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28 u. RAGHUPATI SARMA ETAL 28. Carter J.B., Barr G.D., Levin A.S., Byers V.S., Ponce B., Fudenberg H.H., German D.F. Standardization of tissue culture conditions for spontaneous thymidine-2- 14 C incorporation by unstimulated normal human peripheral lymphocytes : circadian rhythm of DNA synthesis. J. Allergy. Clin. Immunol; 1975, 56, 191. 29. Abo T., Kawate T., Itoh K., Kumagai K. Studies on the bioperiodicity of the Immune response. I. Circadian rhythms of human T, B and K cell traffic in peripheral blood. J. Immunol; 1981, 126,1360. 30. Miyawaki T., Taga K., Nagaoki T., Seki H., Suzuki Y., Taniguchi N. Circadian changes of T lymphocyte subsets in human peripheral blood. Clin. Exp. Immunol; 1984, 55, 618.
Original Article Ind. J. Tub., 1992, 39, 29 LOWER LUNG FIELD TUBERCULOSIS - A TROHOC ANALYSIS P. Ravindran 1 , M. Joshi 2 , P. Sundaram 2 , R. Jose Raj 3 and K. Parameswaran 4 (Received on 15.5.90; Accepted on 5.6.91) Summary. Pulmonary Tuberculosis occasionally presents with atypical features, lower lung field tuberculosis being one among them At trohoc analysis of all tuberculosis admissions done during a period of 5 years-from 1985 to 1989-ibiind 20 cases (2.4%) of lower lung field tuberculosis. Lower lung field tuberculosis was more common in diabetic (13.8%) than in n6n-diabetic tuberculosis patients (1.4%) , the difference being statistically significant (P< 0.005). It was also observed that diagnosis of pulmonary tuberculosis on radiological evidence alone was made more often (40%) in diabetes msellitus than in patients without diabetes (12.1%). Introduction It is well known that diabetics have a higher chance of developing pulmonary tuberculosis, among whom the disease has quite often an atypical presentation. Lower lung field tuberculosis is one such presentation. Material and Methods This study examines the proportion of those with diabetes mellitus among hospitalized patients of pulmonary tuberculosis, and the extent of lower lung field tuberculosis in them. The study design adopted was a Trohoc Analysis' (retrospective cohort) whereby patients with pulmonary tuberculosis were retrospectively analyzed with respect to age, sex, clinical, laboratory and roentgenographic features, associated disorders and response to treatment. A trohoc analysis lacks the accuracy and credibility of a prospective cohort study but is less time consuming, easier to perform and yields almost comparable results. A total of 843 patients with pulmonary tuberculosis who were admitted in the wards of the Department of Respiratory Medicine at the Medical College, Trivandrum over a period of 5 years-1985 to 1989-formed the subject of this study. Results Among the 843 admissions, a total of 20 patients (2.4%) had roentgenographic evidence of lower lung field tuberculosis (lesions below the hilum) : 15 were males and 5 females; 8 patients (40%) belonged to 50-70 age group; the commonest presenting complaint was cough with expectoration (65%); 8 patients had cavitary and 12 (60%) non-cavitary lesions. As regards location, 11 cases had right lung lesions while 9 had left lower lung disease (Table 1). In all, 723 of the 843 admissions were sputum positive (85.8%). The total comprised 65 cases who had diabetes mellitus with 39 (60.0%) being sputum positive and 778 non-diabetics with 684 (87.9%) being sputum positive (Table 2) Sputum was positive for AFB in 14 patients (70%) out of 20 with lower lung field Table. I. Distribution of lower lung field tuberculosis according to right or left lung and nature of lesion as seen in x-ray Nature of lesion Rt. Side of lesion Lt. Both Total 1. Director and Professor; 2. Associate Professor; 3. Assistant Professor; 4. Post Graduate Student From the Department of Respiratory Medicine, Medical College, Trivandrum. Correspondence : Dr. P. Ravindran, Head, Department of Respiratory Medicine, Medical College, Trivandrum.
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