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48 巻, 4 号
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第 2 報 結核感染率の推定中村 健一, 島尾 忠男, 青木 正和1973 年 48 巻 4 号 p. 111-119
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーAn attempt was made to estimate the annual infection rate of tuberculosis from theautumn of 1968 to the autumn of 1969 among children in Okinawa, using the datacollected in a follow-up survey of tuberculin reaction, the results of which were reportedpreviously.
First, several available methods for estimation were examined to determine theiradaptability to this study.
The most popular method in which all positive convertors are considered to newlyinfected appeared to be inadequate for this study.
If the estimation is to be made on population basis, the method in which the differenceof tuberculin positive rate between the two surveys on same population would bexecommended, as it is not only simple but also independent from measurement errors.However, this method is not applicable if the number of negative convertors amongexaminees exceeds that of positive convertors.
The authors then examined the new method proposed by Raj Narain et al and adoptedit considering it to be the most suitable for this study.
In this method, the examinees showing an evident increase exceeding a certain degree intheir tuberculin allergy are considered to be the newly infected.In the distribution curve of the differences in tuberculin reaction from 1st to 2ndsurvey, of those with average reactions of 10-29mm, a bulge is usually found in the tail ofthe elevated side. This bulge represents a group that showed a distinct increase in allergyand, in all probability, consists of the newly infected.
In this survey, the bulge appeared in the elevated tail of more than 17mm.
According to this method, the estimated infection rates for children in Okinawa showedreasonable values: such as 0.313% for 0-4 age group, 0.144% for 5-9 age group, 0.373%for 10-14 age group and 0.261% for 0-44 age group.
In comparing these values with those in European countries, the infection rate oftuberculosis among children in Okinawa is almost the same as those of France or Switzerland at the beginning of the 1960's.
In order to explain the reasons why the positive conversion rate should not be used asthe primary infection rate in this survey, the authors discussed the significance of positiveconversion as an index of tuberculosis infection and factors relating to the fluctuation oftuberculin reaction.抄録全体を表示PDF形式でダウンロード (1385K) -
山本 正彦, 福原 徳光, 青柳 昭雄1973 年 48 巻 4 号 p. 121-127
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーThe therapeutic effects of Lividomycin (LVM) in the retreatment for advancedpulmonary tuberculosis patients were observed.
The patients subjected to this study were 41 cases as listed in table 1, and thebackground factors of these cases were as follows: as for age, younger than 39 years of agein 14 cases, between 40 and 59 years in 23, and older than 60 years in 4; as for the extentof disease by N. T. A. classification, minimal in 1, moderately advanced in 11, far advancedin 29; and as for the cavity, no cavity in 1 case, with non-sclerotic walled cavity in 8 andwith sclerotic walled cavity in 31 cases.
LVM was administered twice a week, and the daily dose of LVM was 2gm. for thepatients with body weight 50kg or more, and 1.5gm. for the patients less than 50kg. In 15 cases, other susceptible or previously unused drug was combined with LVM, while in 26 cases no such drug was combined.
The rate of sputum conversion 3 months after administration of LVM was 53.4% and54.2% after 6 months in the cases other susceptible or previously unused drugs werecombined, and 26.1% and 31.8%, respectively, in the cases no other susceptible orpreviously unused drugs were combined (table 2).
In 21 cases, the susceptibility of bacilli to LVM and KM before the treatment of LVMwas measured. In 7 cases, the bacilli were not susceptible to KM, while in 4 of them thebacilli were susceptible to LVM, and in the other 3 the susceptibility of the bacilli to LVM were slightly decreased. In other 14 cases, the bacilli were susceptible to both LVM andKM (table 3).
In 4 cases, the susceptibility of bacilli to LVM were decreased in the course of LVMtreatment and those to KM were also decreased simultaneously in all cases (table 4).
The adverse effects of LVM were listed in table 5, and the hearing ability at 8, 000c/s inaudiogram was disturbed in 26.3% of the cases during 6 months administration of LVM.抄録全体を表示PDF形式でダウンロード (942K) -
第15次国療化研A研究報告国立療養所化学療法共同研究班1973 年 48 巻 4 号 p. 129-134
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーTuberactionmycin N (Turn-N) is a new antituberculostatica derived from Streptomycesgriseoverticillatus var. tuberacticus (N 6-130).
We have already more than 10 antituberculostatica at hand but there are still number offailure cases which are resistant to almost all drugs.
For such cases, the combination of rifampicin (RFP) and viomycin (VM) is often used.
In the present study, comparison was made between regimens using Tum-N intermittent, VM intermittent and Turn-N daily in combination with RFP.
INH was added to each regimen in spite of the fact that all patients were resistant to INH.
The tested three regimens were as follows: (1) Tum-N 1g biweekly+RFP 0.45g daily+INH 0.3g daily (2) VM 1g biweekly+RFP 0.45g daily+INH 0.3g daily (3) Tum-N 1g daily+RFP 0.45g daily+INH 0.3g daily Number of cases allocated to the three regimens and number of cases subjected to finalanalysis were shown in Table 1. Reason of exclusion at the start of the trial and reason ofdropout during the trial were indicated in Tables 2 and 3, respectively.
Comparability of the three groups as to background factors were demonstrated in Figs. 1 a and b.
As shown in Fig. 2, the rate of sputum conversion by culture of daily Turn-N regimen (3) was superior to intermittent VM regimen (1), awl the effect of three regimens wasexpressed as (2) < (1) < (3). Fig. 3 showed the results in far advanced cases.
Radiographic changes analysed in Tables 4, 5 and 6 revealed no significant difference.
Adverse reactions were listed in Table 7. High incidence of fever and headache in (1) and (3) was due to a special lot of Tum-N which was pyrogenic.
It is concluded that Tum-N is superior in clinical efficacy to VM and a convenient drugto combine with RFP.抄録全体を表示PDF形式でダウンロード (685K) -
結核療法研究協議会1973 年 48 巻 4 号 p. 135-141
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーThe bacteriologic and radiologic results after 1 year of controlled trials of threeregimens for previously untreated patients with pulmonary tuberculosis were reportedalready (Vol.46, No.8). In the present paper, we report the follow-up results up to 2 yearsafter 1 year's treatment of the following regimens: EB0-Streptomycin 1g twice weekly, INH 0.4g daily and PAS 10g daily for 1year (Standard regimen) EB2-Standard regimen of SM, INH and PAS with addition of EB 750mg twiceweekly for 1 year EB7-Standard regimen of SM, INH and PAS with addition of EB 750mg daily for 1 year All patients had cavities and sputum positive on microscopy. 287 patients were included in the study, and 59 had to be excluded because of theprimary drug resistance, etc. Out of the remaining 228 patients, 74 (32.4%) had defaultedfrom the allocated regimens (Table 1).
In the group EB7, 92.0% of 80 patients were evaluated “favourable” or “probablyfavourable” at 12 month, compared with 86.9% in the group EB0 and 82.0% in the groupEB2. This difference was not statistically significant (Table 3). In the group EB7 only 1patient (1.3%) was evaluated “unfavourable” at 12 month compared with 6 patients (8.8%), in the group EB0. This difference was statistically significant at 5% level.Change of regimen because of side-effects was recorded in 5 patients (6.7%) in the group, EB7 and 11 patients (15.3%) in the group EB2 compared with 3 patients (4.3%) in thegroup EB0. This difference was not significant.
In the evaluation at 18 and 24 months, there was no significant difference in the ratio of“favourable” among the three regimens (Tables 4 & 5).
In the group EB7 only 2 patients were evaluated “unfavourable” during 2 yearsincluding 1 year's period of allocated treatment, compared with 11 patients of“unfavourable”, “probably unfavourable” and bacteriological or radiological deteriorationin the group EBo. This difference was statistically significant at 1% level (Table 6). In caseswith multiple cavities or abundant bacilli in sputum, the difference between EB0 and EB7was definite (Table 7).
It was concluded therefore:
1) Multiple drug chemotherapy for previously untreated pulmonary tuberculosispatients reduced the number of unfavourable cases, while defaulters due to toxicityof drugs showed trend to increase.
2) In far advanced cases, multiple drug chemotherapy, is worthy of consideration.抄録全体を表示PDF形式でダウンロード (957K) -
結核療法研究協議会1973 年 48 巻 4 号 p. 143-150
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーThis study was carried out to analyse the actual status of the period of hospitalizationand to determine the adequate period of hospitalization after the surgical treatment. Thematerial consisted of 1, 155 cases who had been operated upon at 40 institutionsparticipating to the Research Committee of Tuberculosis (Ryoken) in 1970, and theoperation failure cases, empyema cases and dead cases not related to the operation andtuberculosis were excluded.
After dividing the period of postoperative hospitalization into 5 groups, i. e. within 3, 6-12, more than 12 months and still hospitalized, cases were analysed, in relation todistricts, institutions, preoperative, bacteriologic findings in sputum and surgical procedures applied.
The period of postoperative hospitalization in 6 districts in Japan, i. e., Hokkaido and Tohoku, Kanto, Chubu, Kinki, Chugoku and Shikoku, and Kyushu showed markeddifference. For instance, the majority of cases were hospitalized for the period of 6 to 12 months postoperatively in Hokkaido and Tohoku, and Kyushu, wheras the majority of cases were hospitalized for the period of 3 to 6 month in Kinki, Chubu and Kanto. The proportion of postoperative hospitalization period differed, quite significantly in eachinstitution. Both preoperative bacteriologic findings in sputum and surgical proceduresapplied showed a close relation to the period of postoperative hospitalization; in bacillipositive cases, hospitalization period was less than 6 months in 32.3%, 6 to 12 months in 39.9% and more than 12 months in 20.3%, while in bacilli negative cases, it was 43.8%, 44.8% and 7.6%, respectively. Cases hospitalized for less than 6 months were 44.8% inpulmonary resections excluding pneumonectomy, 38% in pneumonectomy, 36.7% inthoracoplasty, wheras cases hospitalized for 6 to 12 months were 44.8%, 46.2% and 40.4%, and cases hospitalized for more than 12 months were 7.4%, 14.3% and 26.0%, respectively, in each mode of operation.
According to this finding it can be said that the period of hospitalization after pulmonary resection excluding pneumonectomy is the shortest and that, after thoracoplasty is the longest. The attempt of analysing the reason for difference of the period ofpostoperative hospitalization found between districts as well as institutions revealed thatsuch a difference was not based on the medical conditions but on the old concept aboutsurgical treatment for pulmonary tuberculosis made before chemotherapy era and on theefforts to maintain high occupancy rate of tuberculosis beds. The period of postoperativehospitalization is considered, in general, to be too long and it might be enough tohospitalize them less than 6 months according to the results obtained in this study.抄録全体を表示PDF形式でダウンロード (1188K) -
相沢 好治, 青柳 昭雄, 鳥飼 勝隆, 河合 健, 山田 幸寛, 五味 二郎, 細田 泰弘1973 年 48 巻 4 号 p. 151-156
発行日: 1973/04/15
公開日: 2011/05/24
ジャーナル フリーThe incidence of tuberculous peritonitis has been decreasing owing to advance ofantituberculous chemotherapy. It is, however, still one of the diseases which we shouldtake into account in differential diagnosis. We have experienced two cases of tuberculous peritonitis; 25 years old male with ‘serous, type’ who had ascites, and 25 years old female with ‘adhesive type’ who presentedabdominal pain and vomiting.
In addition to these two cases, six cases of tuberculous peritonitis admitted to Keio Univ. Hospital during last 10 years were discussed. The eight cases composed of five malesand three females with three cases of serous type, three of adhesive type and two ofintermediate type.
Lesions of other organs, such as lung, lymphnodes or intestinal tract, were detected inall cases. This may suggest that tuberculous peritonitis is secondary lesion from othertuberculous lesions. Therefore, early diagnosis and treatment of primary lesions may beessential for prevention of tuberculous peritonitis.抄録全体を表示PDF形式でダウンロード (3609K)
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