Current Cl"

?

Aspects as^n^ lustrated

by

of Pneumothorax Therapy the Results obtained in 191

Cases of Completed Treatment* By OLT HJALTESTED and KJELD TORNING from the British Journal of Tuberculosis, Vol. XXXIII, January 1939, p. 4)

(Ab_dieted ^

for to showing a statistical justification and to establishing the value therapy this tvrax the the authors give an account of kte ,.p ,7eraPy, ?t this treatment in 191 patients within nft5 ^925?31. The results are recorded under v*ew

pneurnn(v! ?f

j

three

in relation to the factors ^rs.t' results known ?uS: institution of the treatment; second, in + character of the pneumoof thorax k? -^e ' anatomical third, correlation and comparison the re^i?u the to original factors and to Veg&rd ?UbSeQl,nnf in the course of the sr G f

*Jth Phenomena

occurring

treatment according to sex; age, prior to tuberculosis, duration of illness and size localization of the disease, presence of tj, of differ slightly as the distribution cavity, ?oo(j in these groups is P?or' pneumothorax an., almost results are distinctly favourable jn un:i ^niform. Theafebrile and and sub-febrile cases cases,

^^sPositPSU^S t? treat

>

'

>

'

ca^tfteral s with '

_

*

for 011

'JM

beginning. The late results depend on the pneumothorax obtained. Pneumothorax is generally poorer in febrile cases and it is incomplete in cases with unseverable adhesions. With ideal pneumothorax SO to 90 per cent of the patients became well, whereas with incomplete pneumothorax the same percentage of patients died. The authors concluded that the adhesions to the chest wall should be severed by cauterization, pneumothorax once instituted should be carried out completely, and that incomplete pneumothorax should be given up and replaced by other operative treatment. In empyema, the prognosis being poor, early radical treatment is indicated. P. K. C. The Pathogenicity of B.C.G. after Prolonged Cultivation on Glycerinated Egg Medium

?

Nation

*reatment

Topics

sedimentation rate

under

30

in

the

.

the%aniCla' 'At of

following eight abstracts, were selected tuberculosis number, but were excluded lack of space.?Editor, I- M. G.

By W. H. FELDMAN (Abstracted from the Tubercle, Vol. XX, March 1939,

p. 253) It is stated by Calmette that the strain of tubercle bacilli known as B. C. G. is definitely and permanently innocuous and it is also said that to preserve its avirulent state the strain should be periodically subon cultured ox-bile-glycerinated medium. potato Attempts to increase the virulence of B. C. G. by culture were made by many workers. No evidence of increased virulence was observed by most of them. According to the author, the term 'virulence' should be distinguished from the term 'pathogenicity'. That the organism has at least a limited pathogenicity has been admitted by Calmette and demonstrated by many. The author made an attempt to increase its pathogenicity by sub-culturing the organism for fifty-

[Oct., 1939

THE INDIAN MEDICAL GAZETTE

634

nine generations on glycerinated egg-yolk slants. The bacteria were then inoculated into guinea-pigs and rabbits subcutaneously, intra-peritoneally, or intravenously. The observation was extended for 453 to 455 days when the surviving animals were killed. When the animals died or were killed, they were carefully examined at necropsy. The principal organs were histologically examined and tissues were emulsified for making cultures and for inoculation of additional animals. In no instance was a progressive tuberculous lesions were observed. Tuberculosis-like disease observed in some instances, consisting of epithelioid tubercles which were frequently quiescent or atrophic. Attempts at re-inoculation by tissue emulsions of these lesions failed invariably. Thus, the findings indicate that cultivation of B. C. G. for fifty-nine _

generations (approximately

egg medium did not pigs or for rabbits.

6

years)

glycerinated increase its virulence for guineaon

S. R. G.

the frequency of relapse is J10^ higher than the incidence of active tuber' culosis in previously healthy persons in the same ag 4 years of to be

seen

inactivity,

group.

P. K. C.

The Treatment of Surgical Tuberculosis in Adults By M. FORRESTER-BROWN (Abstracted from the British Journal of TubercidoslS> Vol. XXXIII, April 1939, p. 107) The author considers the problem of surgical tuber culosis in adults from three aspects, namely? ^ (1) Provision of facilities of treatment.?At Prese such facilities are inadequate and, even where Pre^e.v' the after-care from the dispensaries is unsatisfactory^ 1 Thus, the desirability of establishing institutions surgical tuberculosis cases to work in close associate with orthopaedic hospitals and with proper arrangeroen ,

for after-care is stressed.

A

Study of the Results of Treatment of Pulmonary Tuberculosis in Mexican and White Patients

By F. R. HARPER (Abstracted from the American Review of Tuberculosis, Vol. XXXVII, May 1938, p. 556). The form and the course of tuberculosis had been studied in 290 white and 53 Mexican patients. All these were workers on the railways. In the group of Mexican patients 66 per cent had hsematogenic and exudative forms of disease and only 25 per cent showed a predominantly productive type of disease. As a marked contrast amongst the white group only 8 per cent were hsematogenic and exudative, and 89 per cent were predominantly productive. Cavities were detected in 41 per cent of the Mexicans and 63 per cent of the whites. Extrathoracic tuberculosis was detected in 49 per cent of the Mexican and 20 per cent of the whites. Regarding the results of treatment the Mexican patients did not react as well as the whites. During the course of treatment 32 per cent of the Mexicans died and in 5 years from the onset of the disease 47 per cent died. White patients, as a contrast to this, reacted much better. Only 11 per cent died during the course of treatment and 21 per cent in 5 years time. P. K. S.

On the Frequency of Relapse after Pneumothorax Therapy in Pulmonary Tuberculosis with Cavity Formation By SIGURD COLD (Abstracted from the Tubercle, Vol. XX, April 1939, p. 301)

The

the rate of relapse in patients under or after artificial-pneumothorax (A-P) treatment who have been inactive for at least one year. Renewed activity of lesions was observed author

106

in 21

or

20

investigated

per cent

and tubercle bacilli

were

tem-

porarily found in sputum or gastric lavage without any other signs of activity in 9 or 8.5 per cent. The time distribution of the relapses were as follows: 11 in the 1st year, 6 in the 2nd year, 3 in the 3rd year and 1 in the 8th year of observation. Thus, the risk of relapse is greatest in the 1st year but decreases rapidly. In all the 20 patients that relapsed within the first 3 years of observation A-P was being continued except in one. Hence these relapses could not have been due to ea^ly discontinuance of A-P. Eighty-one patients have been observed for at least one year after cessation of effective A-P treatment. Amongst these, relapse was found in 3 and only transitory positive sputum in 4. It has not been possible to establish the significance of the duration of collapse with the frequency of relapse. After 3 or

t

(2) Early diagnosis.?It is very difficult on accoi of the absence of characteristic signs and of x changes until considerable destruction of bone already occurred, and to the fact that the patients not seek medical advice until an abscess is f?rS. e * or they are incapable of carrying on their work. -c ' doubtful cases of ' lumbago ', ' sciatica ' or rheUin-fais joints-' should be kept under observation in hospi for final diagnosis and treatment. (3) Patient's co-operation.?Educative should be made to produce the willingness on the of the patients to seek early treatment. That j disease is curable and return to useful life is 0 possible, if treated early, should be stressed. j.g) Provisions should also be made so that when made fit can get work suited to their restric

propaga11^ .

pati,eted

capabilities.

P. K. C.

The Results of Phrenic Evulsion in UpPer\ Lobe Cavitation after Six Years Bv A. WILSON RUSSELL (Abstracted from the Tubercle, Vol. XX, p.

^

March

277)

geS The author reports the results of a series of 50 0j in which phrenic evulsion was performed to fo1* been have lobe which cavitation and upper ^vag for a period of six years. Artificial pneumothorax .yC was it in case and primarily attempted every e*re-j}1in only in 4. The immediate beneficial effect 3 months) of phrenic evulsion on cavities was 0 jnjng in 54 per cent or 25 cases out of the reIT1 gither 46 cases in which artificial pneumothorax was ^er ineffective or partially effective. As late results j0ll) an interval of six years following phrenic eVlatioU 19 out of 25 immediately benefited from the ope 'jjjch were alive (76 per cent), only 8 out of % 21 j 3 derived no benefit were alive (38.1 per cent). Lj^e out of 4 in which artificial pneumothorax was en^ out 30 se were alive per (75 per cent), i.e., jjjof jp (60 per cent) were alive after six years. The concludes that phrenic evulsion has a definite v!\eC[ure ? the control of upper lobe cavitation as a sole P1 a with and combination in especially _

c,?mVed

MajDed .

(jgcW

pneumothorax.

Uber den Wert der

^ q

Kollapsbehandlung?

be*

Lungen-tuberkulose. (On the Value Collapse Therapy in Pulmonary Tuberculosis)

By F. LOMMEL chrift, (Abstracted from Deutsche medizinischc WochenS 852) Vol. LXIV, 10th June, 1938, p. j The course of pulmonary tuberculosis is very g of

and it is also very difficult to estimate the ^ jjo particular therapy. Signs and symptoms

any

Oct., 1939] 0

very valuable in this direction. The 'openness' or ciosedness' of a case after treatment are much more ^a*a

assessment of

*n

a

case.

.-the author thinks that any assessment of the result f\,a treatment is untrustworthy if the cases are not

He followed 871 cases for 2 to 12 years, mongst this group 48.7 per cent died and 51.3 per cent 'ere still living. Of those living 12 9 per cent were 38.4 per cent were closed. After 9 to 12 years out 60 per cent were dead. This result could only 1 e compared if similar cases without pneumothorax ould be kept as controls. Raikowski compared his ^ pneumothorax cases with 76 controls where ' was indicated but was not possible for unesions or other causes. In the group of treated ases 51 per cent died within 2 to 15 years, whereas in untreated cases 76 per cent died in the same time, n the treated group 34 per cent were able to continue neir working lives, whereas in the untreated group y 12 per cent reached this stage. Ahlenstiel gave 2q PeLcent better results in the treated than untreated, ,,1 Herrmann gave 43 per cent improvement in treated and 23 per cent in the untreated. The j found the death rate in the untreated group to the treated group to be 38 Q PCl" per cent anc* *n

/or at least ut\?WGd 'uh unilateral

two years.

pneumothorax

jseased,

Hemothorax

jae

^lthor

cent-

be

Regarding sputum findings

21 per cent

in 'fk*16 c'osed in the uncollapsed group and 50 per cent c?hapsed. Finally, he thinks that the comparativ e possibility of healing in the collapsed and

n~collapsed

v

cases are

100 to 42.

P. K S.

^lutenzyme

Blood

thought that an effective ferment againstSCHENK0S Ust tuberculosis might be produced by the help body and a vitamin. The author trje^n, albuminous this side of the question by finding ?ut th? investigate ferm ? mfluence of ascorbic acid on the lypolytic human blood. He found that it raises the level f Pant , estrase and specially that of lipase. With tried to find out the utility of this nietlwl en-k?s ^le treatment of tuberculosis. It was thou Ift probable that such an application of a ferment wax covering ?f the tubercle bacilli, niak Hr?y m ^ess resistant, more liable to chemical tr^t an rrhage.

637

best treated by excising an ellipse of skin under local anaesthesia and extruding the clot. If seen later, it should be allowed to subside, but there is some risk of ulceration of the overlying skin or of the development of an abscess. A skin tag is a common sequela. Intense pain, occurring each time the bowels are open and lasting a considerable time, is generally due to a fissure. It is a frequent complication of prolapsing piles or of polypi and is found in the mid-line posteriorly. A fissure associated with piles is best treated by operation, when both can be dealt with at the same time. An anterior fissure in women is frequently due to the combination of piles and a torn perineum. In such cases the fissure will not heal permanently until the perineum has first been repaired. Conclusions A patient with piles is suffering from a progressive disease, and drugs, ointments and suppositories cannot delay or alter its course. Palliative treatment suffices in the very early stages.* Later a reasonably accurate estimate of the prognosis following injections can be given, and the severe cases can be offered a practically certain cure by operation. Complications are common in the more advanced stages and with a few exceptions must be treated before the piles. The treatment of piles is much more successful than that of diseased veins in other parts of the body.

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