Comparatively little attention has been paid to the factors affecting the fate of the contralateral lung after resection for pulmonary tuberculosis. In particular, the previous history of the patient and his reaction to the tubercle bacillus and the radiological history of the lung, as opposed to the extent of disease at the time of the operation, have been the subject of very little analysis. The records of 101 patients who had survived the immediate post-operative period (three months) were available for study. Their fate and the condition of the contralateral lung at the end of the follow-up period are shown in Table I. In only 11 was the contralateral lung considered to be unsatisfactory. By "unsatisfactory" we mean that a deterioration had taken place during the follow-up period. Hence " satisfactory " means unchanged or improved without intermediate deterioration.Of the six patients who died after the postoperative period (three months), five had satis- Accordingly it seems that deterioration in the contralateral lung if connected with the resection will probably appear within 12 months, and hence the cases followed for the shorter times can reasonably be included with those followed for the full two years.The selection of cases by a number of physicians makes it certain that the group was widely representative both in the type of case and in the important factor of duration of the pre-operative treatment.We have tried to find out if there were any factors in the clinical or radiological history which made deterioration in the contralateral lung especially likely. We have analysed the previous radiological history of the extent of disease in the resected lung, the pre-operative amount of sputum, the length of history, and the ages and sex, with the following results.
The discovery of streptomycin by Schatz, Bugie, and Waksman (1944), followed by the introduction of para-amino salicylic acid (P.A.S.) (Lehmann, 1946) and of isoniazid (Robitzek and Selikoff, 1952), completely revolutionized the treatment of pulmonary tuberculosis. With preliminary antibacterial treatment using combinations of these agents, artificial pneumothorax and thoracoplasty became relatively safe procedures and shorter periods of bed rest were necessary. The results of surgical resection improved enormously, with a high proportion of successes and a low complication rate (Bickford, Edwards, Esplen, Gifford, and Thomas, 1952;Thompson, Savage, and Rosser, 1954), and operation came to be regarded as an essential part of treatment in most patients with extensive disease unsuitable for, or inadequately controlled by, other means. The persistence of cavitation was accepted as the strongest indication for operation, but resection or thoracoplasty continued to be widely employed as an " insurance " measure for the future in patients with lesions of the solid focus type, or in whom cavities had closed with preliminary treatment.As experience was gained with the prolonged administration of combinations of the antibacterial agents, their remarkable efficiency was more and more apparent. It became increasingly doubtful if " insurance " surgery was necessary, or if even the persistence of cavitation was a clear indication for operation. The present investigation was planned in an attempt to clarify these points.MATERIAL AND METHOD The material is drawn from a population of one million, and all patients coming under our care between January, 1954, and December, 1956, were reviewed for the present investigation.The principal purpose was to establish whether insurance " surgery was desirable for patients in whom cavities had already closed. We therefore included for study all patients with cavitary disease.and sputum containing tubercle bacilli, who had achieved sputum conversion and cavity closure during an arbitrary period of six months' antibacterial treatment; these were divided into two groups depending on whether or not surgery was carried out. At the onset we believed that surgery should normally be advised where cavitation persisted after six months' antibacterial treatment, and patients who had surgery for cavitated disease have not been studied. It became clear, however, that a large number of patients in whom cavities persisted after the sputum had become negative remained well in spite of not having surgery, and these have been studied as a third group. Thus there were three groups of patients: Group A, patients with cavity closure after six months' antibacterial treatment, followed by surgery; Group B, patients with cavity closure after six months, without surgery; Group C, patients with persisting cavity after six months, without surgery.All were treated with two or three of the standard antibacterial agents in the rdgimes now accepted in Great Britain, except a small number who had intermittent streptom...
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