Lobar Collapse Therapy Using Endobronchial Valves as a New Complementary Approach to Treat Cavities in Multidrug-Resistant Tuberculosis and Difficult-to-Treat Tuberculosis: A Case Series.

BACKGROUND: The poor treatment outcomes of multidrug-resistant tuberculosis (TB) and the emergence of extensively drug-resistant TB and extremely and totally drug-resistant TB highlight the urgent need for new antituberculous drugs and other adjuvant treatment approaches. OBJECTIVES: We have treated cavitary tuberculosis by the application of endobronchial one-way valves (Zephyr®; Pulmonx Inc., Redwood City, Calif., USA) to induce lobar volume reduction as an adjunct to drug treatment. This report describes the feasibility, effectiveness and safety of the procedure. METHODS: Patients with severe lung destruction, one or more cavities or those who were ineligible for surgical resection and showed an unsatisfactory response to standard drug treatments were enrolled. During bronchoscopy, endobronchial valves were implanted in the lobar or segmental bronchi in order to induce atelectasis and reduce the cavity size. RESULTS: Four TB patients and 1 patient with atypical mycobacteriosis were treated. The mean patient age was 52.6 years. Complete cavity collapses were observed on CT scans in 4 of the 5 cases. All patients showed improvements in their clinical status, and sputum smears became negative within 3-5 months. There were no severe short- or long-term complications. The valves were removed in 3 of the 5 patients after 8 months on average; there was no relapse after 15 months of follow-up. CONCLUSION: These data suggest that endobronchial valves are likely to be useful adjuncts to the treatment of therapeutically difficult patients. More data are required to confirm our findings.

A Change of Heart? British Policies towards Tubercular Refugees during 1959 World Refugee Year.

This article looks at Britain's response to the World Refugee Year (1959-60), and in particular the government's decision to allow entry to refugees with tuberculosis and other chronic illnesses. In doing so, it broke the practice established by the 1920 Aliens' Order which had barred entry to immigrants with a range of medical conditions. This article uses the entry of these sick refugees as an opportunity to explore whether government policy represented as much of a shift in attitude and practice as contemporary accounts suggested. It argues for the importance of setting the reception of tubercular and other 'disabled' refugees in 1959-61 in its very particular historical context, showing it was a case less of the government thinking differently about refugees, and more of how, in a post-Suez context, the government felt obliged to take into account international and public opinion. The work builds on and adds to the growing literature surrounding refugees and disease. It also places the episode within the specificity of the post-war changing epidemiological climate; the creation of the National Health Service; and the welfare state more broadly. In looking at the role of refugee organizations in the Year, the article also contributes to debates over the place of voluntary agencies within British society.

Medicalized social hygiene? Tuberculosis policy in the German Democratic Republic.

This archive-based study investigates tuberculosis policy in the German Democratic Republic (GDR) from the 1940s to the 1960s. The focus is on the sanatorium as the major site of treatment and on BCG vaccination as the major preventive tool. The article tests and accepts the thesis that the GDR's guiding health paradigm is best described by the term "medicalized social hygiene." The article finds that methods of both treatment and prevention were characterized less by radical change and innovation than by tradition and pragmatism at least until the mid-1950s. Thus, "forced institutionalization" of "asocial" patients continued after 1945. Yet the health ministry long hesitated to make BCG vaccination obligatory. The German past, the Cold War context of German-German rivalry, and medical and popular attitudes toward vaccination, TB, and TB patients are considered as possible explanations for the mix of continuity and change in TB policy.

"My flying machine was out of order".

Why did the founders of this organization-which was established in 1884 as the American Climatological Association-want to study climatology and respiratory diseases? In particular, where did the idea of treating tuberculosis with pure air and sunlight come from? How effective was this treatment for a disease that in 1880 afflicted a third of the population of Colorado? Why did this Association not acknowledge technological advances such as weather forecasting or large 20(th) century population movements? This paper seeks to answer those questions in order to inform the Association's possible study of the effects of global climate change on human health, an issue that is arguably comparable to what the founders faced. Recent governmental reports suggest that the medical and health care communities have not yet become engaged. If the ACCA does not, then who will?

From the Zulu medicine to the European phytomedicine Umckaloabo.

Among the Zulus of South Africa a crude root drug of initially unknown botanical origin was used for the treatment of pulmonary diseases and tuberculosis (TB). An English TB patient called "Stevens" heard about it and travelled to South Africa where, according to his account, he was cured by taking an extract of the crude drug. It was extremely difficult to establish the imported crude herbal drug as a "new TB medicine", as neither the plant from which the drug originated was identified nor were the constituents and pharmacological effects known at that time. It was only after a professional search and initial chemical and taxonomic investigations enabled the identity of the plant to be determined that the requirements were met for comprehensive chemical, pharmacological and clinical research into the crude drug. The following report traces the long and difficult path of this "mystery drug" from the Zululand of South Africa to the laboratories of Europe.

Cousin Lizzie's tuberculosis tent.

Before the discovery of antibiotics as a cure for tuberculosis in the 1940s, open-air therapy was the standard treatment for the disease. This article describes how families and health care institutions used tents, shacks, balconies, and verandas to expose loved ones and patients to the cold, pure air that was believed to help them fight tubercle bacillus.

Medicine circles defeating tuberculosis in southern California.

In the late 19th and early 20th centuries, two medicine circles existed in Indian country: one Native and one Euro-American. Traditional doctors among First Nations peoples approached disease in spiritual ways and also used herbal medicine to treat their patients. First Nations people tried to treat infectious diseases brought by newcomers through plant medicine, ritual, and ceremony. Generally unsuccessful, First Nations people and doctors of California learned from practitioners of Western medicine to care for tubercular patients, to avoid the bacteria, and to remove active tubercular patients to sanatoria. Native agency and Western medical practices intersected and worked successfully from 1928-48 to reduce cases and deaths caused by tuberculosis.

[Tuberculosis and the modern ideal of living]. / Die Tuberkulose und das moderne Wohnideal.

Sunlight and fresh air belong to the everyday life's myths. It has influenced our times and personal lives as much as industrialization. Today we are hardly aware of the multiple and omnipresent consequences of this myth. The modern movement with all its facets including modern architecture is barely conceivable without it. What is the link between this triad with all its effects and tuberculosis, the oldest and most important infectious disease which still claims more than 3 million deaths per year worldwide? Tuberculosis was treated by sunlight and fresh air at all times. This treatment was at its zenith during the second half of the 19th century after Hermann Brehmer had initiated this treatment within sanatoria in 1862. The sanatorium vogue lasted until the middle of the last century when streptomycin was isolated by Selman Waksman 1943. A new type of hospital was necessary for treating the patients with sunlight and fresh air: the sanatorium with its wide windows, sheltered open balconies, terraces and "Liegehallen". In return, this airy type of building was the forrunner of a new architectural style, called "Neues Bauen". The latter has profoundly influenced our modern ideal of living since Le Corbusiier built the Villa Savoye, one of the architectural highlights of the 20th century.

[Treatment of pulmonary diseases from the 20th to the 21st century]. / Traitement des maladies pulmonaires: du 20ème au 21ème siècle.

In the 21st century, the treatment of pulmonary diseases will undergo fundamental change. The treatment of patients in general and of pulmonary diseases in particular will transcend the vertical and fragmented approach based on analytical and reductionistic disease concepts to emphasize holistic care given by an interdisciplinary team. Extended life expectancies, understandably ones that represent significant progress in 20th century medicine, will lead to considerably higher costs in the healthcare system and to a redistribution of therapeutic resources. Healthcare centers will form that are better equipped to handle the true needs of the patients and provide better continuity of care. Likewise, this nascent century will bring forth one irreversible sociological change, namely the better informed and better educated patient who, by demanding access to medical information in order to profit from modern technological advances, will become an active partner of the healthcare professionals. The Swiss Lung League, which is celebrating its 100th anniversary this year, has been able to tackle the real pulmonological challenges of the 20th century by taking on a pioneering role in the fight against tuberculosis, smoking and setting benchmarks by providing patients with sophisticated respiratory technology like mechanical home ventilation. Unlike other medical disciplines, it recognized early on the importance of working within a healthcare network. Its strength derives from a synergy of the cantonal leagues' medical and social commitment and the Pulmonological Society's scientific support. Indeed, this trend can be observed all over Europe and the USA. This partnership is self-perpetuating and has adapted its own mentalities and structures to scientific progress and the changing needs of pulmonary patients.

Rib lesions in a prehistoric Puebloan sample from southwestern Colorado.

An unusually high frequency of periosteal lesions of visceral rib surfaces was observed in a small, prehistoric skeletal series from southwestern Colorado. Lesions of this type have been concordant with pulmonary tuberculosis in three studies of human skeletal collections with known cause of death, and in a recent clinical investigation of rib dimensions in living patients with lung disorders. Diseases such as pneumonia and actinomycosis have also been found to cause these lesions, but in much lower frequencies. Archaeological evidence suggests that Puebloan farmers of Sleeping Ute Mountain's southern piedmont, from which the sample is drawn, endured unusually harsh environmental conditions punctuated by severe drought and exacerbated by escalating warfare. It is argued here that these environmental stressors increased susceptibility to an opportunistic respiratory infection reminiscent of tuberculosis, and possibly also some form of pneumonia, resulting in high rates of active disease previously noted only in historic Puebloan peoples.