Because of highly effective anti-tuberculostatic activity of rifampicin (RFP), it was anticipated that the improvement of pulmonary tuberculosis, especially of chest X-ray findings could be achieved faster by combined chemotherapy with RFP than that without RFP. The authors compared retrospectively the grade of improvement of chest X-ray findings between patients receiving combined chemotherapy with RFP (RFP group) and those without RFP (non-RFP group). In all cases, sputa converted to negative and lasted for at least 6 months. A matched pair method was used in this study, and cases with similar background factors composed a pair. Original treatment pairs were 26, and retreatment pairs were 20. The grade of improvement of chest radiogram was estimated and determined by all the research group members, according to the evaluation standard of Gakken classification, every 3 months for 2 years after the start of treatment.
Tubercle bacilli in sputum converted to negative in nearly all cases at the 7 th month, but there-after a few cases in both groups showed transient positive results and, bacteriological relapse was found in each one case of retreatment groups with and without RFP. Continuous positive bacilli in these cases started at the 21st month (Table 4), and these 2 cases were excluded from the evaluation of radiogram at the 21st and the 24th month.
The improvement of chest radiogram was obtained more or less in all cases of original treatment at the 12th month on routine radiogram, and the improvement of non-sclerotic walled cavity at the 9th month on tomogram. No significant difference was observed between both groups, although the improvement was faster in the RFP group than in the non-RFP group. No further improvement was seen 18 months or later (Table 5).
The chest radiogram in the re-treatment group improved slowly and no more improvement was seen 21 months or later; the rates of cases showing improvement were about 58% in RFP group and about 80% in non-RFP group on routine radiogram (Table 6). It is considered that the difference was due to the difference in factors which were neglected in making matched pairs more patients had longer duration of the disease and more resistant drugs in the RFP group than in non-RFP group (Table 2). The improvement of sclerotic walled cavity on tomogram was similar in re-treatment groups; about 85% showed improvement at the 21st month and no further improvement was seen thereafter (Table 6).
In conclusion, the grade of improvement on chest radiogram in RFP group and in non-RFP group was similar, although the improvement was seen faster in RFP group than in non-RFP group.
If RFP is bactericidal against tubercle bacilli, the improvement of chest radiogram is not concerned with the prognosis of pulmonary tuberculosis, as there will be no bacterial relapse. But RFP has not yet been proved to be bactericidal. Accordingly, the improvement of radiogram correlates with the improvement of chronic pulmonary tuberculosis, as radiographic improvement is parallel to the improvement of pathological processes. Based on the above findings, a marked shortening of the duration of chemotherapy in chronic pulmonary tuberculosis could not be expected, even though a regimen including RFP might be a stronger regimen than the standard combination of SM·EPAS·EINH.

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Proportions and absolute numbers of T and B lymphocytes enumerated by spontaneous rosettening with sheep erythrocytes and the presence of surface immunoglobulin and complement receptors were determined among 63 patients with pulmonary tuberculosis. The results were as follows:
1. Both proportions and absolute numbers of T lymphocyte showed a decrease in the cases with C, B and F types of GAKKEN classificasion but that of B lymphocytes showed a increase in the cases with C and D types and a same levels in the cases with B and F types compared with control subjects except F type in which it showed a decrease.
2. Both proportions and absolute numbers of T and B lymphocytes showed a decrease in the cases with cavities compared without cavities.
3. Proportions of T lymphocytes showed a same levels in the cases in which tubercle bacilli were detected as compared to the cases without those.
4. Both proportions and absolute numbers of T, B lymphocytes shows a marked decrease in the cases with so-called “Schub”.
5. Proportions and absolute numbers of both T and B lymphocytes showed a marked decrease in the cases with the negative record in tuberculin reaction as compared to the positive record.

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Open-negative' cavities in the lung usually are the results of chemotherapy. The cavities once excreted tubercle bacilli and thereafter ceased to excrete the bacilli after chemotherapy with antituberculous agents are usually called open-negative cavities. In contrast to these, there are cavities of another type which do not show acid-fast organism from the beginning of observation. The author experienced 4 cases of this type (open-negative cavity) to due infection with atypical mycobacteria.
Three patients, a 16 year-old male, a 39 year-old female and a 28 year-old male, did not show acid-fast organism in their sputum for 5 months, 11 months and 23 months, respectively, by monthly (or more) sputum examinations. The patients received lung resection. From the cavities resected (right lower lobe, left upper lobe and left upper lobe, respectively), Mycobacterium intracellulare (the former two cases) and Mycobacterium chelonei subsp. chelonei (the third case) were isolated.
Another patient, a 67 year-old female, did not show acid-fast organism by monthly examinations for 4 years, and thereafter the patient began to discharge M. intracellulare in the sputum. After the first appearance of the organism, the organism was isolated 9 times by monthly examinations in 2 years. The amount of the organism on isolation medium varied from 3 to a few hundred colonies. A thin-walled cavity with slight pericavitary lesions was observed in left upper lobe of the patient from the beginning of observation. The X-ray picture did not show any significant change during 6 years of the observation period.
All four patients showed a solitary, thin-walled cavity without or, if any, with only slight pericavitary lesions. No significant drainage bronchus was observed on the X-ray picture, except for the fourth patient. Chemotherapy with antituberculous agents did not modify the X-ray picture.
The reason why the organisms were not found in the sputum is considered as follows; thin walled cavities contain a little amount of acid-fast organisms, and only a few amount of the organisms are excreted into sputum, and they are escaped from routine sputum examinations.
In conclusion, thin-walled cavities due to infection with atypical mycobacteria may appear as open-negative cavities.

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A study was made on originally treated cases of pulmonary tuberculosis found in middle Kyushu area during the period from 1972 to 1974 to know the disease status when they were newly detected creasing in the occurrence of it in the area of Kyushu was and to analyze causes of high prevalence of tuberculosis in the above area. The results were as follows:
1. A total number of patients with pulmonary tuberculosis hospitalized at our 10 affiliated Hospitals in Kumamoto, Oita and Miyazaki prefectures for the above three years were 1423, and among them, the originally treated patients were 387 (27%).
2. As the results of investigation on these 387 cases, it was found that the ratio of male to female was 2: 1 and the peak in age distribution were from 21 to 30 years and 60 years and over. The peak in young adult was peculiar to this area.
3. The characteristic findings on chest X-ray in these cases were fresh in nature and extensive lesions. Positive rate of tubercle bacilli in sputum was 47.2% in these cases.
4. The occurrence of two pulmonary tuberculosis cases within the same family was observed in 17.6%, which was considered as being high.
5. 104 (26.9%) cases had been spending normal daily life without any complaints when they were diagnosed. Among them, 29 (25%) patients were positive for in whose sputum tubercule bacilli in their sputum, and they might be an infection source.
6. There are many people in Kyushu who came back to their home town after getting pulmonary tuberculosis at their working place out of Kyushu. It was found out in this investigation that 50 (12.9%) cases in the originally treated cases belonged to the above category. This tendency has been increasing year by year.
7. We would like to emphasize the flexible attitude in the choice of regimens used in the original treatment of pulmonary tuberculosis.

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Risk of developing miliary tuberculosis is increased in a variety of disorders in which host defence mechanisms are impaired. We are presenting four cases of miliary tuberculosis which developed during dialysis therapy for chronic renal failure.
The patients' age ranged from 34 to 59 years. None of them received corticosteroids or immunosuppressive therapy during their hospital treatment. These four patients had been treated at different time and different hospitals except cases 2 and 3. A previous histry of tuberculosis was recorded only in case 2. The clinical symptoms of these cases were fever of unknown origin, and cough and sputum during the period of dialysis therapy. Fever was the most frequently observed sign, which raised to 37-39°C after the dialysis or in the evening. The intermittent fever persisted without response to various antibiotics including CER, CEZ, TC, PC, etc. Two of them complained headache and became comatose in the final stage. Miliary lesions were not visible on the chest radiograms, even just before the time of death. The infiltrative shadows in S6 and pleural effusion were found in some cases temporarily on the chest radiograms during the clinical course. The duration of fever ranged from one month to 3 years. In case 2, the smear examination of sputum for acid-fast bacilli was negative, but positive culture was obtained one month after the death of patient. In case 3, one colony of acid-fast bacilli was cultured from the pleural effusion which disappeared without any antituberculous treatment. The serum BUN and creatinine levels were well controlled by the dialysis therapy in these four cases. The diagnosis of miliary tuberculosis were finally obtained by postmortem examination in all cases.
The tuberculine skin test was not performed in these patients. It is well established that chronic uremia may influence certain immunological reactions and depress tuberculin skin test. This experience suggests that patients under dialysis therapy have a greater risk of developing miliary tuberculosis, and if fever of unknown origin is observed or tuberculosis is suspected, the prompt institution of antituberculous therapy including prophylactic ones is requested.

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