THE INCREASE AND DECLINE IN THE NUMBER OF TUBERCLE BACILLI IN THE SPUTUM FOLLOWING THE THORACOPLASTY AND ITS FOLLOW-UP OBSERVATIONS

Abstract

In the present paper, the authors describe the patterns of discharge of tubercle bacilli in the sputum following thoracoplasty performed on 23 cases during the period from March to December, 1946, excepting 2 cases which died shortly after the operation. The authors also describe the follow-up observations on these cases carried out for 6 years after the operation.
Examinations for tubercle bacilli were performed on 3 consecutive days prior to the operation, on 60 consecutive days after the operation, and on 3 consecutive days at 1 month's intervals for 6 months thereafter.
Examinations were conducted on the stained smear preparations made trom an or the specimens of sputum separately collected at each time of expectorations. Similar examinations were conducted on3 cases in which closed intrapleural pneumorisis was conducted as control cases. After 7 months and thereafter, similar examinations were conducted at 1-3 months' intervals. All of the examinations conducted after 3 years and thereafter were cultural examinations.
When 2 cases, which had cavity in contralateral side, out of 21 cases were separated, the cases were divided into 3 large Groups according to their pattern of discharge of tubercle bacilli.
Group 1. (13 cases)
The smears became negative tubercle bacilli within 6 months after the operation.
Group 2. (3 cases)
The smears remained positive tubercle bacilli even after 6 months or more from the operation. Group 3. (3 cases)
The smears once became negative tubercle bacilli within 1-2 months after the operation. However, the smears were suddenly found converted to positive again approximately 6 months after the operation.
Cases belonging to Group 1 indicate that the thor acoplasty was effective. Cases belonging to Group 2 indicate that the operation was ineffective. Cases belonging to Group 3 indicate that the cavity became open again. Cases of closed intrapleural pneumorisis took similar courses to those of the cases of Group 1.
Cases belonging to Groups 2 and 3 were considered to require revision of thoracoplasty or other treatment. Therefore, revisions were conducted on 5 out of those cases, in all of which the cultures became negative tubercle bacilli later on.
One among the cases belonging to Group 2 became culture negative tubercle bacilli after 5 years without any further treatment. Consequently, firly long period of time is considered to be necessary to become culture negative tubercle bacilli after the operation.
The above results are summarized that, among 23 cases of thoracoplasty, 2 died shortly after the operation, and among the cases of Group 1, 1 died after 5 years due to deteriorated condition of lung on the opposite side, but the remaining 20 cases (86.7%) are enjoying economical life.