1958 年 47 巻 8 号 p. 1008-1025
The course of development of lesions in pulmonary tuberculosis varies, depending on the nature of infiltration and the position of the affected lung field. As a rule, the prognosis of the disease is influenced by such conditions as individual resistance, the bacterial virulence and the number of bacilli in the infection; but in some cases with a certain type and/or situation of infiltration, the infection is destined to get worse in spite of any other various individual conditions. One such case is that in which the lesion is in the upper left lung field.
Apical lesions ordinarily have good prognosis, but a cavity in the apical field makes the lesion take a turn for the worse. The upper left location of the lesion is more serious than cavitation of the infiltration; that is, the upper left lesion will not only have poor prognosis, even if it has no cavity, but will also exert influence on the course of the lesion in the opposite right field if such exists.
Generally, cases with TBB-positive sputum in culture show a tendency to worsen more than those with negative sputum; and the TBB-positive sputum is found most frequently in upper-left lesion cases and left cavity cases. Consequently, patients of left infiltration type with cavity and with bacilli-positive sputum will be most poor in prognosis. Cases in which sputum is found to be TBB-positive in smear tests are more serious than those in which the positive occurs only in culture tests. However, the occurence of cavity or concormitant lesion is of more serious import than bacillary findings, as factors related to prognosis of the disease. In particular these factors seriously affect the course of the left apical lesion; and it has been found that smear findings themselves are closely related with the presence of cavity in the lesion.
As to haemoptysis, its seriousness depends on the stage in the clinical course in which it occurs. Haemoptysis, after chemotherapy has been applied to some degree, is a bad sign. When haemoptysis occurs in the middle and late stages of cases with left cavity, such cases will become more serious in the long run.