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La tubercolosi ilare nell' infanzia
514
TUBERCLE
BARONI, V. L'infiltrato dt Assmann parailare e basilare (Contribute clinicoterapeutico), l~iv. di Patol. e Clin. della Tuberc~.!osi, 1933, 7, 616. The writer, who records three illustrative cases in patients aged from 21 to to 90. with their skiagrams, discusses the various theories as to the origin and favourite site of Assmann's infiltrations, and comes to the conclusion that infiltrations at the base and hilum of the lung are of lymphatic origin, though he does not exclude the possibility of recrudescence of old foei. He emphasises the necessity of prompt intervention by artificial pneumothorax as giving the best immediate and permanent results. TULINI, F. Pub il rene clinicamente sane di malati d( tubercolosi polmonare eliminare bacillidi Koch ? Sanatorhtm, 193.% 4. April, 2'2. The author carried out observations on 50 patients, 15 of whom were in Ranke's first stage, 13 in the secondary stage and 22 in the tertiary stage of pulmonary tuberculosis but without any signs of renal involvement, and in no case did he find tubercle bacilli in cultures of the urine. He concludes that elimination of tubercle bacilli in the urine never occurs in puhnonary tuberculosis, unless ~here is a lesion of the renal epithelium or renal tuberculosis. ACCORIMBONI, ~[. Su due casi di paralisi monolaterale del diaframma. Sanat6rium, 1933, 4, July, 14. A record of two cases of paralysis of ths right half of the diaphragm in subjects of pulmonary tuberculosis, one being a man, aged 41, and the other a woman, aged 20. The writer is of opinion that the paralysis in each case was caused by neuritis of the phrenic nerve due to mediastinal tuberculosis. DE VELASCO, M. Contribuci6n al estudio anatomopatol6gico de la tuberculosis bronc6gena en la primera in~ farcia. Ray. .Espa17. de Tuberculosis, 1933, 4, 481. As the result of the study of the literature and observations on children aged from 1 month to 6 years, the writer comes to the following conclusions. (1) Cavity formation in the
[August, ] 934
primary focus and the passage of the caseous glandular material into a bronchus are the fundamental causes of bronchial dissemination of tuberculosis in early childhood. (2) The |esions, as in the adult, are of two fundamental types, viz., eentro-acinous and panaeinous, both being accompanied by a perifocal reaction. (3) There are no areas of predilection for tuberculous lesions in the child. The writer has not found in his cases the apical lesions which are frequent after the age of 14 years. (4) Isolated forms of tertiary pulmonary tuberculosis are found in the child which anatomically are exactly analogous to the ordinary forms presented by the adult. (5) The study of the anatomical data shows the identity of the lesions in the infantile and adult forms of tuberculosis. The existence of mixed secondary and tertiary forms in which the typical phenomena of each stage may be found shows that it is a mistake to make a classification of distinct periods. (6) The difference in the lesions is to be explained by the quantity and virulence of the organisms, allergic conditions and the nature of the individual. ACCORIMBONI, M., and RE, E. La tubercolosi ilare nell' infanzia, l~iv. di .PatoL c Clin. della Tubercolosi, 1933, q, 841. The writers, who record 11 illustrative cases in children aged from 7 to 13, come to the following conclusions: Perihilar infiltration is frequently found in childhood and should be regarded as one of the commonest forms of onset of pulmonary tuberculosis at this age. Owing to its favourable evolution in most cases and the characteristic exu. dative lesions, it is often classified under tbe heading of the epituberculous infiltration of Eliasberg and Neuland. This description, however, should be avoided so as not to diminish the specific nature of this infiltration which is manifested by a tendency to more or less complete recovery with an occasional termination in caseation. A similar clinical picture is found in reactivation of tuberculous infection in the hilar glands. The hilum is thus the primary site for the diffusion of
A u g u s t , 1934J
PUL3IONARY TUBERCULOSIS
the process to the lungs. The cause of the recrudescence of the tuberculous process and spread to the lungs may frequently be found in an endogenous infection due to some cause which weakens the defensive powers of the system. Less frequently, at least in older children, similar infiltrations may be the expression of a primary tuberculous infection. ROQUET, P. Contribution s l'~tude des ~16ments du pronostio dans la tuberculose polmonaire. Th$se de Paris, 1933, No. 205. The prognosis of pulmonary tuberculosis cannot he determined by any objective test, but must depend on a certain number of factors of unequal importance. :Heredity, physiological considerations and pathological antecedents are of little importance, but more significance should he attached to age, sex and concurrent diseases, such as diabetes or digestive disorders. T h e general condition, especially the temperature, weight, and condition of the heart, plays a predominanb part in the prognosis. The local condition of the lung needs most consideration and should be studied by radiological examination. The extent of the lesions, their presence in one or both lungs, and especially their nature, are extremely important factors in the prognosis. The presence of cavities, as is well known, does not exclude the possibility of recovery. As regards laboratory methods, the result of examination for tubercle bacilli is the only one which is a guide to the severity of pulmonary tuberculosis. Attention should also be paid to the state of activity of the lesions. :Finally, the reaction of the patient to treatment is an important factor in prognosis. I~IELENDRo, J. C. Tuberculosis o infiltrados pulmonares fugaces, l~ev. ~Es2afi. de Tuberculosis, 1933, ,t, 600. A record is given of a girl aged 6 years, who, during an epidemic of influenza, developed a febrile attack and dullness of the base of the left lung. On the twelfth day of disease radiological examination showed an infiltration of the lung, which disappeared in a month's time. In view of its transient duration and the absence of
515
signs of tuberculosis, the writer considers t h a t the condition was due to influenza. DI NATALE, A. Contribute etinico allo studio della broncolithtasi. Lott~ centre la T~tbercolosi, 1933, 4,748. The occurrence of broncholithiasis though not frequent is of importance to the phthisiologist, because its symptoms in most cases resemble those of pulmonary tuberculosis. The diagnosis is difficult and cannot be made with certainty until the calculi are expelled. The condition, however, *nay be suspected when repeated examinations for tubercle bacilli and tuberculin reactions are negative in a patient suffering from hmmop~ysis and intercostal neuralgia in whom bronchieetasis and pulmonary or interlobar abscess can be excluded by radioscopy. The writer records two illustrative cases, one in a woman, aged 34, secondary to a pulmonary abscess, and the other in a man, aged 44, in whom the broneholithiasis was primary. LARYNGEAL TUBERCULOSIS. RUBENSTEIN, C. L. The Costa and Red-Cell Sedimentation Reactions in Laryngeal Tuberculosis. Amer. l?ev. T~tb., 1933, 27, 92. The absolute necessity of having some criterion both of the activity of the disease and of the patient's i m m u n e biological index is nowhere more clearly called for than in laryngeal tuberculosis, where a biopsy or other surgical measure may have disastrous results in the absence of such knowledge. In this connection the blood findings are of great importance, and the writer in this paper gives the results of a comparative study of the Costa and the red-cell sedimentation reactions in 75 sanatorium cases of pulmonary tuberculosis complicated by tuberculous laryngitis. The sedimentation test, although a simple and easily accessible method, has several drawbacks, including the non-specificity of the reaction, its liability to react in the presence of various intercurrent factors, often harmless to t h e body, and the absence of a definite line differentiating between
TUBERCLE
BARONI, V. L'infiltrato dt Assmann parailare e basilare (Contribute clinicoterapeutico), l~iv. di Patol. e Clin. della Tuberc~.!osi, 1933, 7, 616. The writer, who records three illustrative cases in patients aged from 21 to to 90. with their skiagrams, discusses the various theories as to the origin and favourite site of Assmann's infiltrations, and comes to the conclusion that infiltrations at the base and hilum of the lung are of lymphatic origin, though he does not exclude the possibility of recrudescence of old foei. He emphasises the necessity of prompt intervention by artificial pneumothorax as giving the best immediate and permanent results. TULINI, F. Pub il rene clinicamente sane di malati d( tubercolosi polmonare eliminare bacillidi Koch ? Sanatorhtm, 193.% 4. April, 2'2. The author carried out observations on 50 patients, 15 of whom were in Ranke's first stage, 13 in the secondary stage and 22 in the tertiary stage of pulmonary tuberculosis but without any signs of renal involvement, and in no case did he find tubercle bacilli in cultures of the urine. He concludes that elimination of tubercle bacilli in the urine never occurs in puhnonary tuberculosis, unless ~here is a lesion of the renal epithelium or renal tuberculosis. ACCORIMBONI, ~[. Su due casi di paralisi monolaterale del diaframma. Sanat6rium, 1933, 4, July, 14. A record of two cases of paralysis of ths right half of the diaphragm in subjects of pulmonary tuberculosis, one being a man, aged 41, and the other a woman, aged 20. The writer is of opinion that the paralysis in each case was caused by neuritis of the phrenic nerve due to mediastinal tuberculosis. DE VELASCO, M. Contribuci6n al estudio anatomopatol6gico de la tuberculosis bronc6gena en la primera in~ farcia. Ray. .Espa17. de Tuberculosis, 1933, 4, 481. As the result of the study of the literature and observations on children aged from 1 month to 6 years, the writer comes to the following conclusions. (1) Cavity formation in the
[August, ] 934
primary focus and the passage of the caseous glandular material into a bronchus are the fundamental causes of bronchial dissemination of tuberculosis in early childhood. (2) The |esions, as in the adult, are of two fundamental types, viz., eentro-acinous and panaeinous, both being accompanied by a perifocal reaction. (3) There are no areas of predilection for tuberculous lesions in the child. The writer has not found in his cases the apical lesions which are frequent after the age of 14 years. (4) Isolated forms of tertiary pulmonary tuberculosis are found in the child which anatomically are exactly analogous to the ordinary forms presented by the adult. (5) The study of the anatomical data shows the identity of the lesions in the infantile and adult forms of tuberculosis. The existence of mixed secondary and tertiary forms in which the typical phenomena of each stage may be found shows that it is a mistake to make a classification of distinct periods. (6) The difference in the lesions is to be explained by the quantity and virulence of the organisms, allergic conditions and the nature of the individual. ACCORIMBONI, M., and RE, E. La tubercolosi ilare nell' infanzia, l~iv. di .PatoL c Clin. della Tubercolosi, 1933, q, 841. The writers, who record 11 illustrative cases in children aged from 7 to 13, come to the following conclusions: Perihilar infiltration is frequently found in childhood and should be regarded as one of the commonest forms of onset of pulmonary tuberculosis at this age. Owing to its favourable evolution in most cases and the characteristic exu. dative lesions, it is often classified under tbe heading of the epituberculous infiltration of Eliasberg and Neuland. This description, however, should be avoided so as not to diminish the specific nature of this infiltration which is manifested by a tendency to more or less complete recovery with an occasional termination in caseation. A similar clinical picture is found in reactivation of tuberculous infection in the hilar glands. The hilum is thus the primary site for the diffusion of
A u g u s t , 1934J
PUL3IONARY TUBERCULOSIS
the process to the lungs. The cause of the recrudescence of the tuberculous process and spread to the lungs may frequently be found in an endogenous infection due to some cause which weakens the defensive powers of the system. Less frequently, at least in older children, similar infiltrations may be the expression of a primary tuberculous infection. ROQUET, P. Contribution s l'~tude des ~16ments du pronostio dans la tuberculose polmonaire. Th$se de Paris, 1933, No. 205. The prognosis of pulmonary tuberculosis cannot he determined by any objective test, but must depend on a certain number of factors of unequal importance. :Heredity, physiological considerations and pathological antecedents are of little importance, but more significance should he attached to age, sex and concurrent diseases, such as diabetes or digestive disorders. T h e general condition, especially the temperature, weight, and condition of the heart, plays a predominanb part in the prognosis. The local condition of the lung needs most consideration and should be studied by radiological examination. The extent of the lesions, their presence in one or both lungs, and especially their nature, are extremely important factors in the prognosis. The presence of cavities, as is well known, does not exclude the possibility of recovery. As regards laboratory methods, the result of examination for tubercle bacilli is the only one which is a guide to the severity of pulmonary tuberculosis. Attention should also be paid to the state of activity of the lesions. :Finally, the reaction of the patient to treatment is an important factor in prognosis. I~IELENDRo, J. C. Tuberculosis o infiltrados pulmonares fugaces, l~ev. ~Es2afi. de Tuberculosis, 1933, ,t, 600. A record is given of a girl aged 6 years, who, during an epidemic of influenza, developed a febrile attack and dullness of the base of the left lung. On the twelfth day of disease radiological examination showed an infiltration of the lung, which disappeared in a month's time. In view of its transient duration and the absence of
515
signs of tuberculosis, the writer considers t h a t the condition was due to influenza. DI NATALE, A. Contribute etinico allo studio della broncolithtasi. Lott~ centre la T~tbercolosi, 1933, 4,748. The occurrence of broncholithiasis though not frequent is of importance to the phthisiologist, because its symptoms in most cases resemble those of pulmonary tuberculosis. The diagnosis is difficult and cannot be made with certainty until the calculi are expelled. The condition, however, *nay be suspected when repeated examinations for tubercle bacilli and tuberculin reactions are negative in a patient suffering from hmmop~ysis and intercostal neuralgia in whom bronchieetasis and pulmonary or interlobar abscess can be excluded by radioscopy. The writer records two illustrative cases, one in a woman, aged 34, secondary to a pulmonary abscess, and the other in a man, aged 44, in whom the broneholithiasis was primary. LARYNGEAL TUBERCULOSIS. RUBENSTEIN, C. L. The Costa and Red-Cell Sedimentation Reactions in Laryngeal Tuberculosis. Amer. l?ev. T~tb., 1933, 27, 92. The absolute necessity of having some criterion both of the activity of the disease and of the patient's i m m u n e biological index is nowhere more clearly called for than in laryngeal tuberculosis, where a biopsy or other surgical measure may have disastrous results in the absence of such knowledge. In this connection the blood findings are of great importance, and the writer in this paper gives the results of a comparative study of the Costa and the red-cell sedimentation reactions in 75 sanatorium cases of pulmonary tuberculosis complicated by tuberculous laryngitis. The sedimentation test, although a simple and easily accessible method, has several drawbacks, including the non-specificity of the reaction, its liability to react in the presence of various intercurrent factors, often harmless to t h e body, and the absence of a definite line differentiating between