Effective methods for preserving mycobacterial strains were studied. The results are shown in Tables 1, 2 and 3.
1) A simple method of storing cultures, which grew on Ogawa egg medium slants, is to keepthem in a freezer at -20°C. The method succeeded to maintain the viability of bacteria for morethan one year (Table 1).
2) By storing bacteria suspended in a 1% glycerol solution, 1% sodium glutamate solution, or10% glucose solution in a freezer at -20°C the viability was maintained for at least one year. Storage in a phosphate buffer solution and in distilled water were inferior to the above methods (Table 2).
3) By storing lyophilized cultures in a freezer at -20°C, the viability was maintained for at leasttwo years. As a medium used in lyophilization, distilled water was more suitable than a 1% glycerolsolution. Storage of lyophilized samples at room temperature caused loss of the viability after onemonth (Table 3).
While storing cultures in a freezer, Ogawa egg medium slants or tubes containing bacterialsuspension were directly placed into a freezer. The ampules containing bacterial suspension wereimmersed individually into an ethanol-dry-ice mixture (-15°C) and then dried at -30°C.
The first method is the simplest, but the tubes occupy a lot of space in the freezer. Thesecond method is suitable for preservation of a large number of strains, as the method does notoccupy a large space in the freezer. The third method needs some explanation. We did not putSilica Gel in the ampules. Under such condition, we could probably provide a better conditionfor drying, when we used distilled water as a suspension medium than using a 1% glycerolsolution.

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Two hundred cases over a 8-year period who had surgically cervical lymphnode biopsies werestudied for the aim of clinicopathological investigations of cervical lymphadenopathy. Observingby the age group, the youngest was 10 and the oldest was 86 years of age, and the greatest number ofcases were in the age group 20 to 40 years. Patients who showed also the intrapulmonary lesions were140 (70%). Of 200 biopsied cases, 59 (29.5%) were diagnosed as metastatic changes of bronchogeniccarcinoma, 32 (16%) as sarcoidosis, 20 (10%) as tuberculous lymphadenitis, 9 (4.5%) as malignantlymphoma, 7 (3.5%) as necrotizing lymphadenitis and 52 (26%) as non-specific lymphadenitis. Piringer's lymphadenitis (toxoplasmic lymphnode infection) was seen in one case.
Most of the patients with necrotizing lymphadenitis were female in the age from 20 to 40. Common symptoms were pain or tenderness at the region of lymphnode swelling which were not seen inthe patients with non-specific lymphadenitis. Before the biopsy four patients were misdiagnosed astuberculous lumphadenitis, two of them were treated with anti-tuberculous drugs and one with steroid.
Of 20 patients with cervical tuberculous lymphadenitis, 11 were female and the majority werein the age groups 20 to 39. About half of them showed no intra-pulmonary lesions and congromeratednode formation. For the differential diagnosis of lymphadenopathy, the lymphnode biopsy is necessaryespecially in the early phase of lymphnode swelling which was suspicious of tuberculous.

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Uremia is a state with diminished immunological responsiveness. For the purpose of evaluatingthe vulnerability of uremic patients to pulmonary tuberculosis, an epidemiological study was done.The subjects were 2034 dialysis patients in 1976 and 2403 dialysis patients in 1977. Among them 42males and 21 females suffered from pulmonary tuberculosis.
Prevalence, incidence, mean duration of the disease, mortality and fatality of pulmonary tuberculosis in the dialysis patients were 1242/10⁵, persons·year, 932/10⁵, 1.3 year, 155/10⁵ and 17% in maleand 1072/10⁵, 804/10⁵, 1.3 year, 0/10⁵ and 0% in female, respectively. The prevalence, incidence, mortality and fatality were 1.9, 6.4, 9.7 and 1.5 times higher in male dialysis patients than those in thegeneral population, respectively. The prevalence and incidence were 3.5 and 12.4 times higher infemale dialysis patients than those in the general population. The mean duration of the disease wasshorter in dialysis patients: 28% in both sexes of those in the general population.
Pulmonary tuberculosis occupied 67% in male and 44% in female of all tuberculosis amongdialysis patients on June 30, 1976, whereas it was 96% in male and 90% in female among the generalpopulation. Pulmonary tuberculosis occupied 63% in male and 35% in female of all tuberculosisdeveloped during 1976 among the dialysis patients in contrast to 93% in male and 82% in femaleamong the general population. Pulmonary tuberculosis occupied 50% in male and 0% in femaleof all deaths from tuberculosis among dialysis patients, which were much lower than 97% in maleand 91 % in female among the general population.
Prevalence, incidence, mean duration of the disease, mortality and fatality of tuberculosis withsolely pulmonary lesions were 932/10⁵, 854/10⁵, 1.1 year, 155/10⁵ and 18% in male and 402/10⁵, 670/10⁵, 0.6 year, 0/10⁵ and 0% in female, respectively among dialysis patients.
Tuberculosis with solely pulmonary lesions occupied 50% in male and 17% in female of all tuberculosis among dialysis patients on June 30, 1976. This type of tuberculosis occupied 58% in maleand 29% in female of all tuberculosis developed during 1976 among the dialysis patients. This typeof tuberculosis occupied 50% in male and 0% in female of all deaths from tuberculosis among dialysis patients.
Thus, for the first time, a very high vulnerability of pulmonary tuberculosis and the shorter courseof the disease among dialysis patients were proved epidemiologically. Furthermore, the present studydemonstrated a relatively low frequency of pulmonary tuberculosis among all tuberculosis amongdialysis patients in comparison with that among the general population.

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Eighty four pulmonary tuberculosis patients who were admitted to the National Tokyo Chest Hospital and were treated originally by daily administration of INH, RFP and PZA between June1979 and July 1980 were subjected to the study. PZA were given in 35 cases for 2 months and in 49patients for 6 months. PZA dosage was 1.5 gram for patients weighing 45 kilogram and over.
1) Serum uric acid level: All the patients who received PZA showed the increased serum uricacid level, and in 75 patients (90%) the increase was two times of the value before treatment. Patientsshowing uric acid level more than 10 mg/dl were 30 (85.7%) out of 35 patients who received daily 2months PZA and 30 (62.5%) out of 48 patients who received daily 6 months PZA.
2) Arthralgia: Arthralgia was observed in 5 (14.3%) out of 35 patients who received daily 2months PZA and in 11 (22.4%) out of 49 patients who received daily 6 months PZA.
Soon after stopping PZA, serum uric acid level returned to normal and arthralgia disappearedand the re-administration of PZA was possible without or with slight arthralgia. Arthralgia inducedby PZA was related to daily drug dosage and duration of PZA administration, but not to serum uricacid level. The author would like to emphasize: “Do not stop PZA because of hyperuricemia andarthralgia!”

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A 38-year-old male with sputum positive for tubercle bacilli who had a history of administrationof anti-tuberculous drugs was found in a furniture company in Okayama city. The routine chest X-ray examinations in twenty-eight employees of the company has been done twice a year after thediscovery of this patient. As the result of the study, the other four male and two female patients whoseages ranged from twenty to thirty-two, were found during the follow-up of twenty-nine months. Fiveout of six patients were discovered by the routine X-ray examinations without symptoms, and onlyone was symptomatic. In the family of the index case, his wife and mother developed pulmonarytuberculosis, and the PPD skin tests of his children were found to be strongly positive.
Studies on the relationship between the index case and the other six cases suggest the following;
1) The tuberculosis epidemic may occur even in adult, when they have close contact with apatient who discharges a large amount of tubercle bacilli.
2) The detection of positive conversion of the PPD skin test is very useful to investigate the tuberculosis epidemic, however its use is limited due to high coverage of BCG vaccination in children andyoung adult.
3) The identification of the drug resistant pattern of tubercle bacilli is also important in studying the epidemic, but in the present epidemic only two out of seven cases were positive on culture. Thepattern in two strains was similar with each other.
4) The time interval from the contact with the index case to the onset of tuberculosis is distributed in a long period of term in contrast to the other infections diseases epidemic.

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This is a report of 4 cases, considered as caused by exogenous reinfection. They were all females, over 48 years old, and had never been treated or treated only for a few days. Bacilli isolated initiallyfrom these patients were sensitive to 8-10 drugs, but when relapse occurred bacillis became resistanteven to the drugs which had never been used before.
In the 1st case, the change in drug resistance pattern took place between 3rd and 6th month fromthe start of chemotherapy, when the bacilli were still scarcely positive. In the other 3 cases, relapsewas found 1-21 months after the completion of their chemotherapy.
The infection source of drug resistant bacilli was not clear for the 1st and 2nd cases. It was suspected, however, that the 3rd case was probably infected from the 2nd case, and the 4th case from the3rd case, because their drug resistant pattern was quite similar, and the relapse of each case occurredapproximately the same period after they shared the same room.
The prognosis of these cases were as follows: Case 1 had finally a favourable result with cavityclosure and bacilli conversion in spite of all the ineffective chemotherapy after relapse. Case 2 is stillalive, 2 years and 10 months after relapse, though her general condition is quite poor, discharginglarge amount of bacilli with extensive bilateral lung lesions. In cases 3 and 4, their initial 6 monthschemotherapy was very effective but relapse had occurred. All the drugs were ineffective and diedwithin 12 and 4 months, respectively.
Case 3 had been treated by predonin for scleroderma over 2 years before the onset of pulmonarytuberculosis. This predonin therapy was continued until her death and in her clinical course a goodresponse to the 1st chemotherapy was seen until the occurrence of relapse. In her case, it is suspectedthat she had some immune depression, but no special investigations about this purpose were done.Only the number of lymphocyte was found to be slightly decreased. According to the findings at autopsy, almost all the lesions were exsudative in their character, necrotic with numerous acid fast bacilliand no tendency of granulom formation. These findings might be a proof of the presence of immune depression.
Primary and secondary complex could not be found anywhere, although intensive and exhaustiveinvestigations including X-ray photography of the sliced lung were done. In the sinusoid of the hilarlymphnode, agromelation of histiocyte which showed the tendency of necrosis with quite a few acidfast bacilli was found, however, no caseous change or granulom formation was visible there. Thisfinding could not be the direct proof of the exogenous reinfection.
Onset of pulmonary tuberculcsis caused by exogenous reinfection is thought to be very rare inJapan, except in such special cases as laboratory workers dealing with tubercle bacilli or the immunedepressed patients under haemodialysis, steroid treatment or complicated with some kind of diseases.Old patients could be included in this category, however, the more detailed essential conditions causingthe exogenous reinfection are not yet fully clarified.

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