[Pulmonary resection for tuberculosis--report of 1134 cases].
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The first, definition of pulmonary tuberculosis bacilli with multiple drug resistance was decided as "bacilli completely resistant to RFP 50 mcg + SM 20 mcg and/or INH 1 mcg + KM 100 mcg and/or EB 5 mcg and/or another antituberculosis drug" based on 118 cases examined for drug resistance pre-operatively in 35 institutions belonging to the Tuberculosis Research Committee, during the 6 years period 1984 to 1989. Next, 48 pulmonary tuberculous cases with multiple drug resistance were analysed, and the following conclusions were obtained: 1) Pulmonary tuberculosis cases with multiple drug resistance were 36% of 133 cases of positive tuberculosis bacilli before operation. 2) 52% were more than 50 years old. One third showed less than 40 in respiratory index. 3) Most of them did not have effective anti-tuberculosis drug to be used after operation. 4) There was a high rate of pneumonectomy and collapse therapy such as thoracoplasty. 5) Successful rate of treatment was 72.9%, which is rather good for multiple drug resistant tuberculous cases. But bacilli positive rate after operation and mortality were 12.5% and severe complications such as bronchial or pulmonary fistula, thoracic empyema and worsening of tuberculosis after operation was 25%. Therefore surgical treatment for pulmonary tuberculosis with multiple drug resistance needed careful application considering sensitive drug to be used after testing of resistance for all anti-tuberculosis drugs. Surgical treatment should be considered especially if pulmonary tuberculosis cases have complete resistance to RFP and to one drug among SM, INH, KM and EB.
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Five cases of segmental hyperplastic tuberculosis of the colon are reported, the lesions representing every segment. Primary resection is recommended as the treatment of choice. All five patients (only one of whom exhibited evidence of pulmonary tuberculosis) underwent segmental excision of the lesion and end-to-end anastomosis. The postoperative course was uneventful in all instances, and there have been no complications or recurrences. Evidence of carcinoma was not found in any case. In four cases, intestinal tuberculosis was suspected radio-logically prior to operation.
Segmental resection
INTESTINAL TUBERCULOSIS
Primary tuberculosis
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Segmental resection
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We analyzed 21 cases of coexistent pulmonary tuberculosis and lung cancer in the article. All these patients were operated on: pneumonectomy - 9 (42.8%), lobectomy - 8 (38.1%), and explorative thoracotomy - 4 (19%). The mortality was 9.5%. The development of cancer on the site of previous active tuberculosis and residence metatuberculosis changes was evident. This shows the importance of the control strategy of patients on going tuberculosis. CONCLUSIONS. Post tuberculosis pulmonary dysplasia is influenced not only by active pulmonary tuberculosis; in addition it can be influenced by post tubercular findings and sclerotic changes.
Thoracotomy
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Pathogenesis
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