けい肺およびけい肺結核の治療成績について : 第2報 けい肺結核例の観察

抄録

We have treated cases of silico-tuberculosis as well for seven years since July, 1960. A study on 156 cases of them revealed the following results. (1) A remarkable difference of the silico-tuberculosis from the simple silicosis was that the percentage of improvement far surpassed that of aggravation, i.e. improved cases 49%, cases which showed no change 40%, and aggravated cases only 11%. (2) As to the type according to X-ray shadows, p occupied 64%, while n occupied only 6%. Such a distribution may be due to the fact that most of the present cases were silicosis in pottery workers, which ordinarily belong to pneumoconiosis of small opacity, p. (3) As to the type of quantitative features of pneumoconiosis, 81% of all the cases belonged to type 1 and type 2 both of which are relatively mild. (4) The grosser the small opacities (i.e. the qualitative features of the opacities advanced from p to n via m ), the higher was the percentage of aggravated cases; and the more advanced the quantitative features of the silicotic changes, the lower was the percentage of improvement. We see here that the qualitative difference as well as the quantitative difference in the silicosis were also affecting the healing of tuberculosis, but that such effects were not so marked as in the cases of simple silicosis. The reasons for this are: that the present cases were mostly pneumoconioses of the small opacity, p that they were mostly mild cases, and that intensive chemotherapy prove effective. (5) The younger the patient, the more prospective was the improvement. And, the percentage of improvement was low in proportion to the length of employment. (6) The results of healing according to the type of tuberculosis were: in cases of type F more than 60% was fatal, in cases of type B more than half of the cases improved, and most of the cases of type C and of type MT showed no change. Cases of Type F and of type A were not found in the non-open cases of tuberculosis, in which all the cases improved or showed at least no change. (7) Percentage of the cases showing positive tubercular bacilli in the sputum (P) was 52%-33% in the cases without cavities (Q) and 77% in those with cavities (R)-, and the percentage of cases out of P becoming negative through chemotherapy was also 52%-77% in Q and 37% in R-, showing remarkably effective results. Although in 59% of P the bacilli were found fast against the primary chemotherapeutic drug, the percentage of improved cases in P was 67%. (8) Percentage of R among all the 156 cases was 42%, most of which belonged to the type B. And the percentage of improvement in R was 61%, showing disappearance of cavities in half of the cases. Cases still showing positive tuberculous baccili in the sputum after the treatment were seen in 43% of R, the percentage of aggravation being 17%; whereas they were seen in only 10% of Q. (9) Cases of silico-tuberculosis found in workers working in metal mining and quarrying which usually cause small opacity n and m in X-ray shadow were higher in the percentage of aggravation, of positive tuberculous bacilli in the sputum, of the persistence of bacillary discharge, and were worse in the prognosis than those found in workers working in pottery and metal making which ordinarily cause small opacity p.