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Vol. 20. Issue 3.
Pages 118-122 (May - June 1984)
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Vol. 20. Issue 3.
Pages 118-122 (May - June 1984)
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Tuberculosis pulmonar y pleural diagnosticadas y tratadas en una unidad neumologica de un hospital general. Analisis de eficiencia
Lung and pleural tuberculosis diagnosed and treated in a chest service of a general hospital. Efficiency analysis
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J.I. Garcia Del Palacio, A. Lopez Encuentra, J.M. Fernandez Sanchez-Alarcos, J.M. Ignacio Garcia, M.R. Melchor Iñiguez, P. Martin Escribano
Servicio de Neumología. Ciudad Sanitaria 1.° de Octubre. Madrid
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Se han analizado 108 pacientes de tuberculosis pleuropulmonar tratados de forma inicial en una unidad neumológica de un hospital general. La población tuberculosa recibida en esta unidad tenía como característica especial un significativo porcentaje de enfermedades asociadas.

En el 89% de los casos el tratamiento propuesto fue el ternario de 9 meses que incluye la rifampicina. El 55% de los pacientes efectuaron un inicial ingreso hospitalario.

Se realizó un correcto tratamiento en dosis, combinación y tiempos totales, en el 89% de los casos. En el 8% se han efectuado tratamientos incorrectos, la mayoría (5,6%), no imputables a pacientes. En un 3% de casos no existían datos de seguimiento tras el diagnóstico.

La vigilancia toxicológica de la terapéutica ha sido efectuada en la mayoría, detectándose anormalidades enzimáticas hepáticas en un 5-8% de pacientes en los primeros ocho meses de tratamiento. La toxicidad inherente al tratamiento obligó en seis casos a cambio terapéutico, diferente al diseño inicial.

A nuestro parecer no existen limitaciones teóricas ni prácticas al tratamiento de estos pacientes en un hospital general, habiéndose descartado la indiscriminada necesidad del ingreso hospitalario, pero considerando imprescindible el seguimiento de una norma terapéutica previamente admitida por todos los médicos qué se dedican al cuidado de estos pacientes, y que se base sobre datos seguros de curación en el tratamiento de la tuberculosis pleuropulmonar.

108 patients with pleuropulmonary tuberculosis initially treated in a chest Service of a general hospital were analyzed. The patients with tuberculosis treated in this Service had a significantly higher percentage of associated diseases.

Treatment with three drugs for nine months including rifampicin was used in 89% of the cases. 55% of the patients were initially hospitalized.

89% of the cases followed corred treatment (dosage, combination of drugs, and total time of therapy). 8% of the patients followed and incorrect treatment and most of the times (5%) this was not due to the patients. Follow up data was not obtained after making the diagnosis in 3% of the patients.

Surveillance to detect side effects of therapy was done in most of the patients and hepatic enzymatic abnormalities were detected in 5-8% of patients during the first 8 months of therapy. The initial therapeutical regimen had to be changed in 6 patients due to its toxicity.

We do not think that there are any theoretical or practical limitations to the treatment of these patients in a general hospital and we do not recommend the indiscriminate hospitalization of these patients but it is absolutely necessary to follow a therapeutical regimen accepted previously by all physicians taking care of these patients and based on reliable data on its success for curing pleuropulminary tuberculosis.

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Copyright © 1984. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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