British Journal of Tuberculosis and Diseases of the Chest最新文献

A review has been made of 154 children admitted to hospital with a contact history; their age distribution and the pathological lesion on initial X-ray have been given. All these contact children had an abnormality in their original chest X-ray.

Mothers and fathers were the most important source cases of their children's infection. Practically all the source cases had positive sputum on direct examination. Contacts were considered to have been exposed to an infectious source case for at least five months.

It is suggested that there should be an energetic search for contacts of an active case of pulmonary tuberculosis, and BCG offered to tuberculin negative children. Tuberculin positive children under puberty should have an initial X-ray and another within three months. In the absence of any significant pulmonary abnormality, no further X-raying would be required, especially if the source cases' sputum examinations were negative for tubercle bacilli or positive only on culture.

Children in the age group 10–15 run a special risk of the development of post-primary pulmonary tuberculosis, and should continue to be seen at regular intervals.

An analysis is made of 129 cases of tuberculosis and other chest conditions presented to the thoracic surgeons in Singapore in 1954 and the fate of those who had surgery, those who refused or were refused by the surgeons.

Sixty-seven thymic tumours are classified histologically into epithelial, lymphoid and teratomatous groups. The epithelial tumours, forming approximately 80 per cent. of the series, are further subdivided into differentiated, oval- and spindle-celled, lympho-epitheliomatous, granulomatous and undifferentiated types. An account is given of the distinctive histological features and the clinical course described of each of these types of tumour. It is found that once the histology of the neoplasm is known it is possible to give a guide as to the probable outcome and behaviour of the tumour.

A plea is made for the re-examination of the natural history of non-specific chronic lung disease from the viewpoint of bronchiolar pathology.

This entails first an appreciation of the normal structure and function of the bronchial tree in general, and of the small bronchioles in particular.

Summarising previous work, it is concluded that in the commoner form of respiratory tract inflammation, the bronchiolar element, acute bronchiolitis, is the significant lesion and warrants closer attention than has been given it in the past.

Permanent damage following acute bronchiolitis is extremely common, the most important sequel being bronchiolar obliteration. Some degree of diffuse bronchiolar damage, including obliteration, has been demonstrated in all adult lungs examined.

Non-specific chronic lung disease is divided into three main morphological forms: bronchiectasis, emphysema and pulmonary fibrosis. In all three forms bronchiolar damage and obliteration is extreme. Bronchiolar obliteration is regarded as the essential lesion in the pathogenesis of these conditions, the severity of the chronic lung disease being satisfyingly related to the operation of factors acting to produce long-standing bronchiolar obstruction and, therefore, obliteration.

The operation of other factors determines which of the three morphological forms will predominate, and clinically, which diagnosis will be made. In this manner the natural history of chronic lung disease can be examined as a whole, stressing the essential unity of its three morphological forms.