameter of the pulmonary trunk was measured using computed tomography in 35 patients with chronic obstructive pulmonary disease (COPD), 18 patients with bronchial asthma (BA) and 12 patients with bronchiectasis (BE). Statistically significant difference was found between the mean PAP in the patients studied and that in healthy. PAP values in the COPD and BA patients were higher than those in the BE patients. The PAP increase in patients with BE and BA was functional. The PAP higher 30 mm Hg in the COPD patients was accompanied by dilation of the pulmonary trunk which evidenced the organic nature of the pulmonary hypertension.

The study was designed to evaluate influence of 6-month therapy with salmeterol on clinical and functional parameters and quality of life in 20 patients with moderate to severe COPD. The disease symptoms were analyzed before and in 3 and 6 months of the treatment using the Piggario scale, the lung function parameters (FEV₁, FVC, TLC, RV, Raw) were measures with spirography and body plethysmography, physical tolerance was assessed in 6-minute walking test, quality of life was evaluated with the Saint George's Respiratory Questionnaire. Results showed that Salmeterol reduced dyspnoea, cough, sputum production and improved tolerance to the cold air in the COPD patients. The 6-minute walking distance and FEV₁ significantly increased to the end of the study period. The quality of life improved greatly in all scales of the questionnaire. We concluded that salmeterol was reliably effective in COPD patients living at the strong continental climate of the Eastern Siberia.

We tried to evaluate activity of Beclason ECO Easy Breath compared with freon-containing Beclason Easy Breath in patients with moderate to severe bronchia! asthma (BA). A dose of Beclason ECO Easy Breath was chosen considering experimental results and initial clinical trials. Moreover, efficacy of Beclason ECO Easy breath was compared with than of Flixotide in equal doses. The study was two-staged. The 1-st stage was preliminary, the patients were given 1 500 meg of Beclason Easy Breath or 1 000 meg of Flixotide daily to stabilize their status. If the BA became well-controlled after that the patient was transferred to the 2-nd stage which was the study stage. The patients were transferred to the Beclason ECO Easy Breath 1000 meg daily for 3 months. The drug was well tolerated and there were no adverse effects. The BA course was stable. A need in the β₂-agonists reduced in some cases, lung function parameters became higher. Comparing therapeutic doses of Beclason ECO Easy Breath and Flixotide we noted that most the patients demonstrated a growth of spirometric parameters when changing Flixotide 1 000 meg daily to Beclason ECO Easy Breath in the same dose which was apparently provided by regular and long (6 months) use of the basic anti-inflammatory drugs in adequate doses and the breath-activated aerosol delivery device. Some patients needed higher doses of the drug and the ratio of Beclason ECO Easy Breath to Flixotide was 1.5 : 1.

QoL and CP were evaluated in bronchial asthma (BA) patients treated with different aerosol delivery systems. The QoL was evaluated using the MOS SF-36 questionnaire, the CP was evaluated using the lcBa-50 questionnaire which is an original Russian questionnaire. Twenty-six atopic BA patients (18 to 74 yrs, 15 men and 11 women) receiving Beclazone EB 250 meg in one puff, 750 meg daily, were transferred to Beclojet at the same doses. Reliable increase in QoL and CP parameters was shown after changing the aerosol. So, the optimized delivery systems can improve the QoL and the CP. Besides that, Beclojet was shown to improve them better then Beclason EB.

The article displays clinical and radiological follow-up analysis of 98 patients with disseminated lung tuberculosis in a severe epidemiological situation. Currently the disseminated tuberculosis is diagnosed more often in patients younger than 40 yrs. Clinical features were intensive, intoxication syndrome presented in 93.9%, local signs in 92.9 % of the patients and only 2 % of them did not demonstrate clinical symptoms. Extrapulmonary lesions were quite rare (18.4 %), 85.1 % of the patients were МВТ positive, destructive cavities were detected in 76 % of them. Of the patients with destructive lung injuries, 85.1 % had multiple cavities that greatly worsening the prognosis.

To develop a programme for aimed correction of patients with chronic lung tuberculosis we examined 253 residents of Samara region: 152 males aged 45.7 ± 3.8 yrs in average and 101 females aged 44.0 ± 3.9 yrs in average. General clinical, functional, laboratory, radiological, endoscopic methods and a set of psychological tests were included into the examination. The analyzed results permitted to create a psychological correcting programme. Its efficacy was proved statistically based on dynamics of a type of attitude towards a disease and certain clinical signs. This programme reduced psychogenic disorders, increased motivation and adaptive abilities of the patients, decreased a risk of secondary (disease-induced) mental disorders and improved effects of medication.