Diagnosis of sputum smear- and sputum culture-negative pulmonary tuberculosis.

A group of patients with new or enlarging apical lung lesions thought to be tuberculous was randomly selected for observation without treatment. All were tuberculin-positive and all had sputum negative for Mycobacterium tuberculosis on direct examination and on culture. Of the 152 patients, 88 (58%) developed bacteriologically confirmed pulmonary tuberculosis during a follow-up period of up to 65 months.

Ultrashort-course chemotherapy for culture-negative pulmonary tuberculosis--a qualified success.

A group of 250 patients with new or enlarging apical lung lesions which were thought to be tuberculous, and who had positive tuberculin tests but negative sputum smears and cultures for Mycobacterium tuberculosis, were treated with an ultrashort (3-month), 4-drug (rifampicin, isoniazid, pyrazinamide and ethambutol) regimen. One patient developed bacteriologically positive pulmonary tuberculosis (PTB) during the treatment period and 35 others (14%) developed bacteriologically positive PTB after completing the drug regimen.

Short-course chemotherapy for silicotuberculosis.

The use of short-course chemotherapy in silicotuberculosis in the goldmining industry in South Africa is described in a comparative trial of 94 cases of silicotuberculosis and two matched-pair control groups with pulmonary tuberculosis only. The theoretical and practical considerations of short-course chemotherapy are discussed. It is concluded that this is an effective means of treatment for pulmonary tuberculosis in patients with silicosis as well as in patients with pulmonary tuberculosis only, irrespective of previous exposure to silica dust. There are no valid reasons why the basic tenets of short-course chemotherapy for the treatment of pulmonary tuberculosis should not apply in silicotuberculosis.

Pleural biopsy. A report of 750 biopsies performed using Abrams's pleural biopsy punch.

We present the results of 750 consecutive pleural biopsies performed with the Abrams pleural biopsy punch to indicate the effectiveness, safety and ease of the procedure. The biopsies were performed by 27 members of our medical staff. Pleural tissue was obtained in 90% of the biopsy specimens taken from patients with pleural effusions and in 79% of those taken in the absence of pleural fluid. These 'dry' biopsies were restricted to those operators with a minimum experience of 50 previous biopsies. Inclusion of tissue other than pleura occurred more frequently in the 'dry' biopsies (16.6%) than in those with pleural fluid (0.8%). There were no complications which required intervention. The problem of 'idiopathic' pleural disease is discussed. We emphasize the biopsy technique and the need for a constant and interested histologist.

Criteria for the diagnosis of pulmonary tuberculosis.

Diagnostic criteria for pulmonary tuberculosis are presented in the form of a weighted diagnostic protocol. These criteria were evolved to standardize the diagnosis of pulmonary tuberculosis for a prospective study of the disease and its treatment, and were first tested in the evaluation of 469 referred patients, of whom 300 were found to have tuberculosis. The criteria have subsequently been validated clinically and statistically through their application to 1679 patients with radiological abnormalities suggestive of tuberculous disease, of whom 1154 were proved to have pulmonary tuberculosis. Application of these criteria whenever pulmonary tuberculosis is suspected has removed the dilemma often faced by clinicians when presented with a suggestive chest radiograph, a single sputum smear positive for acid-fast bacilli resembling Mycobacterium tuberculosis, or a strongly positive tuberculin test. We believe that these criteria put each of these separate findings into perspective. They allow the diagnosis of pulmonary tuberculosis to be made with confidence and prevent the erroneous diagnosis of non-tuberculous disease. Their use should alleviate the tendency towards an overdiagnosis of active pulmonary tuberculous disease, and thereby the waste of therapeutic and social resources.

Short-course chemotherapy for pulmonary tuberculosis. A 100-day interrupted regimen.

A 100-day interrupted regimen is described which is a useful and efficacious treatment for pulmonary tuberculosis. It is well tolerated, guarantees treatment supervision, and has acceptable relapse rates under normal programme conditions. The 5-day-a-week administration makes it particularly suitable for industrial medical services as well as for other outpatient health care clinical services.

Patterns of pyrexia in pulmonary tuberculosis.

This report emphasizes several less well-known features of the pyrexia associated with pulmonary tuberculosis, including the occasional absence of pyrexia in disseminated tuberculosis and the resolution of fever in some patients before and in the majority of patients within the first days of treatment.

The diagnosis of pulmonary tuberculosis.

A group of 300 patients with newly diagnosed pulmonary tuberculosis was studied to determine the role of peripheral features in establishing the diagnosis. Our findings suggest that, when evaluating a suggestive radiological lesion, little or no importance can be attached to the erythrocyte sedimentation rate, the Heaf test, or to the absence of symptoms.

An inexpensive apparatus (airflometer) to assess lung function.

The Airflometer is presented as an inexpensive instrument suitable for lung function testing in general clinical practice. Utilizing the close correlation between the Airflometer (AFM) reading and the forced expiratory volume in 1 second (FEV1), we have produced a nomogram from which the AFM reading for normal males and females can be predicted.