Natural history of segmental lesions in primary pulmonary tuberculosis: long-term review of 383 patients.

history of segmental lesions in primary pulmonary tuberculosis: long-term review of 383 patients. A long-term follow-up of 383 children suffering from primary pulmonary tuberculosis with consolidation-collapse of lung segments supported the view that early surgical treatment is not necessary in the majority of patients. Only 21 children required thoracotomy; of these, 5 were observed for 8 to 12 months, the remaining 16 for periods of 1 to 9 years before operation was under-taken. With modern chemotherapy, supplemented perhaps by early steroid treatment in the more severe cases, a favourable outcome can be expected. Before the advent of chemotherapy and modem anaesthesia, which made thoracotomy and lung resection a relatively safe procedure, it had been noted in this hospital that many children suffering from primary pulmonary tuberculosis with consolidation collapse of lung segments recovered well on conservative treatment. In 1952, Thomas advised the surgical evacuation of enlarged mediastinal tuberculous glands with or without the resection of diseased lung, an idea subsequently expanded by Jacobs (1958). This conception of treatment, though questioned by Adler and Richards (1953) and Macpherson, Zorab, and Reid (1960), has never been refuted by any long-term follow-up of a large series of children, and therefore this study was undertaken. At a time when tuberculosis, as stated by Crofton and Douglas (1969), is still a major cause of death and disability in the world as a whole, with 10 to 12 million active cases of pulmonary tuberculosis and 1 to 2 million deaths per year, it seems appropriate to present our findings. Material and methods All children suffering from primary pulmonary tuberculosis with consolidation-collapse of lung segments discharged from this hospital for the 8 years 1952 to 1959 were followed up through their local chest clinics. The majority of these children came from Manchester, the children's part of the hospital having been built in 1931 for the specific purpose of long-term Received 1 June 1972. treatment of pulmonary and nonpulmonary tuberculosis, combining the facilities of a hospital with full educational opportunities made available by a staff of 10 teachers. The hospital is situated on the North Wales coast 350 feet above sea level and some 70 miles away from Manchester. No attempt was made to distinguish, as did Adler and Richards (1953), between atelectasis and consolidation, as this distinction can be difficult to define precisely when a small volume of lung tissue such as a bronchial segment is involved. …