The results of a one-year anti-tuberculosis campaign in Nepal between October 1976 and September 1977 were analyzed in relation to the difference in the efficiency of efforts between the plains area and the hilly area.
Three representative districts in each of the plains and hilly areas were selected. The door to-door visit method was used in these areas, and the BCG vaccinators here were able to visit every house to give BCG vaccination and detect evident cases of pulmonary tuberculosis. They also inquired about the family composition (registered population) and collected sputum specimens from people with suspicious chest symptom among family members 15 years of age and over residing at home (contacted population).
The results were summarized as follows;
1) The ratio of the number of persons with whom the BCG vaccinators actually contacted for interview when they visited their house (the contacted population) to the total population was as follows;
in all-age groups, 39% in the plains area, and 50% in the hilly area, and the average was 45%. Hilly area>Plains area (p<0.001). in adults of 15 years of age and over, 34% in the plains area, and 41% in the hilly area, and the average was 38%. Hilly area>Plains area (p<0.001). in children under 15 years of age, 47% in the plains area, and 64% in the hilly area, and the average was 55%. Hilly area>Plains area (p<0.001).
2) The ratio of the contacted population to the number of persons who were confirmed by the BCG vaccinators and registered through the interview (registered population) was as follows;
in all-age groups, 64% in the plains area, and 56% in the hilly area, and the average was 59%. Plains area>Hilly area (p<0.001).
in adults 15 years of age and over, 55% in the plains area, and 47% in the hilly area, and the average was 50%. Plains area>Hilly area (p<0.001).
in children under 15 years of age, 78% in the plains area, and 69% in the hilly area, and the average was 73%. Plains area>Hilly area (p<0.001).
3) Paragraphs (1) and (2) above clearly show that the ratio of contacted population to registered population is higher in the plains area than in the hilly area, though the ratio of the number of persons with whom the BCG vaccinators were actually able to contact to the total population (contacted population/total population), in other words, the efficiency of the initial stage of the door-to-door visit method of anti-tuberculosis campaign in which patients are detected and cured, is higher in the hilly area than in the plains area.
This results from the fact that the number of unregistered families and family members was greater in the plains area than in the hilly area.
4) The ratio of the number of symptomatic cases to the size of the contacted population of 15 years of age and over was 3. 8% in the plains area, and 5. 5% in the hilly area, and the average was 4. 7%. Hilly area>Plains area (p<0.001).
5) The sputum smear positive rate among the contacted population of 15 years of age and over was 0.15% in the plains area, and 0.22% in the hilly area, and the average was 0.19%. Hilly area>Plains area (p<0.001).
6) The sputum smear positive rate among the symptomatic cases was 3.98% in the plains area, and 3.99% in the hilly area, and the average was 3.98%.
Since the sputum smear positive rate among the symptomatic cases was similar in the plains and hilly areas (p>0.9) in spite of the fact that the ratio of symptomatics and sputum smear positives to the contacted population of 15 years of age and over was higher in the hilly area than in the plains area as shown in paragraphs (4) and (5) above, it appears that the sensitivity of symptomatic case-finding method is constant.

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Mycobacterium nonchromogenicum, M. terrae and M. triviale are regarded as nonpathogens belonging belonging to the Group III of Runyon. Several authors have reported that these be differentiable from each other, while it is also true that these resemble each other and form a complex, M. nonchromogenicum complexi. Recently, several papers appeared, informing that these organisms caused infections in human. It is noteworthy that there are papers reporting that all these three have caused arthritisl. It is desired to detect a simple method for identifying and differentiating these organisms from other slowly growing mycobacteria.
Previously, Tsukamura and Tsukamura reported that M. nonchromogenicum and M. terrae could grow on a modified Sauton agar medium containing 0. 1% NaNO₂ after incubation for 4 weeks, and Abbott et al. reported that M. terrae and M. triviale grew on oleic acid-albumin agar medium containing nitrite. However, there were a considerable number of strains that did not grow on these media.
In the present study, the present authors have presented a selective medium for the M. nonchromogenicum complex. It is an Ogawa egg medium containing 0.2% NaNO₂. The nitrite Ogawa egg medium and the Ogawa egg medium (control) were inoculated with one loopful of test organisms, and growth on these media were observed after incubation at 37°C for 2 weeks. It has been shown that all strains tested belonging to the M. nonchromogenicum complex grew on the nitrite-Ogawa egg medium, while other slowly growing mycobacteria did not grow on it (Table 1).

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Morphological examinations of drug resistant colonies of mycobacterium tuberculosis were performed with the scanning electron microscope (SEM).
Three strains (246, 55 & 69) of M. tuberculosis isolated from three patients were subjected to the study. The drug resistant colonies of these strains of M. tuberculosis, in vitro, were obtained either 1) through a series of subcultures on a gradually increased concentration of drugs, or 2) treatment with N-methyl-N'-nitro-N-nitrosoguanidine (NG). By thesemethodss, colonies grown on egg-medium (Ogawa) monoresistant to either of Streptomycin (1, 000μg/ml), Kanamycin (1, 000μg/ml), Para-aminosalicylic acid (100μg/ml) or Isoniazid (50μg/ml) were obtained, and they were abbreviated as SM1000-R, KM1000-R, PASloo-RR and INHso-RR. These single-drug resistant colonies were all rough in appearance on the egg-medium. Three-drug-resistant colonies, (SM-PAS-INH) lo-RR, were obtained by the same method mentioned-above.
The surface of these drug resistant colonies of tubercule bacilli were observed with the SEM and it differed from the colonies of each parent sensitive strain in morphological features. The surface of the drug resistant colonies were more sticky than their parent strains; the filaments and granules were more prevalent in the drug resistant colonies. Occasionally, these drug resistant colonies were trapped with a net-like substance over the surface of the colonies. The morphologi cal changes related to the kind of drugs, i. e., KMiooo-RR colonies showed most marked changes, next PASloo-RR and INHso-RR, and least SMiooo-RR colonies. A slight difference was found between monodrug resistant strains obtained by methods No.1 and 2. The surface of the (SM PAS-INH) lo-RR colonies obtained by method No.1 showed some changes from the parent colo nies, while those obtained by method No.2 showed marked variation.
It seems that these morphological changes of in vitro produced drug-resistant M. tuberculosis related to the emergence of drug resistance.

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Both the macrophage migration inhibitory factor (MIF) and leucocyte migration inhibitory factor (LIF) in guinea pigs vaccinated (V) or vaccinated-challenged (VC) with heat-killed BCG were studied in relation to delayed type hypersensitivity, and the results were compared with that in normal guinea pigs (N).
Macrophage inhibitory capacity was determined by direct and indirect migration inhibition tests by J. R. David. Leucocyte inhibitory capacity was determined by direct and indirect migration inhibition tests by M. Søborg.
1) Three kinds of PPD concentrations (20, 40, 80μg/ml) were used in the culture media of lymphocytes obtained from sensitized animals (Fig. 2). The migration indices of MIF and LIF were determined at 24 hours (Figs 3 and 4). These conditions were established on the results of preliminary experiments.
2) The results of both the direct macrophage migration inhibition test and the direct leucocyte migration inhibition test showed remarkable migration inhibitory capacity not only in the V-group but also in the VC-group (Table 1, and Fig. 5).
3) MIF and LIF production of peripheral blood lymphocytes were tested by using the indirect migration inhibition test. Both productions were remarkable only in the V-group, and MIF productions were weak in the VC-group. LIF productions in the VC-group were not demon strable, because migration promoting factors accelerated the migration of target cells in the test involved (Table 2, and Fig. 6).
4) MIF and LIF productions were determined in the spleen cells and the inguinal lymphnode cells of the V-and VC-groups, and compared with the V-and VC-groups of blood lympho-cytes by using the indirect migration inhibition test. The results showed that remarkable MIF productions were seen in the lymph node cells of the V-group as well as in the peripheral blood lymphocytes. On the contrary, the spleen cells of the V-group did not produce MIF at all, although remarkable MIF productions were seen in the spleen cells of the VC-group. On the other hand, MIF productions of VC-lymphnode cells were as weak as the production of the VC-peripheral blood lymphocytes (Fig. 7). LIF production of spleen cells and inguinal lymph node cells were remarkable in the V-group as well as in the peripheral blood lymphocytes. However, LIF productions of all those cells in the VC-group were not shown, because the leucocyte migration was accelerated by unknown factors as in the results seen in VC-peripheral blood lymphocytes (Fig. 8).
5) Peripheral blood lymphocytes of the V-group incubated with anti-thymocyte serum reduced the productions of MIF and LIF. In addition, peripheral blood lymphocytes of the VC-group incubated with anti-thymocyte serum lost not only MIF producing capacity but also the producing capacity of migration promoting factors (Figs 9, and 10). These results suggest that MIF and LIF are mainly produced by T-lymphocytes and that the migration promoting factors are also produced by T-lymphocytes.
It was demonstrated that LIF plays an important role in delayed type hypersensitivity as does MIF. However, immunological behaviors of both lymphokines were somewhat different. This difference must be investigated in a future study concerning delayed type hypersensitivity.

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Three cases of pulmonary tuberculosis misdiagnosed as lung cancer were presented. All three cases had tuberculoma and satellite lesions, the latter resembling to metastatic tumor in regional lymphnode, and they were interpreted as T₁N₁M₀ on chest X-ray.
One of the main causes of misinterpretation was the location of the satellite lesions. Satellite lesions were found in the hilum on the P-A chest film, and their real location was S₆ in the first case and S3 in the second case. In the third case, main lesion was located in the lower lung field which was uncommon in tuberculosis with another neighbouring tuberculoma located near to the hilum.

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An autopsy case of acute tuberculous pneumonia and miliary tuberculosis in a 79-year-old man, was reported.
He was admitted to the hospital because of high fever and dyspnea. Chest X-ray films showed diffuse confluent air-space opacities throughout both lung fields with small nodular and ground-glass lesions.
Transbronchial lung biopsy of the right lower lobe was performed eight days after admission. The biopsy specimen was caseous granuloma with infiltrations of epithelioid cells and giant cells. Therefore, intensive anti-tuberculous chemotherapy with INH, RFP and SM, and tapering of predonisolone was started. Rapid tapering of corticosteroid gave rise to flare up of acute tuber culous pneumonia, and resulted in respiratory failure. The findings at autopsy were widely disseminated miliary tuberculosis, acute tuberculous pneumonia, interstitial pneumonitis, and multiple gastric ulcers.
The use of corticosteroid in tuberculosis was discussed.

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