岡山医学会雑誌

Objective: To examine the specificity of QuantiFERON^®TB-2G (QFT) in tuberculosis contact investigations of children. Methods: A schoolgirl was diagnosed with smear-positive pulmonary tuberculosis. To determine the extent of tuberculosis infection among contact schoolchildren, tuberculin skin tests were performed on 75 children enrolled in the school. All the children had been vaccinated with BCG at least once. The QFT test was then given to the 68 children who had tuberculin reactions including erythema larger than 10mm in diameter. Written informed consent was obtained from a parent of each child. Results: The number of infected subjects was 22 based on tuberculin skin test results. Of the 68 contacts, 1 was positive for QFT, 2 were doubtful positive, and the remaining 65 were negative. During the 2-year follow-up, none of the children developed tuberculosis. Specificity was 95.6%. Conclusions: It was confirmed that the additional use of QFT would reduce the number of indications for chemoprophylaxis cases. The current criteria for the indication of chemoprophylaxis based on a strong tuberculin reaction are considered unreliable, causing many subjects with strong reactions to be given unnecessary preventive medications.

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We visualized subepicardial small veins (ID>100μm) and venules (ID<100μm) in a beating human heart using a needle-probe video-microscope with a CCD camera and examined the effects of nitroglycerin (NTG) on the vessels. In 9 patients who underwent cardiac surgery, we observed small veins (n=12) and venules (n=9). We carefully obtained access of the needle lens probe into the subepicardial small veins and venules. The microvascular diameter responses after superfusion of NTG were monitored for 5min. The diameter changes of the microvessels were analyzed at end diastole. In the control condition, the phasic diameter changes of both small veins and venules increased from end-diastole to end-systole and the diameter changes of the vessels during cardiac cycle reached almost 10%. Both small veins and venules started to dilate just after NTG. The dilation of small veins at 1min after NTG increased to 147±10μm from control values of 131±9μm (13.7±4.2%, p<0.01), whereas the diameters of venules increased to 65±9μm from 60±8μm (6.0±5.0%, p<0.05) at 1min. However, venules continued to dilate, reaching their maximum dilation at 2∼3min. In conclusion, the human subepicardial microvessels were clearly visualized by the needle-probe videomicroscope. The degree of vasodilation in response to NTG in small veins and venules was about the same, at almost 10%, thereby reducing flow resistances.

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The collaboration of various medical teams is crucial for the appropriate treatment of cancer patients. However, in Japan, it is very difficult for oral surgeons to cooperate with head and neck surgeons due to conflicts in the treatment of those patients. There have been few studies on this subject. In the current work, we report on the collaboration of head and neck surgeons, plastic surgeons and oral surgeons in operations on two patients with gingival carcinomas in the mandible. We first prepared plaster 3D models of the patients'mouths by means of ink-jet from CT data. We pre-bent the reconstruction plates using the preoperative 3D models. Therefore, we could save the time required to bend the plate. Plaster models are cheaper than resin models. It is also easy to model the surgery using the plate. During the operation, head and neck surgeons resected the tumors, plastic surgeons performed reconstruction with vascularized bone or skin graft, and oral surgeons (dentists) did plate fixation and took charge of the patients'occlusion. This method resulted in patients having good occlusion after the operation.

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