Advanced Pulmonary Tuberculosis Research Articles

A Clinical and Sociomedical Study for the Probable Causes of Intractable Far Advanced Pulmonary Tuberculosis

A Clinical and Sociomedical Study for the Probable Causes of Intractable Far Advanced Pulmonary Tuberculosis

The virulence of tubercle bacilli for guinea pigs and the susceptibility of guinea pigs to tubercle bacilli.

Three hundred thirty-six guinea pigs of the Hartley strain were infected with tubercle bacilli isolated from 7 patients in South India, all of whom had moderate to far advanced pulmonary tuberculosis. In addition, one control group of 24 animals was injected with H37Rv and another control group of 24 animals was injected with saline. All inocula used for infection contained more than 105 viable units, and all infected animals acquired a pattern of skin sensitivity to six mycobacterial antigens typical for tuberculous infection. Mastitis, orchitis, or both, and skin lesions developed in many infected animals. The possibility that these were due to a contaminant was evaluated and rejected. Based on the mortality curves, the tubercle bacilli isolated from 2 patients were virulent whereas the bacilli isolated from 5 patients were less virulent to the guinea pig. Despite homogeneity of the animals with respect to age, sex, and genetic background, individual susceptibility to tuberculosis varied appreciably. Th...

Clinical experience of long-term home oxygen therapy.

Background: Long-term low flow oxygen therapy not only increases survival, but also improves the quality of life in patients with chronic obstructive pulmonary disease (COPD) with chronic hypoxemia. For the assessment and improvement of the status of home oxygen therapy, we analyzed clinical experience of 26 patients who have been administered low flow oxygen at home. Method: Twenty-six patients (18 men and 8 women) who have been received long-term oxygen therapy (LTOT) at home were examined. We reviewed physical characteristics, clinical history, pulmonary function test, ECG, arterial blood gas analysis, hemoglobin and hematocrit, types of oxygen devices, inhalation time per day, concentration of administered , duration of therapy, and problems in the home oxygen therapy. Results: The underlying diseases of patients were COPD 14 cases, far advanced old pulmonary tuberculosis 9 cases, bronchiectasis 2 cases, and idiopathic pulmonary fibrosis 1 case. The reasons for LTOT at home were noted for cor pulmonale 21 cases, for dyspnea on exertion and severe ventilatory impairment 4 cases, and for oxygen desaturation during sleep 1 case. The mean values of aterial blood gas analysis before home oxygen therapy were 57.7 mmHg, 48.2 mmHg, and 87.7%. And the mean values of each parameters in the pulmonary function test were VC 2.05 L, 0.92 L, and /FVC% 51.9%. Nineteen patients have used oxygen tanks as oxygen devices, 1 patient oxygen concentrator, 2 patients oxygen tank and liquid oxygen, and other 4 patients oxygen tank together with portable oxygen. The duration of oxygen therapy was below 1 year in 3 cases, 1~2 years in 15 cases, 3~5 years in 6 cases, 9 years in 1 case, and 10 years in 1 case. All patients have inhalated oxygen with flow rate less than 2.5 L/min. And only 10 patients have inhalated oxygen more than 15 hours per day, but most of them short time per day. Conclusion: For the effective oxygen administration, it is necessary that education for long-term low flow oxygen therapy to patients, their family and neighbor should be done, and also the institutional backup for getting convenient oxygen devices is required.

Clinical results in first treatment and retreatment of advanced pulmonary tuberculosis with rifampicin

Clinical results in first treatment and retreatment of advanced pulmonary tuberculosis with rifampicin

Rifampin and ethambutol in the retreatment of advanced pulmonary tuberculosis.

Rifampin and ethambutol in the retreatment of advanced pulmonary tuberculosis.

Survival Following Extensive Pulmonary Resection in Advanced Tuberculosis

Pulmonary function was studied in a 36-year-old woman who had undergone left pneumonectomy, left thoracoplasty, right upper lobectomy and resection of the medial segment of the right middle lobe, because of advanced pulmonary tuberculosis. At the time of the study, her sputum was negative and she was leading a fairly active life. The vital capacity was 50 per cent of predicted and the one-second forced expiratory volume was 45–51 per cent of vital capacity. Total lung capacity was 75 per cent of predicted (for both lungs) and residual volume was 48 per cent of total lung capacity. Arterial blood gases and pH were normal at rest. Arterial O 2 tension and pH decreased, and arterial CO 2 tension increased during exercise. Ventilation equivalent was normal, the venous admixture-like effect and the alveolar-arterial O 2 gradient were greater than normal and the resting O 2 diffusing capacity was reduced.

Serum Proteins in Pulmonary Tuberculosis

In two large controlled studies of corticosteroid-supplemented therapy in advanced pulmonary tuberculosis, mutual confirmation of the serum protein abnormalities of the disease was possible. Initially, albumin was depressed and α-1, α-2 and γ-globulins were increased. Total proteins and β-globulins were slightly increased in the study characterized by less extensive disease, but were normal in the other. Initial abnormalities of the serum proteins were related to various clinical background factors. Fever was the most notable with respect to albumin, α-1 and α-2 globulin and race was the major factor related to γ-globulin. During conventional treatment, β-globulin (if elevated) was restored to normal first, followed by α-1 and α-2 in that order. In these patients with advanced tuberculosis, albumin and γ-globulin averages improved, but failed to return to normal during eight months of observation. Corticosteroid therapy produced more rapid normalization of albumin and α-1 globulin, but these proteins and α-2 were transiently more abnormal than controls following withdrawal. The most striking effect was the reduction of elevated γ-globulin values to normal in two months without a later “rebound.” Normal Negroes have lower albumin and higher γ-globulin than whites. In tuberculosis, albumin values were the same in both races throughout treatment. However, γ-globulin was consistently higher in the Negro. The effect of corticosteroids on serum proteins was the same in the two races.

Serum Cholesterol and Serum Lipids in Patients with Far Advanced Active Pulmonary Tuberculosis on Three Drugs — Preliminary Report

1) The serum cholesterol values increased over the eight weeks of study in these patients on a normal hospital diet. 2) There was a decrease in serum cholesterol as a result of a diet low in fat (less than 40 grams of fat per day) and a diet low in fat plus 16 ml per day of poly-unsaturated oil in chronically ill patients with far advanced active pulmonary tuberculosis on streptomycin, isoniazid and para-aminosalicylic acid (or some form of this drug depending upon the tolerance of the patient). 3) The rates of decrease of serum cholesterol are the same on both dietary regimens. The addition of 16 ml of high poly-unsaturated oil per day to the low fat 2400 calories diet did not show a significant decrease of the serum cholesterol below that of the diet without the oil. 4) There was a decrease in serum lipids in the patients on a low fat diet during the eight weeks of study. 5) There is no marked change in weights for the three groups during the eight weeks of study. 6) It can be stated that there is a reduction in serum cholesterol and serum lipids by decreasing the fat intake in chronically ill patients on three drugs, as was found by previous workers using normal healthy individuals, unstable diabetics, or mentally ill patients.

An Autopsy Case of far Advanced Pulmonary Tuberculosis Complicated with Amyloidosis and Fungus Infection

An Autopsy Case of far Advanced Pulmonary Tuberculosis Complicated with Amyloidosis and Fungus Infection

EXPERIENCE OF RE-TREATMENT WITH SO-CALLED SECONDARY ARUGS IN DRUG-RESISTANT PULMONARY TUBERCULOSIS

A re-treatment by double or triple regimen with ethionamide, cycloserine, and pyrazinamide was evaluated in 27 patients of advanced primary drug-resistant pulmonary tuberculosis who han 6 to 17 months of therapy with Primary drugs. Reversal of infectiousness was observed in 64% of far-advanced patients. There was no deaths. Four patients have discontinued ethionamide because of severe gastrointestinal troubles. Liver toxicity to pyrazinamide as evidenced by an abnormal liver function test occurred in one patient. There was no jaundice. Several patients were required to discontinue certain drugs temporarily.

CLINICAL STUDY ON 4-4'-DIETHOXYTHIOCARBANILIDE IN ADVANCED RESISTANT PULMONARY TUBERCULOSIS

For this clinal observation we, clincians, have selected the sampling 21 persons of far advanced resistant pulmonary tuberculosis patients. who were divided into two groups, group A and B. At first, to group A we administered DETC and INH on everyday basis, combining with another two primary drugs(INH PAS or SM) in the way triple therapy. But to group B we also administered DETC and INH on everyday basis in the way double therapy. In such a way we continued to treat the patients through six months. During this clinical observation period or shortly after the completion of this treatment, we examined and observed the general conditions of these patients(body weight, body temperature, sputum amount and ESR). the chest X-ray finding, the concentration sputum or its culturesmera of finding, the transformation or conversion of resistance to primary drugs and the were obtained on DETC The results were obtained (1) In both groups all the clinical symptoms of patients has been improved especially the daily output of sputum has been reduced remarkably in more than a half of patients in both groups. The ESR is lessened in two-thirds, especially in most of group A. (2) The chest X-ray finding is shown to have taken a slight turn respectively almost in a half of group A and one-third of group B. (3) In the culture situation of M.tbc in sputum in a concentration method, 10 cases showed negative conversion and 12 cases showed reduction, total 22 cases this figure is equal to 71.0 percent have been improved. (4) The culture result is found that M.tbc stopped its growth in 5 cases(19.2%) of 25 cases without any contamination in Ogawa's solid media and Youmans liquid media. (5) In the transforming of sensitivity of AFB fro primary drugs in patients sputum, its resistance converted into sensitivity is shown respectively in 2 cases in INH and PAS, and Its sensitivity converted into resistance is in none. Its resistance in negative conversion is shown in 1 cases in INH, 2 in PAS and 2 in SM. The weakened resistance is shown in 5 cases in INH, none in PAS and 2 in SM. And its none-reaction is shown in 10 in INH, 14 in PAS, 13 in SM. So the latter case takes a largest shore of them. (6) The sensitivity of M.tbc. for DETC in sputum in the larger part of group A and B after the administration over sex month-period, four-fifths maintain its sensitivity, and in the rest about one-fifth(6 cases of 20 cases) the resistance in addition 5 cases(23.1%) 1 microgram per milliliter. (7) There is little difference between group A and B in the clinical effect on DETC. (8) Theside effect on DETC is G-1 trouble 2, skin lesion 3, fever 5, flusing 1. Accordingly the discovery rate in 32.3% but the symptoms are all not serious and transitent. As result there is no need stopping the administration. The side effect is shown in 9 of 10 persons within the first month since the administration began.

Treatment of pulmonary tuberculosis with cultures resistant to two or more drugs: A series of 44 patients

Summary The treatment is described of 44 patients with long-standing chronic and advanced pulmonary tuberculosis. Their cultures were resistant to two or three standard drugs, and, in 19 patients, to at least one ‘reserve’ drug as well. All but six (two died and three discharged against medical advice) have been treated for at least one year. In 14, the cultures were sensitive to one of the standard drugs; six to streptomycin, two to PAS and six to isoniazid. They were given the standard drug, plus ethionamide and pyrazinamide in seven cases and pyrazinamide, cycloserine and thiacetazone in the other seven. In all but one, the sputum became and has remained negative on culture. One patient relapsed after six months when he took his drugs irregularly. In 15 resistance to all three standard drugs was present, but not to any of the ‘reserve’ drugs. Two died and three discharged themselves during the first month because of ethionamide intolerance. In the remaining 10, the sputum became negative on culture; eight were given ethionamide plus two or three other ‘reserve’ drugs and two viomycin, pyrazinamide and cycloserine. One relapsed after 11 months when he took his drugs irregularly; three died in the second year from non-tuberculous diseases: their sputum was persistently negative. The sputum remains negative in the other six. In five there was resistance to the standard drugs and also to ethionamide. They were treated with kanamycin, pyrazinamide and cycloserine: their cultures became and remain negative. In ten resistance was present to at least two of the ‘reserve’ as well as to the standard drugs. In five, a combination of three or four drugs was possible, ethionamide always being included: all five have persistently negative cultures. In the other five the cultures were resistant to ethionamide and pyrazinamide: a combination of four ‘reserve’ drugs had no effect, but in four of the five there has been a promising early response after rifamycin had been added. These results emphasize the success of regimes of three or preferably four ‘reserve’ drugs, of the flexibility in these regimes when toxic reactions, unpleasant side-effects or resistance occur, and the rewards of patience and persistence in treatment.

A controlled trial of isoniazid and 4-4 diisoamyloxythiosemicarbanilide compared with isoniazid and pas and isoniazid, streptomycin and pas

Forty-eight previously untreated patients with advanced pulmonary tuberculosis were allocated at random to three treatment groups: IsH-isoniazid 300 mg. daily in a single dose with 4-4′ diisoamyloxythiosemicarbanilide (‘Isoxyl’) 3 g. twice daily; PH-isoniazid 300 mg. daily with 6 g. PAS twice daily; SPH-streptomycin 1 g. daily or alternate days with isoniazid and PAS. Nine patients were excluded, leaving 39 patients (13 IsH, 11 PH and 15 SPH). All had cultures sensitive to isoniazid and PAS and all but one (PH) to streptomycin. All 15 SPH patients became culture negative. One of the 11 PH patients had isoniazid resistant cultures from the 2nd month. Cultures oecame negative in the remaining 10. Of the 13 patients in the IsH group only 4 became negative and isoniazid-resistant cultures were obtained from 9. The results of treatment of advanced pulmonary tuberculosis with isoniazid and ‘Isoxyl’ appear to be no better than the results expected with isoniazid alone. 48 malades présentant une tuberculose pulmonaire avancée, et n'ayant jamais été traités. furent répartis au hasard en trois groupes de traitement: IsH-isoniazide 300 mg. par jour en une seule prise plus 3 g. de 4-4′ diisoamyloxythiosemicarbanilide (‘Isoxyl’) 2 fois par jour; PH-isoniazide 300 mg. par jour plus 6 g. de PAS 2 fois par jour; SPH-streptomycine 1 g. par jour ou tous les deux jours plus isoniazide et PAS. 9 malades furent exclus, laissant 39 malades dans l'enquête (13 IsH 11 PH, et 15 SPH). Ils avaient tous des cultures sensibles à l'isoniazide et au PAS, et tous sauf un (PH) à la streptomycine. Les 15 malades du groupe SPH se négativèrent. Un des 11 malades du groupe PH eut des cultures résistantes à l'isoniazide à partir du 2 éme mois. Pour les 10 autres les cultures devinrent négatives. Parmi les 13 malades du groupe IsH, 4 seulement devinrent négatifs et les 9 autres eurent des cultures résistantes à l'isoniazide. Les résultats du traitement des tuberculoses avancées par isoniazide et ‘Isoxyl’ ne semblent pas meilleurs que les résultats que l'on pourrait espérer par l'isoniazide seul. 48 enfermos de tuberculosis pulmonar avanzada, sin tratamiento previo, fueron seleccionados al azar en 3 grupos: IsH-isoniazida 300 mg. en una dosis, con 4-4′ diisoamyloxythiosemicarbanilida (‘Isoxyl’) 3 g., dos veces por día; PH-isoniazida 300 mg. diarios, con PAS, 6 g. dos veces por día; SPH-estreptomicina 1 g. diario ó día por medio, con isoniazida y PAS. Fueron excluidos 9 enfermos, quedando 39 (13 IsH, 11 PH y 15 PSH). Todos tenían bacilos sensibles a isoniazida y PAS y todos, menos 1 (PH), a la estreptomicina. Los 15 del grupo SPH se negativizaron al cultivo. Uno de los 11 del grupo PH presentó bacilos resistentes a la isoniazida a partir del 2 o mes. Los cultivos fueron negativos en los 10 restantes. De los 13 enfermos del grupo IsH se negativizaron sólo 4, mientras que 9 presentaron bacilos resistentes a la isoniazida. Los resultados del tratamiento con isoniazida e ‘Isoyl’ en la tuberculosis pulmonar avanzada parecen no ser mejores que los resultados esperados con isoniazida sola.

Resection in Advanced Pulmonary Tuberculosis : Experience with 142 Cases

One hundred forty-four pulmonary resections performed on 142 patients with advanced tuberculosis, many of them salvage cases, are reviewed and analyzed. The overall mortality rate was 4.2 per cent. The postoperative complication rate was 17.3 per cent of which 11.06 per cent were bronchopleural fistulae and empyemata. These complications occurred in 8.8 per cent of the segmentectomies and 6.3 per cent of the lobectomies. Of the 119 patients whose present condition is known, 110 patients (77.4 per cent of the entire series) are well and working, their sputum negative.

Shift of the Mediastinum with Respiration: A Bronchospirometric Study in Pulmonary Tuberculosis

Mediastinal shift during respiration was observed in 28 per cent of 800 patients with advanced pulmonary tuberculosis; roentgenographic and pulmonary data were analyzed in 75 consecutive patients selected from this series. A group of 61 patients without mediastinal shift served as controls. The patients with mediastinal shift had more severe impairment of ventilatory function than the controls and bronchospirometry showed greater inequality of lateralization of this impairment. Mediastinal shift was classified as obstructive, restrictive or combined, depending on the ventilatory defect in the lung producing the mediastinal shift. Bronchospirometry showed significantly greater impairment of function of the lung producing the shift in the restrictive than in the obstructive group. In all groups, oxygen uptake of the lung responsible for the mediastinal shift was impaired more than ventilation or vital capacity. Shift of the mediastinum with respiration cannot be produced experimentally during bronchospirometry if thoracic bellows function on the side of bronchial occlusion is impaired and adequate trans-mediastinal pressure gradients are not developed. Mediastinal shift cannot occur if the mediastinum is fixed due to pleural or parenchymal lung disease, but mediastinal fixation was rarely observed.

Chemotherapy for patients with cultures resistant to streptomycin, isoniazid and pas

The results are given of treating 122 patients with far advanced pulmonary tuberculosis and cultures resistant to streptomycin, isoniazid and PAS. 39 had surgical treatment and 83 had chemotherapy alone. The following drugs were used: ethionamide (0·5 g. twice daily), pyrazinamide (0·5 g. three times daily), cycloserine (0·25 g. three times daily), viomycin (1 g. daily or 2 g. twice a week. Fifty-five patients were treated initially with three of the secondary drugs for a minimum of three months, and an average period of 12 months; treatment was then continued with two drugs. Of this 55, 51 (93%) became negative on culture. Two patients with positive cultures did not take the drugs regularly. Another patient had one of the drugs (viomycin) intermittently and—as was discovered later—had no appreciable concentration of ethionamide in the serum after either oral or rectal administration of the drug. Four patients died, three of them after the sputum had become persistently negative. Twenty-eight patients had only two drugs initially: only 9 (32%) became negative. Fifteen died and in 13 of these the sputum was still positive. There was little difference between the three drug and two drug group in the severity of disease and other factors. The difficulties of treatment with the secondary drugs are emphasized. However, satisfactory results can be achieved if some basic rules and principles of good chemotherapy are observed, and if the patients are willing to co-operate.

A Electrocardiographic Study among the 100 Cases of Chronic, Far-advanced Pulmonary Tuberculosis

The author have made a study on the E.C.G. findings among the cases of chronic far advanced pulmonary tuberculosis. The results obtained are as follows:1. The findings reflect, the long-lasting burden to the right heart:a. Right ventricular hypertrophy 9 b. Chronic cor-pulmonale 8 2. Other Significant findings:a. Left ventricular hypertrophy 4 b. Myocardial damage 4 c. Ventricular premature beats 4 d. Low voltage 4 c. Sinus tachycardia 18 f. W.P.W, & auricular fibrillation 1 respectively

The Review Of Pneumonectomyh for Advanced Pulmonary Tuberculosis

I have reviewed the results of 30 cases of pneumonectomy for advanced pulmonary tuberculosis in past two years and the summary of results is as follows:1) Recently, in Korea the cases of pneumonectomy for tuberculosis are gradually increased while the % of lobectomy and segmental resection has been decreased.2) According to the x-Ray findings all cases indicated for pneumonectomy are classified into 3groups.e,g, opaque, far extended and empyema group.3) The mortality was 6.6%, and of these death early dead was mainly caused by cardiorespiratory insufficiency while the late death was due to the respiratory insufficiency secondary to tuberculous spread of opposite lung.4) There was no complication of bronchofistula, but one case of empyema was occurred after 20days of operation due to wound infection.5) In most cases, postoperatively, it should be strictly observed the occurrence of mediastinal shift, anoxia and pulmonary edema. We have routinely preferred to apply the digitalization for about 5days preoperatively and aminophylline injection postoperatively.

Study on the Prevention of Postoperative Compilations for Advanced Pulmonary Tuberculosis

The author studied the pulmonary reparation for advanced pulmonary tuberculosis in CS case and particularly the postoperative complications during the period from April 1960 to March 1962. In foreign countries, although they have good indication for it, it is reported that 10% of complications and 2% of mortality and 1/2 resemt. But in Korea, the most cases of pulmonary tuberculosis, for pulmonary resection had a long history of disease, irregular chemotherapy for long period and extensive lesions which were not good indication. The high rate of complication and death are expected. The major complications postoperatively were the bronehofistula, emphysema and spread. The causes of bracehofistula are those of the pathological changes at the brochial stump, the insufficiency of expansion and the suture material of the bronchial stump. The emphysema were caused by the direct contamination of the plural cavity during operation and secondary infection from the infected operative wound in the chest. On the other hand, as the emergent complication postoperatively, there were bleeding, oliguria, fall of blood persentre and dyspnea. Inthese case, the renal insufficiencies accompanied with oliguria, increased no protein were fatal. The author notieed that the renal insufficiencies were caused by postoperative and anesthetic shock, renal toxin due to PAS and the overloading of blood transfusion, 1. In these cases, the segmentectomy was only 6% and pneumonectomy was 33% which was higher than that of foreign countries. 2.AS postoperative complications, there were 4.4% of bronchofistula, 1.4% of emphysema, 4.4% of poor expansion and 2.9% of spread. 3. The postoperative complications were bleeding, oliguria, fall of blood pressure, respiratory insufficiency and cardiac insufficiency. Among these, twocases were died by acute renal insufficiency. 4. The postoperative critical complications were mostly seen in cases of abnormal E.C.G. and more than 3,000cc of blood transfusion. 5. To prevent the fall of blood pressure postoperatively, as the blood transfusion is used, the special attention should be paid for it.

The Value of Steroids in the Treatment of Moderately Advanced Pulmonary Tuberculosis

The Value of Steroids in the Treatment of Moderately Advanced Pulmonary Tuberculosis