Pulmonary resection in tuberculosis

Newer surgical and anesthetic techniques and the use of streptomycin and para-aminosalicylic acid (PAS) have made possible increased success in pulmonary resection for tuberculosis. Especially in early cases, however, bed rest and pneumothorax or pneumoperitoneum should be given adequate trial before resection is decided upon. In all cases a thorough bronchoscopic examination should be made first and the findings carefully evaluated. Pulmonary resection may be advisable for lesions of certain kinds which do not respond well to thoracotomy; for lesions which have not responded to trial of other methods; for a lung destroyed by tuberculosis; and in cases of active disease in an unexpanded lung. The experience of the author and of others emphasizes the importance of correct postoperative care. Since tuberculosis is rarely limited to the resected area, at least six months' rest in bed under medical supervision is necessary to permit cure of residual disease. Streptomycin with PAS is particularly valuable in the postoperative period; therefore indiscriminate use of it in earlier treatment should be avoided lest resistance develop.