Lancet
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Randomized Controlled Trial Comparative Study Clinical Trial
Short-course chemotherapy in pulmonary tuberculosis. A controlled trial by the British Thoracic and Tuberculosis Association.
The results of short courses of chemotherapy using rifampicin plus isoniazid, supplemented for the first two months by streptomycin or ethambutol, in patients with newly diagnosed pulmonary tuberculosis, have been studied. 174 patients with little or no cavitation received six months chemotherapy. 1 (0.6%) failed to convert to culture negative during treatment and 5 (3%) relapsed in the twelve months after the end of treatment. In 177 patients with similar disease, twelve months chemotherapy was 100% effective in rendering the sputum culture negative and in preventing relapse in the six months after the end of treatment. 151 patients with more extensive cavitation received chemotherapy for nine months; this was 100% effective in sputum conversion and in preventing relapse in the nine months after the end of treatment. In 155 patients with similar disease, the eighteen-month regimen was uniformly successful in sputum conversion. ⋯ Streptomycin produced significant adverse effects in 8% of patients whilst ethambutol caused none. Chemotherapy with rifampicin plus isoniazed for nine months, supplemented initially by ethambutol, is more acceptable than standard chemotherapy for eighteen months, is highly effective in sputum conversion, and has resulted in no relapses over a nine-month follow-up period. Further follow-up is being continued to confirm that relapse does not occur.
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Ethical problems in medicine usually arise when normal guiding principles appear to be in conflict. In the case of babies with severe spina bifida, or similar abnormalities, two such fundamental principles may be applied with opposing conclusions. The first is that any decision requires an estimate of the balance of suffering and happiness for those concerned in an action, and the other is the assertion that human life is sacred. ⋯ The distinction between ordinary and extraordinary means may vary with circumstance, and so the application of this principle involves decisions at a third or more practical level. These include an assessment of the child's abnormality, of the effects of this upon the quality of life possible for the child, and of the burdens that will be placed on the family and society. At each level the ethical decisions involve complex choices, and clearly any present policies must be regarded as temporary unavoidable compromises rather than as final solutions.