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Volume 52 (2001)
- Issue 6 Pages 431-
- Issue 5 Pages 369-
- Issue 4 Pages 299-
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- Issue 2 Pages 59-
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Volume 52, Issue 5
Displaying 1-9 of 9 articles from this issue
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Special Issue of Tuberculosis as a Re-emerging Infectious Disease
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Toru Mori2001 Volume 52 Issue 5 Pages 369-376
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSAs in many Western countries, tuberculosis has become a re-emerging infectious disease in Japan recently. Discussions have been held from the epidemiological point of view highlighting the recent characteristics of the problem and the most effective ways of combatting it.
Infection: The steep and long-lasting decline in the risk of tuberculosis infection after the war has brought about a kind generation gap : a younger generation that has been only sparsely infected, and a older generation that has been heavily infected. This gap plays an important role in the increasing occurrence of small epidemics of tuberculosis.
Clinical development: The main source of the disease in recent years is the old generation that was infected decades ago. The prevention of the disease and its early detection in this age segment has been neglected until now. Enhancing treatment of latent tuberculosis infection, or chemoprophylaxis, is an important alternative to BCG vaccination. Teaching about tuberculosis to medical students and doctors will be increasingly important in order to maintain the alertness of the medical profession for the purpose of the early case-detection of tuberculosis. Also, for active case-detection or screening, indiscriminate mass miniature radiophotography services should be replaced with selective ones, i.e., contact examinations and screening for high risk individuals from a socio-economic point of view.
Clinical course: There is a clear drift of tuberculosis occurrence to the medically and socio-economically weaker segments of the population, as well as to older people, which will further deteriorate the prognosis of these patients. Case management for regular drug therapy will be of critical importance and should be strengthened, as in DOTS strategies in Western and developing countries since 1990s.View full abstractDownload PDF (858K) -
Atsuyuki Kurashima2001 Volume 52 Issue 5 Pages 377-382
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSIn the later half of the 1980s, tuberculosis increased on a worldwide scale and the serious situation of the spread of multiple-drug-resistant tuberculosis has pressed medical staffs to re-examine tuberculosis as an emergency revival infectious disease. In 1994, the CDC (Center for disease control) of the USA proposed a new concept of tuberculosis bacillus detection system. Since the discovery of the mycobacterium tuberculosis by Koch, there had been no basic change in this area for 120 years. Recently, with the introduction of new technologies, revolutionary changes have come about. The most striking techniques are direct tuberculous DNA detection from samples by PCR amplification methods and species identification by DNA hybridization methods. Although these methods have are some problems, they are superior in speed and all much more effective when combined with conventional methods. In addition, the recently developed automated-liquid-culture system has a higher sensitivity than conventional solid medium system and the detection period has also been greatly shortened. In Japan, the mycobacterium tuberculosis test guidelines were revised after 20 years due to this progress and to maintain international consistency. In future, even more efficient systems for detecting the tolerance gene, for example by using a DNA chip, are expected. Since more than 80% of tuberculosis diagnosis are made under symptomatic examination today, these new diagnostic technics are excellent. However physicians must be aware of tuberculosis when they see senior citizens. With declination of incidence of tuberculosis infection in young generation, single infection would easily cause spread group infection. In particular, first-time therapy is important, and WHO has recommended and performed directly observed treatment and short-course chemotherapy (DOTS) as the most effective strategy to inhibit a TB pandemic. Currently, New York city, which has introduced DOTS since 1992, has achieved a 98% therapy-completion rate and succeeded in decreasing tuberculosis morbidity to about 1/3 of its peak. In Japan, DOT has been introduced into some localities. Now, a wider use is demanded.View full abstractDownload PDF (751K) -
Hideo Takagi, Satoshi Horiguchi2001 Volume 52 Issue 5 Pages 383-386
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSThe incidence of general tuberculosis has markedly decreased since the introduction of effective chemotherapy. However, laryngeal tuberculosis has been on the increase in recent years.
Seven cases of laryngeal tuberculosis treated at our department between 1992 and 1999 are presented in this paper. The tuberculosis involved the vocal cords in 4 patients and the epiglottis in 3. Six out of the 7 patients complained of hoarseness, and 3 complained of pharyngalgia. Chest radiography, sputum test, and PPD were supplemental tools for diagnosis. Chest radiographic findings were interpreted as showing advanced pulmonary disease in 6 patients. In sputum cytology, 4 patients were positive for acid-fast bacilli, and the other 3 were negative. Pathological examination was mandatory for a final diagnosis and to rule out malignancies.
Laryngeal tuberculosis is often associated with pulmonary tuberculosis, and tubercule bacilli are often detected in the sputum. Therefore, early diagnosis and treatment are essential.View full abstractDownload PDF (702K) -
Keizo Inagaki2001 Volume 52 Issue 5 Pages 387-394
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSTracheal and bronchial tuberculosis are secondary to pulmonary tuberculosis, and then the standard diagnosis and treatment are similar to those for pulmonary tuberculosis. However, their clinical features are specific, because their lesions localize in the endotracheal and endobronchial wall and develop into the trachea with the granulation, cicatrization and destraction of cartilages. This study is an analysis of the surgical treatment of stenosis following tracheal and bronchial tuberculosis its the clinical features. Subjects who underwent surgical treatment were 48 of 236 patients diagnosed with this disease by bronchoscopy from 1978 to 1999 at Nakano National Chest Hospital and International Medical Center of Japan. There were 18 males and 30 females. The main lesions localized in the trachea of 4 cases, in the left bronchus of 33 cases and in the right bronchus of 16 cases. Stenosis of the left main bronchus was found in 31 of 33 patients. The patients were classified into two groups according to surgical procedure. Group A (n=19) was treated by simple pulmonary resection, while Group B (n=29) underwent tracheal and bronchial reconstruction. A simple pulmonary resection was performed for 17 of 19 patients of Group A from 1978 to 1988, and a reconstructive procedure was done for 27 of 29 instances of Group B from 1989 to 1999. The surgical indication for Group A was lung removal due to irreversible function loss, such as destroyed lung, and Group B was recovery and preserving the function of the peripheral lung from stenosis in cases of atelectasis. The time lag was shorter in Group B than in Group A from the start of pulmonary tuberculosis to operation. The evaluation of lung function by INDEX (FEV1.0/PVC) between before-surgery and after-surgery showed an average improvement + 9% in Group B, and was unchanged in Group A. All patients returned to regular work, although 11 of the 48 patients (22.9%) had perioperative complications. As a result, reconstructive procedures are thought to be very useful for tuberculous tracheal and bronchial stenosis under early diagnosis.View full abstractDownload PDF (990K) -
Shinji Shishido2001 Volume 52 Issue 5 Pages 395-399
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSBecause tuberculosis is transmitted by the airborne route except under exceptional circumstances, measures against airborne transmission has become a main goal.
First, it is very important to examine the two-step tuberculin skin test for hospital employees under 40 years of age at time of hiring in order to establish a reliable baseline. If possible, this two-step tuberculin skin test is recommended for other hospital employees too. Next, in the event of close contact and bronchoscopy by hospital employees with infectious patients, the use of special N95 masks for minute particles, which have been developed for the prevention of tubercle bacillus infection, is needed. Basic improvements on hard aspects, for example separation of an air conditioning systems in the tuberculosis (TB) wards and TB rooms from that in other wards rooms or arrangement of ventilation system in TB wards and TB rooms, are required. Risks of nosocomial infection are predicted to increase in the future due to some situations: i.e., the percentage of people who have been infected with TB has decreased and the number of young people without TB immunity is large. Early diagnosis is most important for prevention of TB infection. On daily medical examination, it is very important to manage patients constantly, keeping interests for TB with the preparation of manuals for the prevention of nosocomial TB infection.View full abstractDownload PDF (429K)
Original
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Tomokazu Yoshizaki, Hideaki Shiga, Jun-ichiro Sanada, Noboru Terayama, ...2001 Volume 52 Issue 5 Pages 400-408
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSSuperselective intra-arterial infusion of cisplatin (CDDP) has been an effective chemotherapy for head and neck squamous cell carcinoma. However, to establish a more effective protocol, the response and side effects of the additional usage of pirarubicin (THP ; 20 mg/body) to CDDP (100 mg/body) for hypopharyngeal and laryngeal cancer was evaluated in a prospective randomized study.
Fifteen patients with laryngeal squamous cell carcinoma and 8 patients with hypopharyngeal squamous cell carcinoma participated in the protocol. Patients received 2 or 3 cycles of a superselective intra-arterial delivery of CDDP or CDDP + THP during the radiation dose (200 cGy/day × 30-35). Simultaneous intravenous infusion of sodium thiosulfate, an antagonist of CDDP, was given to all patients with chemotherapy. The dose of sodium thiosulfate was determined by accessing the reduction of a cultured AH-66 cell toxicity of CDDP. A complete response (CR) to treatment in the primary site was achieved in 9/12 (75%) and a partial response (PR) was achieved in 2/12 (17%) for the CDDP group. CD was 7/11 (64%), and PR was 1/11 (9%) for the CDDP + THP group. The CDDP + THP group tended to develop a severe mucosal toxicity compared to the CDDP groups (p=0.11).
These results suggest that the superselective intra-arterial delivery of THP (20 mg/body) in addition to CDDP (100 mg/body) not only decreases the response rate but also increases toxicity in the treatment of hypopharyngeal and laryngeal cancer.View full abstractDownload PDF (1140K)
Case Report
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Hiromu Shiraishi, Hiroyuki Oiki, Masahiro Ishikawa, Yukio Tanaka, Kiyo ...2001 Volume 52 Issue 5 Pages 409-413
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSA 25-year-old man hospitalized due to swallowing pain, fever, anterior neck pain and disphagia was reported. His WBC count was 19,860/mm3, and his CRP was 10.4 mg/dl. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated an abscess in and around the left lobe of the thyroid.
Under a diagnosis of acute suppurative thyroiditis he was treated with antibiotics.
A barium esophagogram obtained after resolution of his acute infection demonstrated a bilateral piriform sinus fistula. A left fistulectomy was performed and no recurrence was observed after surgery.View full abstractDownload PDF (1166K) -
Hirotaka Hara, Yuji Imate, Osamu Horiike, Takeshi Okuda, Hiroshi Yamas ...2001 Volume 52 Issue 5 Pages 414-419
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSAdvanced deep neck infection is an incidentally fatal disease for aged patients or patients with severe diabetes mellitus. Ultimate priority should be placed on saving the life of patients affected with a deep neck infection. However, deep neck infection causes certain complications even when patients recover from the infection.
We present the case of a 80-year-old woman with a swallowing disturbance as a subsequent complication of severe gas gangrene in the neck. Videofluorography showed a restriction in the movement of the hyoid bone and a leakage of bolus into the larynx. Cricopharyngeal myotomy on the left side and anterior traction of the hyoid bone were performed. After laryngeal suspension and the cricopharyngeal myotomy followed by the two months rehabilitation of swallowing, the patient was almost free from swallowing disturbances on discharge. We think the surgical debridement of the suprahyoid muscles and a severe scar contraction on the right neck caused the swallowing disturbance of this patient.View full abstractDownload PDF (1708K) -
Mamiko Nakamura, Hideki Hirabayashi, Tadao Asai, Satoru Fukami, Kaori ...2001 Volume 52 Issue 5 Pages 420-425
Published: October 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSA fifty-five year old man complained of neck pain and swelling after upper gastrointestinal endoscopic examination. He had a deep cervical abscess caused by hypopharyngeal and esophageal perforation. In the present case, the abscess appeared to have occurred rapidly because oral consumption was continued despite severe pain. The patient's diabetes mellitus also made the rapid appearance of the abscess.
The abscess which included a large amount of gas had compressed the larynx, hypopharynx, and cervical trachea. We immediately performed drainage by Dean's incision method and a tracheotomy. A large amount of putrefactive abscess exsisted in the anterior visceral space. The incision was left open due to suspected anaerobic infection. The wound was closed after complete drainage.
Simple neck radiography and an axial CT were beneficial for diagnosis of the abscess. The axial CT of the neck in particular appeared to be essential for determining the degree of abscess and its extension into the mediastinum.
Patient should not be allowed oral feeding, and subsequently antibiotic therapy should be given, if the perforation is small or exhibits no signs of infection. If the perforation is large or shows complications, such as deep cervical abscess, external drainage should be performed immediately. Moreover, the neck incision should be left open if anaerobic infection is suspected, and the wound should be closed secondarily after confirming the subsidence of inflammation.View full abstractDownload PDF (1037K)
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