The purpose of the study is to quantify the direct effect of the MMR under the present Japanese medical service. A mathematical model was built which can generate the number of deaths among tuberculosis patient's cohort under situations with different degrees of case-finding service, and the number of relapses and progressions from cases of less severe type to more developed one. The model is of deterministic type and consists of six states of tuberculosis population each combined with parameters. The effect of the MMR computed with the model was then compared with the risk of cancer deaths due to radiophotographic radiations and with costs involved in the MMR procedure and treatment of the detected cases. It was found that the benefit of the MMR in terms of the lives saved (man-years) was rather small especially for young adults which is almost counter-balanced by the risk. Also it was remarkable that the present day MMR detects and leads to the treatment more cases of both infectious and non-infectious types than those which would be expected if all the MMR-examinees were only left to the routine clinical practice without MMR-service. The level of the routine clinical service is very influential on the above risk/benefit balance. It was also shown by calculation that the chances of infection under the situation without any MMR would not increase so much. The MMR made discriminately for general population especially for younger generations should be abolished and appropriate alternative control measures should be introduced and be strengthened.

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There are two types of cell populations which mediate the tuberculin hypersensitivity: sensi-tized T lymphocytes and non-specific accessory cells. The present study was undertaken to eluci-date the identity of cells which can transfer tuberculin hypersensitivity, those which produce the macrophage migration inhibitory factor (MIF), and those which produce the leucocyte migration inhibitory factor (LIF). In addition, it was studied that the relation between the MIF or LIF producibilities of transferred sensitized cells and the composition of infiltrating cells in the skin reaction site in normal (non-irradiated) or irradiated (800 rad) recipients.
The results were as follows:
1. The ability of tuberculin-type hypersensitivity (TTH) transfer, MIF production and LIF production were equally prominent in the regional lymph node cells of guinea pigs vaccinated (V group) with heat-killed BCG.
2. The ability of TTH transfer and LIF production were prominent, but MIF production was not detected in the spleen cells of the V group.
3. The ability of TTH transfer and MIF production was detected in the regional lymph node cells of guinea pigs vaccinated and challenged (VC group) with heat-killed BCG, but that ability was weaker than that of regional lymph node cells of the V group. Leucocyte migration stimula-ting activity was observed in the regional lymph node cells of the VC group, but LIF production was not seen there.
4. The ability of TTH transfer was most dominant in the spleen cells of the VC group. MIF production was also detected in the spleen cells, and was equal to that of the regional lymph node cells of the VC group. Leucocyte migration stimulating activity, but not LIF production, was observed in the spleen cells of the VC group, as was the case in the regional lymph node cells of the VC group.
5. In the skin lesions of the PPD test on, normal or ⁶⁰Co-irradiated (800 rad) recipients, the number of infiltrating non-specific accessory cells, i. e., mononuclear cells or polymorphonuclear leucocytes, was not histopathologically parallel with the MIF or LIF producibilities of transferred sensitized regional lymph node cells or spleen cells of the V group.
6. The PPD-skin lesions of ⁶⁰Co-irradiated (800 rad) recipients were macroscopically more prominent than those of normal (non-irradiated) recipients transferred with sensitized regional lymph node cells or with spleen cells of the V group. However, the total number of infiltrating cells in the skin lesions of irradiated recipients decreased to about half of the number in those of normal (non-irradiated) recipients.
It was concluded that the ability of TTH transfer in vivo and the ability of MIF production in vitro are not always parallel, and that the ability of TTH transfer in vivo is parallel with the ability of each of LIF or leucocyte migration stimulating factor production in vitro, and that the total number of infiltrating cells in skin reaction site was not always correlated with the size of the skin reaction, but the number of infiltrating cells in the skin reaction site was strongly con-trolled by the total number of mobile cells in each animals.

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Mice were infected intravenously with Mycobacterium tuberculosis, and all the mice were observed without any treatment for one week to ensure the formation of suitable chronic lesions.
As the anti-tuberculous drugs, isoniazid (INH), rifampicin (RFP), ethambutol (EB), and pyra-zinamide (PZA) were employed in this experiment.
The mice were divided into five groups according to the regimen of chemotherapy. The first group was treated with INH·RFP·EB, the second one with INH·RFP·PZA, the third one with INH·PZA, the fouth one with INH alone and the fifth one remained untreated as the control.
After giving chemotherapy for eight weeks, viable count of tubercle bacilli recovered from the lungs and spleens of the treated mice were recorded and compared with those of the untreated mice. It was confirmed that the chemotherapy with the combination of INH·RFP·EB or INH·RFP·PZA was more effective than that with INH alone or INH·PZA. Although the population of tubercle bacilli recovered from the lungs and spleens of the treated mice has been reduced significantly, tubercle bacilli could not been eradicated by the doses and period of chemotherapy used in this experiment. Number of bacilli in bacteriologically relapsed cases especially treated by regimens containing RFP was smaller than the untreated control. The sensitivity test revealed no emergence of drug resistance to INH, RFP and EB.

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From Jan. 1951 to Dec. 1970 eighty-three patients with pulmonary tuberculosis underwent pneumonectomy at the Seirei Hospital. By analysing bacteriologic and histopathologic findings of the resected specimen and post-operative course, operative indication of these cases was retrospecti-vely examined.
In 1963 the author proposed a criterion of surgical curability. Scores were given on unfavourable factors for the success of surgery according to its grade: namely, 5 points for %VC less than 30 (I''), 4 points for %VC 30 to 40 (I'), 3 points for %VC 40 to 50 (I), 2 points for sputum positive with or without drug resistance (b), one point for bi-lateral operation (II) combined with “b” plus extensive lesions with solitary cavity larger than 5 cm in diameter or multiple cavities (c), or low pulmonary function plus “b” or “I bc”, one point for “c” combined with I II or II b, and one point for re-operation (a) combined with “b” or “bc”. According to the total sum of given scores, the author classified the surgical curability as follows: Grade-0 (0 point), Grade-1 (1 or 2 points), Grade-2 (3 or 4 points), Grade-3 (5 to 7 points) and Grade-4 (8 or 9 points).
Death during hospitalization was observed in 7 patients. The causes of immediate death in one case of Grade-1 was bleeding and one another case of Grade-3 was anaesthetic accident. Early death in 2 cases of Grade-3 and one case of Grade-4, and late death in 2 cases of Grade-3 were all due to cor pulmonale. These 5 cases were judged as contraindication for pneumonectomy.
The remaining 76 cases converted to negative and were discharged from the hospital, and only one case of Grade-3 died from haemoptoe 3 years later due to progression of the disease. During several years after discharge, non-tuberculous death occured in 12 cases, 9 cases died from cardiopulmonary insufficiency and 3 from pneumonia within 2.5 to 21 (average 8.6) years after the operation. Two died from suicide, one each from cancer, aortic aneurysm and traffic accident, and 2 from unknown cause. Questionnaires of 8 patients were not yet obtained.
Forty-eight cases were ascertained to be alive and healthy. Dividing by the grade, 10 out of 17 in Grade-0, 7 out of 11 in Grade-1, 17 out of 23 in Grade-2, 13 out of 28 in Grade-3 and one out of 4 in Grade-4. Average %VC of these cases at the time of discharge was 56. 05±13. 13 in Grade-0, 41.42±11.41in Grade-1, 47.30±4. 05 in Grade-2, and 39. 50±3.86 in Grade-3 and 4.
Analysing restrospectively, 13 cases were judged as no need of operation, 7 as curable by lo-bectomy and 5 as contra-indication for pneumonectomy. From the present day view of surgical indication in the Rifampicin-era, almost all cases except 3 cases of destroyed lung with haemoptoe and 10 cases of empyema with or without bronchial fistulae, may be considered to be controlled successfully by chemotherapy alone and, therefore, no need of any surgical procedure.
Although empyema with positive sputum and pleural fluid, associated with destroyed lung and bronchial fistulae, may be justified as the absolute indication for pneumonectomy, however, the operation should not be done for those with pulmonary hypo-function, unless uni-lateral pulmonary artery occulusion test is successful. Nevertheless, primary pneumonectomy in those cases is often so dangerous that it is recommended initially to evacuate pleural contents by means of open drainage for the purpose of preventing aspiration to the opposite lung, and to pack gauze permeating the suspension of Rifampicin and Etambutol, each 300mg in 100ml of 15% alcohol, in the pleural space. Such preliminary treatment is very useful in controlling the disease process.

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A 41-year-old female was admitted to our hospital on Dec. 13, 1980 with chief complaints of cough and fever. The Mantoux reaction was strongly positive, but the examinations of sputa and gastric juice failed to reveal any tubercle bacilli.
On fiberoptic bronchoscopy three ulcers were observed along the right wall of the trachea covered with white necrotic mass, and the some white necrotic masses were observed along the front wall of the right main bronchus continuing to the orifice of the right middle lobe bronchus. Brushing of white necrotic masses revealed acid fast bacilli on smear, and later confirmed by culture as M. tuberculosis.
Since one month before admission she had an inhalation therapy of corticosteroid against cough and sore throat, but her cough became more frequent and her body temperature went up.
Above results and her clinical history may suggest that tracheo-bronchial tuberculosis was induced by the inhalation therapy of corticosteroid.

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It has been well noticed that a transient aggravation is observed during chemotherapy for tuberculosis, especially in patients who were treated with rifampicin (RFP). A 34 years old man with pulmonary and renal tuberculosis was treated with combined regimen composed of RFP, isoniazid, and streptomycin. Seven weeks after the initiation of chemotherapy, left pleural effusion and right paratracheal lymph nodes enlargement appeared. Because of negative findings of sputum for tubercle bacilli, we continued the same regimen. As a result, chest X-ray film revealed the improvement of pleural effusion and enlarged paratracheal lymphnodes. These findings suggest that the aggravation observed was not true one and they were a transient one.
In conclusion, tuberculosis with a transient aggravation shoud be treated with the same regimen including RFP if tubercle bacilli are negative on culture.

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