菌陰性空洞の長期観察

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In order to investigate the prognosis of open negative cavity, 34 cases of pulmonarytuberculosis were followed up for 5 to 14 years, average 9.7 years, after open negativecavity was attained. The open negative cavity (O. N. C.) was defined as follows: At thebeginning of treatment, cavity was observed on chest radiogram and tubercle bacilli wereconfirmed in sputum, and during chemotherapy, the cavity remained while bacilli becamecontinuously negative both on smear and culture for 12 months by monthly examinations.<BR>Of 34 cases, 13 had an unilocular cavity and 21 had a multilocular cavity, and they werefollowed up on the average 10.2 and 9.1 years, respectively.<BR>Bacteriological relapse was observed in only 2 cases or 5.9%. Radiological worsening wasobserved in 2 of 14 unilocular cavities and in 4 of 23 multilocular cavities. The worsening wasconfirmed to be tuberculous in one unilocular cavity and 2 multilocular cavities, while in theother 2 multilocular cavities, the worsening was due to the other infection (fungus infection, etc.), and in another one unilocular cavity, changes were judged as worsened as the shadowbecame larger through atelectasis formation in the segment where a cavity existed 8 yearsafter O. N. C. was attained. O. N. C. was classified by Iwasaki according to the thickness of cavity wall on radiograminto A, B, C, D, E, F, G, H and I, and the details are presented in notes of Table 6. Accordingto this classification, types B and D were dominant in unilocular cavities and types C, F, Gand H were dominant in multilocular cavities when O. N. C. was attained. Five years later, complete disappearance of cavity, inspissation into a small shadow or changes into type Cwere most frequently seen in unilocular cavities, while multilocular cavities showed types C, H, I and D and solid atelectatic shadow. Accordingly, the type of cavity showed changesduring 5 years period after O. N. C. was attained. If the effective chemotherapy is properlycontinued, the cavity wall became thinner and changed into types A, C or D, and thereaftersome of the cavities showed complete disappearance or contraction or the contraction of cavitary area. The former might be an essential change of tuberculous cavity and the latter issecondary change probably due to protection mechanism of the host. In the case of cavities with thicker wall, the prognosis was in general unfavourable if the thickness of cavity showedno changes.<BR>The duration of chemotherapy was about 3 years in cases with unilocular cavity and 5 to 6 years in cases with multilocular cavity after O. N. C. was attained. Regimen of chemotherapywas changed to previously unused drugs among cases showing no changes in thickness ofcavity wall, and 2 cases of multilocular cavity showed diminution in thickness of cavity wallafter changing the regimen.<BR>It can be concluded as follows from the above results: Pulmonary tuberculosis patientswith open negative cavity should be treated with the effective chemotherapy for at least 4to 5 years after O. N. C. is attained until the cavity wall becomes thin.
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菌陰性空洞の長期観察

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