Development of drug-resistant tubercle bacilli in the course of chemotherapy is one of the most important problems in the research of tuberculosis.
The purposes of the present studies were, first, to establish the method for obtaining the drug-resistant tubercle bacilli with high frequency in experimental tuberculosis, and, second, to analyze the main factors responsible for the development of drug -resistant tubercle bacilli in vivo.

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The relation between the bacilli negative conversion rate and the number of combined sensitive antituberculous drugs in retreatment with intermittent administration of rifampicin for severe pulmonary tuberculosis was observed. The dose of rifampicin was 0.45g a day twice weekly and 47 cases could be observed. They were severe pulmonary tuberculous patients, and had been already treated with almost all antituberculous drugs.
Before retreatment, the sensitivity of the strains isolated from the patients sputa was examined for 11 antituberculous drugs in Kirchner's semi-liquid agar media.
Following results were obtained.
1) The bacilli negative conversion rate increased in proportion to the number of combined sensitive antituberculous drugs.
2) The more the number of combined sensitive antituberculous drugs, the sooner the negative conversion of tubercle bacilli in sputum.

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This study was made to review the present status of surgical treatment for the tuberculous empyema in Japan. The material consisted of 552 cases who had been operated upon at 36 institutions belonging to Tuberculosis Research Committee (RYOKEN) during 4 years' period from 1968 to 1971 and followed up for the period of at least 6 months postoperatively.
In this study the died case not related to the thoracic operation and tuberculous worsening were excluded. The tuberculous empyema case was defined as the case who had had a purulent or pus-like fluid in the pleural space after the onset of pulmonary tuber culosis, or during and after treatment of pulmonary tuberculosis. The primary empyema case was difined as the case not related to the thoracic operation and the secondary one as the case related to the thoracic operation. The total empyema case was defined as the case with empyema space expanding around from apex to diaphragm and the partial empyema case as the case with smaller empyema space than the above mentioned on the radiogram.
The empyema cases were classified into 3 types by the causes, the presence of fistula and the size of empyema space; the primary and secondary, the fistulous and nonfistulous, and the total and partial empyema.
The ratio of primary cases to secondary cases was 60%: 40%, that of fistulous cases to nonfistulous cases was 70%: 30% and that of total cases to partial cases was 45%: 55%.
The causes of empyema were quite different in the primary and secondary empyema; the pleurisy comprised 63.5%, the artificial pneumothorax 29.5% and the spontaneous pneumothorax 7.1% in the former and the failure of pulmonary resection comprised 76.6%, the failure of extrapleural plombage 14.6%, the failure of cavernostomy 4.4%, the failure of thoracoplasty 3.1 % and the other operations 1.3% in the latter. The failure of pulmonary resection was more predominant as the cause of empyema in the secondary fistulous cases than in the secondary nonfistulous cases.
Regarding the preoperative background factors, cases with %VC less than 40 were found in 17.0% and cases with %VC more than 71 only in 21, 6% in all cases, whereas 20.4% and 15.9% in the fistulous cases, and 8.5% and 35.3% in the nonfistulous cases, respectively. Cases with FEV1.0/PVC less than 30 occupied 24.9% and cases with FEV_1.0/PVC more than 61 occupied 12.9% in all cases. The former was 28.8% in the fistulous cases and the latter was 25.3% in the nonfistulous cases. According to these findings the preoperative respiratory function was lower in the empyema case as compared with that of the usual tuberculosis cases.
The bacteriologic study of a pus obtained from the empyema space just before and/or during the operation revealed the infection rate of 43.0% in which tubercle bacilli. were found in 16.4%, cocci in 16.0%, both tubercle bacilli and cocci in 6.1%, fungus in 1.9% and others in 2.6%. This finding differed markedly according to the type of empyema; a high percentage of infection rate by cocci were seen in the fistulous cases than in the nonfistulous cases. The same tendency was proved between the primary cases and the secondary cases.

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Screening tests for diabetes mellitus were conducted on all tuberculosis patients hospitalized in the national chest hospitals participated to the joint study group on pulmonary tuberculosis and diabetes mellitus.
The tests were performed 12 times at regular six months interval from July 1966 until January 1972.

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We used a combination of RIFAMPICIN (RFP, 0.45 g daily), PAS and INH in 15 new patients with renal tuberculosis, who had not received any kind of antituberculous therapy previously, and compared its results to those of conventional therapy with a combination of SM, PAS and INH. Changes in subjective symptoms, urinalysis, tubercle bacilli in urine, pyelogram and cystoscopic findings were compared between the RFP group (the group of patients receiving RFP, PAS and INH in combination) and the SM group (the group of patients receiving SM, PAS and INH in combination). It was revealed that the effect of RFP group was similar to that of SM group. Concerning the side effects, some patients of the RFP group developed increases in S-GOT and S-GPT and complained of gastro intestinal symptoms, but all such side effects were slight and therapy could be continued.

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We recently experienced an interesting case having persistent fever of unknown origin, and acid-fast bacilli of Runyon Group II were frequently demonstrated in circulating blood. A clinical and bacteriological study was made.
The patient is a 31-year-old housewife. She developed a high fever accompanied by shaking chills. Gram-positive bacilli were demonstrated once in the circulating venous blood, but following administration of antibiotics bacteria could not be detected and fever subsided. Thereafter fever recurred, and despite various therapies fever persisted. At the time of admission, acid-fast bacilli of Runyon Group II were isolated from the venous blood and furthermore the patient had a high fever. of 39°C-40°C and complained of general malaise, and diarrhea and cough during high fever, but sputum, chest pain and skin eruption could not be observed. Swelling of the cervical, inguinal, and axillary lymph nodes were noted together with enlargement of the liver and spleen. Pigmentation having a dia meter of about 10-15cm was noted on the left leg and it was accompanied by induration, erythema, and pain. Clinical and bacteriological examinations suggested malignant lymphoma and septicemia due to acid-fast bacilli. After February 1972 in addition to anti tuberculosis therapy given heretofore, treatment for malignant limphoma was commenced, and acid-fast bacilli detected over a period of 10 months from the venous blood could no longer be isolated and the patient's condition improved.
During the 12-month period from 28 May 1971 to 26 April 1972 bacteriological tests were performed. 37 times, and only scotochromogenic acid-fast bacilli could be isolated on 25 occasions. Being all retarded in growth, they were considered as belonging to Runyon Group II strain. Study made of the strains isolated from 28 May 1971 to 7 September 1971 indicated that their characteristics were consistent ivith those of M. scrofulaceum and M. gordonae. More interesting was the fact that the strains detected on 2, 3, 5, and 21 July 1971 and 11 August 1971 were composed of two types, M. scrofulaceum and M. gordonae. Intradermal response to various types of acid-fast bacilli tuberculin test was negative. Agglutination reaction with the patient's serum using an isolated bacterium of M. gordonae was 512 fold. The value is higher than that of serum of a healthy individual, suggesting that this strain might have some pathogenic significance.
In this patient having malignant lymphoma as an underlying disease, septicemia-like symptoms developed during the course of the disease probably due to M. scrofulaceum and M. gordonae.

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