[The present aspect of tuberculous pleurisy--report of the 29th series (A) of CSUCT--Cooperative Study Unit of Chemotherapy of Tuberculosis (CSUCT) of the National Sanatoria in Japan].
CSUCT carried out 9-21 month's follow up of 273 patients with exudative tuberculous pleurisy who were admitted to 39 national sanatoria in 1985, and were treated for the first time. The background factors of the patients at the time of admission were as follows: the average age, 47.2; male/female ratio 3:1; idiopathic pleurisy 163 cases and secondary pleurisy 110 cases. Distribution of maximal temperature on admission; 37.0 degrees C or less 24.4%; 37.1-38.0 degrees C 37.8%; 38.1-39.0 degrees C 28.5%; higher than 39.0 degrees C 9.3%. Younger patients tended to show higher temperature than the older. The positivity of tuberculin reaction was 84.3%, and among them 34% were strongly positive (greater than or equal to 20 mm). There was no correlation between the volume of pleural effusion and the intensity of tuberculin reaction. In patients more than 60 years of ages, the positivity was low (76.0%). The erythrocyte sedimentation rate (after 1 hour) was 63.6 +/- 31.6 mm.


METHODS
cough in 72%; sputum in 48.5%; chest pain in 57.5%; tubercle bacilli in sputum in 11.6%. We compared idiopathic pleurisy (I) and secondary pleurisy (S) and total cases of pleurisy (T) regarding several factors; average age (I: 46.7, S: 48.0, T: 47.2); peak season of incidence (I: Feb. Mar. S: Mar. April, T: Feb. Mar. April); the period of hospitalisation (I: 4.07 months, S: 5.80 months, T: 4.77 months); the positive rate of tubercle bacilli in the pleural effusion (I: 9.0%, S: 12.9%, T: 10.5%); %VC (mean value) on admission (I: 71.4%, S: 69.8%, T: 70.7 +/- 17.0%); %VC after treatment (I: 79.0%, S: 79.7%, T: 79.4 +/- 17.9%), and we found no significant difference in the above factors between I. and S. In 49 patients who were treated by chemotherapy with steroids, %VC before treatment was 68.9% (mean value), and that after treatment was 81.2% (mean value), however, there was no significant difference between the %VC of these patients and that of total patients. Recent chemotherapy (SM or EB + INH + RFP) greatly contributed to improve clinical symptoms by accelerating the absorption of pleural effusion and in minimizing the formation of pleural thickening. Previously, we experienced often deterioration of tuberculous lesions in relation to the use of steroids. By the use of recent intensified chemotherapy, the harmful side effects of steroids became almost insignificant, and at the same time, treatment with steroids is needed only in a few cases.
Nakamura
E
E
National Chubu Hospital, Aichi, Japan.
Haga
T
T
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D014396:Tuberculosis, Pleural / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
D000305:Adrenal Cortex Hormones