| Study of The Late Results And Factors Influencing The Prognosis in Pulmonary Tuberculosis |
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Hyo Keun Lee |
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Chest Clinic, Severance Hospital Seoul, Korea |
| 폐결핵의 원격성적 및 예후에 영향을 미치는 인자에 관한 연구 |
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이효근 |
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| Abstract |
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Since the introduction of specific drugs great advances in the treatment of pulmonary tuberculosis have been made and some of older methods of treatment have been amost abandoned. Pulmonary tuberculosis is a long-standing, chronic disease and the final aim of all therapy is a complete return to normal life.
Therefore, the true value of various types of treatment can be measured most effectively by comparing the long-term follow-up results of patients treated in different ways. It is also felt that an analysis of the late results obtained in patients followed for many years might reveal much information of value in guiding the future handling of this disease. The purpose of this study is to present the late results and analyze the factors influencing the results of four to fifteen years follow-up on 387 cases of pulmonary tuberculosis discharged from the Piedmont Sanatorium in 1942 to 1953. This was accomplished with the co-operation of the local health departments serving the counties and cities of Virginia. Following results and factors, influencing the results of four to fifteen years follow-up, are found through this study.
1) There are no significant differences in mortality of male and female patients.
2) In the male group the mortality increases with the age. In the female group this trend is reversed and the mortality of the younger group.
3) The greater the extent of disease, the higher the mortality.
4) There is a definite correlation between the absence or presence of cavitary lesions and the mortality rates.
Patients with no cavity show a better prognosis than those with one or more cavities. The larger the cavity, the higher the mortality rate. There is a minor differnce in the mortality who have cavity in right or lungs respectively. In unilateral cavities there is no difference in mortality according to position. Bilateral cavitation presents a worse prognosis than those unilateral cavitation.
5) Patients with positive bacteriological findings on discharge show poorer prognosis than those with negative findings.
6. Patients who show moderate to marked improvement within eight months of therapy show better results than those who fail to improve within that period.
7. Prolonged chemotherapy is markedly effective in minimal cases. In moderately advanced and far advanced cases with cavitary lesions, the combination of chemotherapy and excisional surgery produces the best results.
8. The greater the extent of disease of the contralateral lung at operation, the higher the mortality.
9. Chemotherapy should be continued for long period, at least more than 12 months, and the superior regimens are SM-PAS-INH and INH-PAS.
10. Among all treatment groups, as a whole, most of the deaths occure during the first four years after discharge, following which the proportion of annual deaths occur at a much lower rate.
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