Characteristics of Tuberculosis Detected during Chemotherapy for a Solid Tumor / 결핵및호흡기질환

BACKGROUND: Some malignancies including lymphoma, head and neck cancer, and lung cancer are believed to be associated with the reactivation of tuberculosis (TB) because cyclic anti-cancer chemotherapy can induce the leukopenia or immunological deterioration. This report describes the clinical characteristics and treatment response of TB that developed during cyclic anti-cancer chemotherapy in patients with a solid tumor. MATERIALS AND METHODS: From January 1 2000 to July 31 2004, patients with TB diagnosed microbiologically, pa?thologically, or clinically during anti-cancer chemotherapy in a tertiary hospital were enrolled, and their medical records were reviewed. Patients with the known risk factors for the reactivation of TB were excluded. RESULTS: Twenty-two patients were enrolled and their mean age was 56.5 years (range 21-78). The male to female ratio was 3.4:1 and pulmonary TB was the main variant (20 patients, 90.9%). Gastric cancer (10 patients, 45.4%) and lymphoma (4 patients, 18.2%) were the leading underlying malignancies. The other malignancies included lung cancer, head and neck cancer, breast cancer, cervix cancer, and ovary cancer. Fifteen patients (68.2%) had a healed scar on a simple chest radiograph suggesting a previous TB infection. Among these patients, new TB lesions involved the same lobe or the ipsilateral pleura in 13 patients (87.6%). An isoniazid and rifampicin based regimen were started in all the subjects except for one patient with a hepatic dysfunction. The mean duration of medication was 9.9 +/- 2.4 months and no adverse events resulting in a regimen change were observed. With the exception of 5 patients who died of the progression of the underlying malignancy, 70.6% (12/17) completed the anti-TB treatment. CONCLUSION: The clinical characteristics and response to anti-TB treatment for TB that developed during anti- cancer chemotherapy for a solid tumor were not different from those of patients who developed TB in the general population.

The Effects of the decortication on pulmonary function in tuberculous empyema / 결핵

BACKGROUND: The purpose decortication is to eliminate the infection focus and to improve the decreased lung function due to chronic empyema. However, lung function is not improved in all cases. It would be clinically useful it we could predict preoperatively whether lung function would improve after decortication. The purpose of this study is to find useful indices for predicting the possible improvement of lung function after decortication. METHOD: The medical records of 37 tuberculous empyema patients who underwent pleural decortication were analyzed retrospectively from 1990 to 1996. The measurements of preoperative and postoperative forced vital capacity(FVC) were used for evaluating the effects of decortication. RESULTS: The sex ratio was 29 : 8 (male to female), and the median age was 34 years. The time interval between the formation of empyema and operation was 1 month to 30 years. Postoperative pulmonary function test was performed 5.4±2.6 months later. FVC(forced vital capacity) was significantly increased from 2.77±0.67(L) to 2.95± 0.81(L). Interestingly, postoperative pulmonary function was significantly improved in patients who were less than 40 years old, within 4 months after diagnosis of tuberculous empyema, in the group with FVC of less than 60% of the predicted value and in the absence of calcification. CONCLUSION: The improvement of lung function after decortication was expected in patients younger than 40 years old, within 4 months after diagnosis of tuberculous empyema, in the group having less than 60% of the predicted FVC, without calcification.