Far-advanced Pulmonary Tuberculosis Research Articles

The Influence of Smoking on Pulmonary Tuberculosis in Diabetic and Non-Diabetic Patients

BackgroundBoth smoking and diabetes can increase the risk and influence the manifestations and outcomes of tuberculosis (TB). It is not clear whether the influence of smoking on pulmonary TB differs between non-diabetic and diabetic patients. Herein, we assessed the manifestations and outcomes of TB in relation to smoking in both diabetic and non-diabetic TB patients.Methodology/Principal FindingsAll diabetic culture-positive pulmonary TB patients notified from 2005–2010 at three teaching hospitals in Taiwan were enrolled. A culture-positive pulmonary TB patient without DM who was notified to the health authority immediately prior to each diabetic TB patient was selected for comparison. The 972 patients in this study cohort included 365 (37.6%) non-diabetic non-smokers, 149 (15.3%) non-diabetic smokers, 284 (29.2%) diabetic non-smokers, and 174 (17.9%) diabetic smokers. The adjusted relative risk of a pretreatment positive smear for a smoker compared with a non-smoker was 2.19 (95% CI 1.38–3.47) in non-diabetic patients and 2.23 (95% CI 1.29–3.87) in diabetic culture-positive pulmonary TB patients. The adjusted relative risk for a positive smear among diabetic smokers was 5.61 (95% CI 3.35–9.41) compared with non-diabetic non-smokers. Smoking was significantly associated with an increased frequency of bilateral lung parenchyma involvement (AdjOR 1.84, 95% CI 1.16–2.93), far-advanced pulmonary TB (AdjOR 1.91, 95% CI 1.04–3.50), cavitary lesions (AdjOR 2.03, 95% CI 1.29–3.20), and unfavorable outcomes of TB (AdjOR 2.35, 95% CI 1.02–5.41) in non-diabetic patients. However, smoking was not associated with cavitary lung parenchyma lesions regarding the location, number or size of the cavity in diabetic TB patients.Conclusions/SignificanceSmoking and diabetes have joint effects on a pretreatment positive smear. Diabetic smokers had more than a 5-fold increased risk of a pretreatment positive smear than did non-diabetic non-smokers, indicating remarkable joint effects of diabetes and smoking on the risk of TB transmission.

Clinical Characteristics of Tuberculous Empyema

Background : In contrast to tuberculous pleurisy, tuberculous empyema is a chronic active infectious disease of the pleural cavity that is frequently accompanied by cavitary or advanced pulmonary lesions. The condition requires long-term anti-tuberculous medication with external drainage. The clinical features and treatment outcome of tuberculous empyema are unclear despite the high prevalence of tuberculosis in Korea. Methods : From January 1991 through April 2004, 17 patients diagnosed with tuberculous empyema in Kyungpook National University Hospital were enrolled in this study. Their medical records and chest radiographs were reviewed. Results : Twelve patients(71%) had a history of tuberculosis and six of the 12 patients were under current anti-tuberculous medication. Productive cough, fever, and dyspnea were the main complaints. There was no predominance between the right and left lungs. Nine patients(53%) had far-advanced pulmonary tuberculosis, two(12%) had a cavitary lesion, and seven(41%) had a pyopneumothorax on the chest radiograph. All eight cases in whom the data of pleural fluid WBC differential count was available showed polymorphonuclear leukocyte predominance. Eight patients(47%) had other bacterial infections as well. The overall rates of a positive sputum AFB smear and culture for M. tuberculosis were 71% and 64%, respectively. The positive AFB smear and culture rates for M. tuberculosis from the pleural fluid were 33% and 36%, respectively. Twelve of the 16 patients(75%) were treated successfully. Three underwent additional surgical intervention. Two patients (12%) died during treatment. Conclusion : Tuberculous empyema is frequently accompanied by advanced pulmonary lesions, and polymorphonuclear leukocytes are predominant in the pleural fluid. Other accompanying bacterial infections in the pleural cavity are also common in tuberculous empyema patients. Therefore, tuberculous empyema should be considered in differential diagnosis of patients with polymorphonuclear leukocyte-predominant pleural effusion. In addition, more active effort will be needed to achieve a bacteriological diagnosis in the pleural fluid.

Lymphocyte Proportion and Cytokines from the Bone Marrow of Patients with Far-Advanced Pulmonary Tuberculosis with Peripheral Lymphocytopenia

Background : The poor prognostic factors of far-advanced pulmonary tuberculosis(FAPTB) are lymphocytopenia in the peripheral blood(PB)(<1,000/mm 3 ) and T4-cell count ≤500/mm 3 . However, the cause of PB lymphocytopenia in FAPTB is unclear. The aim of this study was to analyze the lymphocyte proportion and cytokines of the bone marrow(BM) in FAPTB patients with peripheral lymphocytopenia in order to clarify whether the limiting step of the lymphocytopenia occurs in production, differentiation, or circulation. Methods : This study included patients with FAPTB between August 1999 and August 2002 who visited Gachon Medical School Gil Medical Center. The exclusion criteria were old age(≥65years), cachexia or a low body weight, shock, hematologic diseases, or BM involvement of tuberculosis. The distributions of cells in PB and BM were analyzed and compared to the control group. The interleukin(IL)-2, IL-7, IL-10, TNF-α, Interferon-γ, and TGF-β levels in the BM were measured by ELISA.

Laryngeal Tuberculosis

Laryngeal tuberculosis usually occurs with active, far-advanced pulmonary tuberculosis. A single patient with laryngeal tuberculosis had a normal chest roentgenogram. Tuberculin skin testing of exposed hospital personnel revealed three conversions of 36 tested. This case supports the view that laryngeal tuberculosis may be infectious and can occur without obvious pulmonary disease.

A comparative study of daily followed by twice or once weekly regimens of ethambutol and rifampicin in retreatment of patients with pulmonary tuberculosis The results at l year

The present report concerns the results at 1 year of a co-operative controlled clinical study carried out in Poland of the retreatment of patients with active, chronic, polyresistant far-advanced pulmonary tuberculosis with an oral regimen of daily followed by intermittent ethambutol and rifampicin. A comparison was made of once — and twice-weekly supervised intermittent regimens of rifampicin 1200 mg plus ethambutol 50 mg/kg body weight under out-patient conditions after an initial inpatient phase of rifampicin 600mg and ethambutol 25 mg/kg daily for 12 weeks.Patients were allocated at random to the regimens. Of 247 patients admitted to the study, 201 (81 per cent) completed 1 year's treatment as prescribed by the protocol, 46 (19 per cent) patients terminated their treatment prematurely before 1 year.After the daily phase of 12 weeks' treatment, 82 per cent were negative on smear and 85 per cent on culture; in the continuation intermittent phase, 98 per cent of patients in the once-weekly (E1R1) regimen were negative on culture at 28 weeks and 98 per cent in the twice-weekly (E2R2) regimen. The corresponding proportions at 52 weeks were 97 per cent and 97 per cent. At 12 months, 96 per cent of 101 ER/E1R1 and 96 per cent of 100 ER/E1R2 patients who completed 1 year's treatment were culture-negative.The once-weekly and twice-weekly regimens were of similar bacteriological effectivity. Of 46 patients with premature termination of treatment before 1 year 91 per cent were culture-negative at the time of stopping treatment. Of all 247 patients, 96 per cent attained culture negativity at the time treatment was completed at 1 year or terminated prematurely.Adverse reactions, mainly mild and transient abnormalities of liver function, occurred in 12 per cent of the patients during the daily phase of treatment. During the intermittent phase, side-effects were observed in 29 per cent. They were systemic reactions to rifampicin in 26 per cent, hepatic disturbances in 2·5 per cent and visual impairment due to ethambutol in 1 patient. The frequency of systemic reactions was 29 per cent in the E1R1 and 24 per cent in the E2R2 series, a statistical non-significant difference. It was higher in patients over 50 years of age than in the younger groups (P<0·001). Ten per cent of patients stopped treatment prematurely because of drug toxicity.The regularity of attendance with no omission of any occasion for drug intake was 93 per cent of E1R1 and 88 per cent of E2R2 patients. In 4 per cent treatment was terminated prematurely because of uncooperativeness.The results at 1 year expressed in terms of the bacteriological response at the end of the year, and the incidence of modifications to chemotherapy because of toxicity or default in 235 patients showed that 83 per cent had a favourable response, 97 per cent being culture negative. Seventeen per cent of patients had an unfavourable response, 4 per cent because of bacteriological failure, 10 per cent because of drug toxicity and 3 per cent because of default.Both regimens were thus highly effective and produced a relatively low incidence of toxicity, showing that daily followed by once — or twice-weekly rifampicin and ethambutol supervised, in the intermittent phase under out-patient conditions are of great practical value in the retreatment of patients with chronic, far-advanced pulmonary tuberculosis.

Laryngeal Tuberculosis or Tumor

Comments1 November 1974Laryngeal Tuberculosis or TumorJAMES O. MORSE, M.D.JAMES O. MORSE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-5-711 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Dr. Rohwedder has described very well the picture of upper respiratory tract tuberculosis (1). Several tuberculous larynxes should be spared unnecessary biopsies as a result of this paper, and some laryngoscopists may even escape conversion of their tuberculin reactions. We have recently been troubled by a case in which the opposite course occurred, with unfortunate results.A 50-year-old alcoholic man was admitted with far-advanced pulmonary tuberculosis. Because of hoarseness, indirect laryngoscopy was done 6 days after admission. The epiglottis was injected, thickened, and covered with a whitish exudate. The arytenoids were injected and thickened, but the remainder...Reference1. ROHWEDDER J: Upper respiratory tract tuberculosis. Sixteen cases in a general hospital. Ann Intern Med 80:708-713, 1974 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JAMES O. MORSE, M.D.Affiliations: Clinical Chest Section Veterans Administration Hospital Tucson, Arizona 85723 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLaryngeal tuberculosis in the United States of America: A forgotten diseaseDisfonía y tuberculosis laríngea: presentación de dos casos y revisión de la bibliografíaTuberculosis laríngea: estudio de 11 casosVideostroboscopic Findings in Laryngeal TuberculosisOral tuberculosisThe presentation of laryngeal tuberculosisCase 51-1983Laryngeal tuberculosis in TanzaniaThe changing pattern of laryngeal tuberculosisTuberculosis of the Larynx Masquerading as Carcinoma 1 November 1974Volume 81, Issue 5Page: 711-712KeywordsAlcoholicsBiopsyLarynxRespiratory systemTuberculin ePublished: 1 December 2008 Issue Published: 1 November 1974 PDF downloadLoading ...

Preresectional Thoracoplasty in Unilateral Extensive Lung Resection in Pulmonary Tuberculosis

Thirty-four patients with preresectional thoracoplasty prior to extensive pulmonary resection for tuberculosis are presented. Most of them had far-advanced pulmonary tuberculosis with unilateral cavities. Postresectional complications occurred in 3 or 8.8 per cent of cases with no mortality. All were discharged with negative sputum or gastric cultures, except for one with bilateral disease, who returned to his native country and is doing well. Preresectional thoracoplasty in the chronically ill patients with an increased surgical risk is recommended prior to extensive resection. Specific indications are listed.

Tuberculous Cervical Lymphadenitis

ABSTRACT To the Editor:— In The Journal (199:681, 1967) Dr. V. A. Plessinger answers a query on tuberculous cervical lymphadenitis. I would like to take exception to two of his statements which appear to be highly controversial. In the first statement Dr. Plessinger says, cervical lymphadenitis most commonly is secondary to tuberculosis of the tonsils or the mouth. While tuberculosis of the mouth and/or tonsils is an exceedingly rare condition, it usually (but not always) is associated with faradvanced pulmonary tuberculosis in debilitated patients. Tuberculous cervical lymphadenitis (scrofula of the old days), is a much more frequently encountered entity. As a rule it is not associated with any lesions of the mouth, tonsils, etc. It is frequently a manifestation of primary tuberculous infection and is often found simultaneously with tracheobronchial lymphadenopathy and with supraclavicular glands involvement and retrograde extension to the cervical glands. Every physician who reads chest x-ray

Capreomycin in the re-treatment of patients with pulmonary tuberculosis

Summary Capreomycin was administered in combination with other drugs in sixteen patients with far-advanced pulmonary tuberculosis who had failed to undergo sputum conversion on previous combined chemotherapy. Among eleven patients treated with capreomycin for more than 6 months, three became sputum negative on culture and remained so for a follow-up period of several months. In two of these cases capreomycin had been administered with cycloserine and in the third case with 4-4′ diisoamyloxythiocarbanilide, both companion drugs being administered for the first time. A complete reciprocal cross-resistance with viomycin was found in all cases developing resistance to capreomycin during treatment.

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, &amp; auricular fibrillation 1 respectively

Abnormal Heartsounds in Far-advanced Pulmonary Tuberculosis Patients

Abnormal Heartsounds in Far-advanced Pulmonary Tuberculosis Patients

On the Cause of Death and the Process in Far-advanced Pulmonary Tuberculosis

On the Cause of Death and the Process in Far-advanced Pulmonary Tuberculosis

重症肺結核の外科的療法に関する病態生理学的研究

重症肺結核の外科的療法に関する病態生理学的研究

On the Clinzcal Effects of Intracavitary Administration of Antituberculous Drugs in Far-advanced Pulmonary Tuberculosis

On the Clinzcal Effects of Intracavitary Administration of Antituberculous Drugs in Far-advanced Pulmonary Tuberculosis

Adrenocortical steroid therapy and chemotherapy in acute, far-advanced toxic pulmonary tuberculosis: A preliminary report

1. 1. Four cases of acute, far-advanced pulmonary tuberculosis with organisms susceptible to antimicrobial agents and complicated by persistence of toxicity, fever, and failure to show improvement, or worsening, or standard antimicrobial therapy, are reported. One case had definite adrenocortical hypofunction. 2. 2. Adrenocortical steroids were given as adjunctive therapy to these cases, following which there appeared to be an accelerated improvement, clinically, radiographically, and hematologically in all four cases, and bacteriologically in three, There was one death in the series and it is possible that steroid therapy may have been a contributory factor. 3. 3. The pertinent literature is reviewed.

Treatment of pulmonary tuberculosis by viomycin combined with oxytetracycline

Twenty patients with chronic far-advanced pulmonary tuberculosis have been treated with viomycin and oxytetracycline, most for six months or more. Previous treatment for a mean of twenty-three months with streptomycin, PAS and isoniazid had failed and in all high bacillary resistance had emerged. Results were good, considering the apparently hopeless state of most of the patients. In 4, there was cavity closure. In 5, there was moderate to very considerable resolution, but ‘insurance operations’ were performed afterwards. In 5, there was little or no improvement, but operations were subsequently carried out without major incident. In 4, there was no radiological change; in 1 there was deterioration and 1 died from amyloidosis. Among the 10 patients who subsequently underwent operation, there was no major complication. Changes in sensitivity to these drugs appeared only with oxytetracycline, in 3 cases.

A study of the bone marrow in far-advanced pulmonary tuberculosis.

A study of the bone marrow in far-advanced pulmonary tuberculosis.

Isoniazid and streptomycin in the treatment of pulmonary tuberculosis.

Clinical studies with isoniazid and related compounds have demonstrated antituberculous activity of high magnitude and thus confirmed results of in vitro and in vivo investigations. Particularly significant are the evaluations recorded by Selikoff, Robitzek, and Ornstein¹on 166 patients with pulmonary and extra pulmonary tuberculosis treated with isoniazid or iproniazid alone, and those of Clark and co-workers²on 14 patients with miliary and meningeal tuberculosis treated with isoniazid alone. These authors suggest that preliminary studies with isoniazid and iproniazid reveal therapeutic efficacy equal or superior to that observed with streptomycin employed singly. Treatment of 61 patients with moderately or far-advanced pulmonary tuberculosis at Fitzsimons Army Hospital with 150 or 300 mg. of isoniazid alone daily for four to eight months resulted in observations essentially in accord with the views expressed above.³Symptomatic response was uniformly favorable and was supported by objective improvement as measured by serial chest

Tuberculosis Chemotherapy with Hydrazine Derivatives of Isonicotinic Acid

1) Ninety-two patients with moderately or far-advanced pulmonary tuberculosis classified largely as progressive and caseous-pneumonic, have been treated with the hydrazide of isonicotinic acid (Rimifon) and its isopropyl derivative (Marsilid). 2) All patients had positive sputum and active disease before institution of therapy. Forty-five were toxic and febrile. 3) Patients, divided into groups, were treated with 2, 4, and 10 milligrams per Kilo of Marsilid and 4 mg. of Rimifon for from four to 15 weeks. 4) Complete elimination of fever and toxicity occurred within two to three weeks in all cases. Appetite increase and restored sense of well-being were matched and overshadowed by weight gains which varied up to 64 pounds and averaged 18 pounds at an average of nine weeks of treatment. 5) Sputum negativity was obtained in 25 per cent of patients in from four to 15 weeks of treatment and in another 28 per cent, sharp reductions from consistent plain smear positivity to “occasionally positive” occurred. 6) Cough and expectoration were completely eliminated, or almost so, in from two to three weeks. 7) Among the 92 cases, in from four to 15 weeks, cavity closure occurred in two cases, marked reduction in cavity size was noted in 33 cases, clearing of exudate occurred 17 times. 8) Marked simultaneous diminution in several cavities within the same lung was seen three times. 9) Extension of exudate occurred four times and was minimal. One equivical new cavity appeared at the site of a pre-therapy exudate. 10) There was no death due to progression of tuberculosis. 11) Cure or marked improvement has been seen in cases of tuberculous laryngitis, tuberculous otitis, tuberculous glossitis. 12) Toxic effects of Marsilid and Rimifon therapy include hyper-reflexia, leg-twitching, constipation, vertigo and reflex disturbance of micturition. 13) No death due to therapy has occurred. 14) Every patient has been benefited by therapy. 15) Clinical investigation of these previously untried new compounds, the hydrazide of isonicotinic acid (Rimifon) and its isopropyl derivative (Marsilid) reveals that they are potent agents for the treatment of human tuberculosis.

An unusual case of suicide: Three through-and-through bullet wounds of the heart

The unusual feature of the case presented is the multiplicity of bullet wounds of the heart, self inflicted, any one of which would appear to be immediately fatal. The motives for suicide were apparently poverty and far-advanced pulmonary tuberculosis. Penetrating wounds of the heart may heal spontaneously and death may occur later from another cause independent of the former heart injury.