Treatment of far Advanced Drug Resistant Pulmonary Tuberculosis Reviewed from Its Prognosis.

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The authors made a study on the prognosis of 69far advanced cases of pulmonary tuberculosis admitted to the author's sanatorium during the period from December 1958 to December 1960. The clinical course of the disease was divided into the following 3 categories, namely, Group I died, Group II unchanged including slightly improved or deteriorated, and Group HI improved. The clinical course was reviewed in relation to the method of treatment and the extent and the character of pulmonary lesions, and the following conclusions were obtained.1. Accoding to the classification of pu lmonary lesions advocated by the Research Committee for the Treatment of Pulmonary Tuberculosis supported by the Ministry of Education, far advanced cases were divided into type F (far advanced mixed type), type B (mainly infiltrative caseous type lesions with cavity) and type C (mainly fibro-caseous type lesion with cavity). As shown in Table 1, however, no significant correlation was found between the course of the disease and the type of lesions. Dr. Isoe suggested the classification of far advanced cases of pulmonary tuberculosis according to the combination of the character of cavity and the extent of pulmonary lesions on each side of the lung, and as shown in Table 2, the prognosis was better among cases with non-cavitary slight lesions on the other side of the lung. But, even the latter classification was found to be insufficient to estimate the prognosis of far advanced cases, and the new classification of far advanced cases more suitable for this purpose must be made in the future.2. Most of the cases started chemotherapy immediately after the discovery of the disease, but, as shown in Table 4, more cases were found to be late in starting chemotherapy after the discovery of the disease among Group I. Most of the cases started chemotherapy with SM+PAS, INH+PAS or INH alone and continued on work among Group I, with SM+PAS and bed rest at home among Group II, and SM+INH+PAS in hospital among Group III. (Table 5) On admission to the author's sanatorium, as shown in Table 6, sensitive or low grade resistant cases were found more frequently among Group. III, and the more favourable response to chemotherapy during hospitalization was found among sensi tive cases. The above-mentioned facts suggest the importance of initiating chemotherapy with triple combination under hospitalization immediately after the discovery of the disease in order to obtain the better results of treatment.3. Among Group II, 8 cases (40 %) showed progress and 3 cases (15 %) showed slight improvement during admission. Among Group III, tubercle bacilli in sputum converted to negative in all cases, and among them 7 cases by the help of surgical treatment such as thoracoplasty, pulmonary resection and cavernostomy. For far advanced drug resistant cases hopeless to be cured by chemotherapy, if the conditions allow, surgical treatment must be conducted in proper time.4. Among Group I, II cases (52 %) died within 2 years after admission. Among causes of death, as shown in Table 9, cor pulmonale and general debility occupied each 6 cases respectively, death relating to the surgical treatment 5 cases, intestinal tuberculosis 2 cases and haemoptysis 2 cases. Thus, among 14 operated cases, 5 cases died after surgical treatment, and the fact suggests that surgical treatment for far advanced drug resistant cases of pulmonary tuberculosis must be planned and conducted carefully considering the technique of operation, pulmonary function and the grade of drug resistance.
一般社団法人日本結核病学会の論文

Treatment of far Advanced Drug Resistant Pulmonary Tuberculosis Reviewed from Its Prognosis.

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