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PubMedDate not supplied

Breast cancer following multiple chest fluoroscopies among tuberculosis patients. A case-control study in Denmark.

A case-control study of breast cancer among tuberculosis (TB) patients in Denmark (1937-1954) was conducted to provide additional information on the radiation risk associated with low-dose chest fluoroscopy exposures. Records of 46013 TB patients were linked to the Danish Cancer Registry and 125 subsequent female breast cancers identified. Medical records were located for 89 (71%) of these women who developed breast cancer and on 390 controls, who were individually matched to cases on age and calendar year of TB diagnosis, and survival. Common risk factors for breast cancer such as nulliparity (relative risk (RR) = 2.5) and high relative weight (RR = 2.6) were also identified in this population of TB patients. However no risk was evident with exposure to any type of fluoroscopy (RR = 0.6; 95% CI = 0.2-1.4), or to fluoroscopies performed to monitor lung collapse therapy (RR = 0.8; 95% CI = 0.5-1.4). Although based on only 7 breast cancers, there was a suggestion of an increased risk among women who received greater than 1 Gy to their breasts (RR = 1.6; 95% CI = 0.4-6.3). Because of the infrequent use of fluoroscopy in our study, the breast doses were too low, 0.27 Gy on average, to expect to detect a significant elevation in breast cancer risk overall. The findings do suggest, however, that current estimates of breast cancer risk following radiation are not greater than presently accepted, and that a relative excess of 40 per cent can be excluded with reasonable confidence following breast doses on the order of 0.3 Gy.

Breast Neoplasms↗

PubMed1997

Tuberculosis then and now: a personal perspective on the last 50 years.

Rates of death from tuberculosis in the United States decreased from 194 per 100,000 persons in 1900 to 40 per 100,000 persons in 1945, in part because the epidemic of tuberculosis in the western world was running its course and in part because of public health initiatives and improved socioeconomic conditions. In 1945, 63,000 persons died of tuberculosis and 115,000 new cases of the disease emerged. Streptomycin and para-aminosalicylic acid had just been discovered; the discovery of isoniazid followed, in 1952. Sanitarium care, nonsurgical and surgical collapse therapy, and resectional surgery were in widespread use. By the middle of the 1950s, it was evident that bedrest did not add to the benefit produced by effective chemotherapy, and sanitariums began to close, a process that was completed by the 1970s. As mortality and morbidity due to tuberculosis rapidly decreased, the U.S. government decreased funding for tuberculosis and many states and cities downgraded their tuberculosis control programs. After 1984, the rate of new cases of tuberculosis, which had decreased to 9.4 per 100,000, began to increase and focal outbreaks of multidrug-resistant tuberculosis were reported. Noncompliance with drug therapy, homelessness, immigration to the United States from developing countries, and human immunodeficiency virus (HIV) infection were invoked as explanations. With the reinstitution of federal funding, improved case-finding and surveillance, and the practice of having patients receive therapy while under direct observation, the rate of new cases of tuberculosis decreased to 8.7 per 100,000 in 1995, the lowest rate since national surveillance was begun in 1953. However, at the end of the 20th century, the worldwide burden of tuberculosis, which is engrafted onto the pandemic of HIV infection, is enormous: an estimated 7.6 million new cases in developing countries and 400,000 new cases in industrial nations.

Antitubercular Agents↗

PubMedDate not supplied

[Iatrogenic sequelae of pulmonary tuberculosis].

OBJECTIVES: The purpose of this study is to underline how topical is the chapter of the sequelae of pulmonary tuberculosis and to try to make a classification. Pulmonary tuberculosis can be cured definitely or hesitate in disease (BK negative) that is totally independent from tuberculosis about their pathogenesis and clinical features. They are called sequelae. MATERIALS AND METHODS: We made a statistical analysis that investigate a group of 110 patients without active infection (BK negative) admitted in the hospital because of a sequela of pulmonary tuberculosis. Patients were treated in the past by collapse-therapy or by antibiotic-therapy until their spittle became negative for BK. RESULTS: A significant (p < 0.05) relationship between each kind of sequela, among the most important ones (fibrothorax, interstitial fibrosis, bronchiectasis, empyema with or without pleural fistula, parafibrotic emphysema), and type of treatment, results. CONCLUSIONS: The sequelae of tuberculosis of the lung are highly disadvantageous for people who are affected; are observed frequently; are closely dependent on what kind of treatment the patient has received; are classified in iatrogenic, not iatrogenic or mixed.

Adolescent↗

PubMed2003

Bronchoscopic lung volume reduction.

AIM: Because traditional lung volume reduction involves major surgery in unfit patients, resource implications are formidable. Many patients are too ill for consideration and overall survival rates have lead to questions about its continuation. We report on a new method of lung volume reduction, through a bronchoscopic approach. Patients with severe dyspnoea with end stage emphysema were recruited. Target areas for collapse therapy were upper lobes or segments with severe destruction, occupying a large volume, with surrounding lung compression and little perfusion. These were delineated radiologically and with ventilation-perfusion scanning. Endobronchial bloc-kade was initially with detachable, silicone balloons and later with especially designed and hospital manufactured stainless steel wire stents containing bio-compatible sponge. METHODS: Five males and 3 females with preoperative breathlessness at rest and muscle wasting were treated. Operative time was a mean of 67.5 min. Rehabilitation began immediately and 7 patients left hospital the following day. RESULTS: Five patients had improvements in well-being, dyspnoea, exercise tolerance, lifestyles and medication requirements. One patient survived at least 2 years and 2 are still alive 4(1/2) years later. Endoscopic balloon replacement with wire and sponge devices was required in 5 patients. Complications were related to intraoperative oxygenation problems in 2 patients and late infections in 4. CONCLUSIONS: Bronchoscopic lung volume reduction for the treatment of end-stage emphysema subjectively improved the majority of patients. The use of stents was promising: balloons were disappointing.

Aged↗

PubMed1953