Studies on Various Pulmonary Functions on Tuberculosis Patients: Part 1: Long Volumes and Ventilatory Capacities in Tuberculosis(TB) Patients, Part 2: Various Pressure-Volume Relationships of the Respiratory Apparatus in Tuberculosis (TB) Patients

Abstract

A) Studies on Unoperated PatientsThirty TB patients who have been admitted to the Masan Transportation Sanatorium were selected for the study along with ten healthy men acting as the control group. Patients were divided into three equal groups, the minimal(Min), moder-ately-advanced(MA) and far-advanced(FA), dependent upon the severity of disease. Ages of subjects ranged from 20 to 49 years old, with the average of 33. The vital capacity and its subdivisions, the residual volume, the maximal breathing capacity, the minute volume and the resting oxygen consumption were measured and the data obtained from each group was compared with one another. Results may be briefly summarized as follows:1. The vital capacity as well as the inspriatory capacity and the expiratory reserve clume showed a moderate reduction in the FA group, suggesting a reduction in the ventilatory volume of the lung as a result of the extensive lesion in this group. 2. The residual volume increased progressively as the severity of TB increased. 3. The maximal breathing capacity was lowered while the timed vital capacity was delayed in the FA group.4. The calculated values of both the Leshe's index and the index of air trapping were significantly increased.5. Neither the capacity ratio nor the calculated air velocity index showed any significant difference among various groups. suggesting that the air-way resistance is not altered in TB patients.6. The minute cilume as well as the resting oxygen consumption showed no significant difference among various groups.7. These results are considered to be largely due to both the emphysematous and fibrotic changes of the lung, which ar known to occur secondarily in the far-advanced TB patients.B) Studies on Operated PatientsVarious surgical operations such as pnemnonectomy(3 cases), thoracoplasty(4 cases), left upper lobectomy(4 cases) and right upper lobectomy(5 cases) were performed on pulmonary TB patients when they were considered to improve the disease. Ages of patients ranged from 30 to 47 years old. with the average of 35.Measurements of various lung volumes and of ventilatory capacities, as indicated in the previous section, were made before and after(3to 12 months) the operation and results are compared as summarized below:1. The vital capacity as well as the inspiratory capacity and the expiratory reserve volume were reduced most after the pneumonectomy, moderately after the left or right upper lobectomy and least after the thoracoplasty.2. The R.V./T.L.C. ratio was increased by 14.3%, and 5.5% after left upper lobectomy and pneumonectomy, respectively, but it showed little change after either right upper lobectomy or thoracoplasty. The increase in this ratio seems to indicate that the remaining lung tissue overexpands in order to fill the space provided by the resection.3. The maximal breathing capacity was lowered most after both the pneumonectomy(by 28.4%) and the thoracoplasty(by 19.3%), and decreased less after the left or right upper lobectomy.4. The timed vital capacity showed slight improvement(by5%) in all groups after the surgery.5. Calculated values of the air velocity index the capacity ratio, the Leslie's index and the index of air trapping showed no significant change in all groups after the surgery.6. The resting minute volume was significantly increased after the pneumonectomy, while the resing oxygen consumption was no alterd, with the result that the ventilation equivalent was raised in this group. This is probably due to the reduction in the surface area available for the gas exchange after the pneumonecomy, which would invariably lower the overall efficiency of the gas exchange. No significant changes were seen in other groups.