| The Outcome of Initially Diagnosed Pulmonary Tuberculosis Patients seen at Tuberculosis Specialists Private Clinic |
|
Chan Sae Lee |
|
Visiting professor Internal Medicine Catholic Medical College, Seoul Office addr., 280 Kwanchol-Dong, Seoul, Korea |
| 결핵전문의 진료소에서 본 초진단 폐결핵환자의 귀추 |
|
이찬세 |
|
|
|
|
| Abstract |
|
The records of 123 pulmonary tuberculosis patients initially diagnosed during three and half years from December 1965 to June 1969 at this clinic has been analysed retrospectively for a study of the general out-come of these patients and of any influencial factors on it particularly induced by a specialist of tuberculosis disease.
(Total cases) The ratio of initially diagnosed cases to total pulmonary tuberculosis cases registered at this
clinic was 13.27%. There were definitly more males than females fe with the ratio of 4 to 1.
The largest age group was between 16 and 30 years with 52.03%, the next one was 31 to 45 years with 30.89%, and there were only 7 cases under 15 years age because this was an adult clinic.
There were 39.02% of minimal, 56.1% of moderately advanced, and only 4. 88% of far advanced by extent of disease according to USA, NTA Classification.
Those figures showed some differences to compare with the results of 1965 national tuberculosis survey and total tuberculosis cases registered at this clinic by higher ratio of male patients, slightly younger age group of the majority, and smaller percentage of far advanced cases.
The sputum examination was done in 79.33% of the patients and 59.45% of them were reported as positive. It was much higher rate of successful sputum examination and finding positive than other clinics due to a better physician-patient relationship in this clinic. 75. 66% of sputum positive cases were sensitive to SM, PAS, INH and 24-14% were resistant to one or two drugs, which is quite similar with several other reports in this country.
When grouped according to the mode of onset of disease 54. 47% were gradual, 21. 14% were found on mass-x-ray, same 21. 14% were hemoptic, remaining 3.25% were acute pneumonic. The usefulness of mass-x-ray on case finding in this country was again conformable.
If the diseases were classified according to the dynamic status by author’s method, only 58.54% were easily changeable, and 15.44% were hardly changeable, so, even among the initially diagnosed cases the remarkable improvement of the pulmonary lesions could be expected only in about 60 to 70% in general.
There were only 4.88% of these patients that were referred by fellow physicians while 95.12% were sent by the patient self or by their relatives or friends. The place of initial diagnosis appered to be important factor to influence the duration of continued treatment at this clinic with the P value less than 0.005, that is, among the patients whose diagnosis was initially made at this cIinic, 72. 0% of them continued their treatment for more than five months at this cIinic whi1e only 20.55% of the referred one did so. It was also thought to be due to the difference of the physician-patient relationship developing at the moment of the first diagnosis besides the distance of the patient’s residency.
For the reason of terminating the treatment, 32.52% were selftransferred to other clinics including selfmedications, 13.01 % needed no treatment due to insignificant disease, 7.31 % were uncoroperative, 6.5% were economiclly very poor, 3.25% were stilI continueing their treatment with unsuccessful resuIts, and only 37.4% completed the treatment with satisfactory results. Although the ratio of successful case were not sufficiently large enough it was far superior than the results obtained at the health center clinics or at other clinics in this country.
(The patients continued the treatment for more than 5 months at this clinic) There were 51 cases who continued their treatment for more than 5 months at this clinic. The sex ratio, the frequency af age group, and the extent of disease was quite simillar with above total cases.
The sputum examination was done in 92.16% with 70.59% positives and 70.0% of them showed seneitive to SM, PAS, INH., 15.0% resistant to both of SM. and INH.
The regimens of chemotherapy were not statistically planned but followed some general principles, that is, SM. injection was given daily for first 2 to 3 months then switched to biweekly or discontinued according to the circumstances and the majority patients were given the combination of SM and INH.
There were 62.75% of SM-INH regime, 19.61% of SM-INH-PAS, in a few cases ETM or MBT was given instead of PAS because of strong suspesion of primary resistant infection, and in 7.84% INH single was prescribed for the disease appeared to be very minimal.
As an overall effectiveness of above treament, sputum conversion occurred in 86.11 % and roentgeno-logical improvement was obtained in 74.51 %, 31. 37% moderate and 43.14% marked degree, and those improvement were achieved within 6 months of the treatment in the majority cases with 81. 57% of xray improvement and 87. 1 % of sputum conversion.
There were no case of roentgenological progression at the end of the treatment, although 2 cases showed zig-zag courses due to interupted irregelar treatment.
However there were 5 cases, 13.89% of persistently sputum positive cases although most of them showed moderate degree x-ray improvement.
The reason for those failures were considered as insufficient period of treatment in 2 cases, inadequate chemotherapy in one case, interrupted irregular treatment and overworking in 2 cases.
An analytic study of the factors influencial to the results of treatment without considering the differences of the drug regimes showed a moderate significant relationship between the changeability classification of disease and the x-ray improvement with P value less than 0.05 while the extent of disease or the mode of onset had no significance.
(In conclusion of above observations) The author claimed that the value of tuberculosis specialist could be recognizable in establishing a better physician-patient relationship important to have adequate examinations of the disease and to give regular continued patient care.
And it was strongly recommended to provide better environment for the tuberculosis patients to minimize their individual burdens, economic as well as psychologic, that is, improved accommodations of tuberculosis hospital maned by specialists, besides the improvement of present ambulatory treatment system to provide sufficient prolonged treatment and for better control of tuberculosis discascs. |
|
PDF Links
Full text via DOI
Download Citation
