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Volume 58, Issue 2
Displaying 1-6 of 6 articles from this issue
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[in Japanese]1983 Volume 58 Issue 2 Pages 53-60
Published: 1983
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (1410K) -
Kazuchikao KIDO, Kenichi TOHYAMA, Masato IKEDA1983 Volume 58 Issue 2 Pages 61-66
Published: 1983
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculin sensitivity of school children aged 6 and 13 in Kyushu district was investigated in relation to the time of BCG revaccination. The number tested by tuberculin at 6 years of age was 13, 703 in whole Kyushu district excluding Okinawa and 16, 378 in Okinawa, and the number of tuberculin tested children aged 13 was 14, 481 and 15, 634, respectively.
The tuberculin sensitivity of school children in Okinawa where BCG vaccination had never been carried out for pre-school children showed an exponential distribution (L-shaped distribution). Tuber culin sensitivity of children aged 6 in other Kyushu district showed a distribution pattern similar to that of Okinawa, though approximately 60% of them were BCG vaccinated below 4 years of age. The fact suggests that the tuberculin sensitivity among them was not influenced much by the previous first BCG vaccination, and the proportion of tuberculin positive reactors was rather small.
The tuberculin sensitivity of children aged 13 in Kyushu district showed normal distribution and the proportion of positive reactors was much higher. The fact suggests the influence of BCG vaccination at 6 years of age to the tuberculin sensitivity at 13 years.
Taking into consideration the above fact on post-vaccination tuberculin sensitivity and the fact that the risk of infection increases in puberty, we came to the conclusion that the first BCG vaccination should be done in earlier period after birth, preferably within 1 year after birth and latest at the age of 1, and the second vaccination at 13 years of age under the present tuberculosis situation in Japan.View full abstractDownload PDF (551K) -
8. Characteristics of Lymphnode TuberculosisHajime INAMOTO1983 Volume 58 Issue 2 Pages 67-71
Published: 1983
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDialysis patients have a high susceptibility to lymphnode tuberculosis. In order to clarify its features, an epidemiological study was done.
The subjects were 7, 274 dialysis patients including 150 cases complicated with tuberculosis. Among them 20 males and 20 females were lymphnode tuberculosis. They were between 20s and 60s of age with the maximal age distribution at 40s and 50s. Five males and 3 females died from it.
Tuberculous lymphadenitis located most frequently at cervical area, then at axillary, supraclavicular, inguinal area, etc.
The frequency of onset of lymphnode tuberculosis was the highest during the initial 3 months of dialysis therapy, then it tapered down with the duration of dialysis therapy, although it remained high. Thus dialysis and/or renal failure are proved to be significant predisposing factors to the development of lymphnode tuberculosis.
Twelve patients among 24 had a past history of tuberculosis. The episodes of tuberculosis oc curred 28.7 years ago in average. Fibrotic pulmonary tuberculosis was found in chest roentgenograms of additional 7 patients. It would be suggested that reactivation of tuberculosis play an important role for the development of lymphnode tuberculosis in dialysis patients.
Lymphnode swelling was the most common among the symptoms and signs that led to the diag nosis. Then it was followed by fever, especially fever irresponsive to usual antibiotics, fatigue, weak ness, etc. Lymphnode biopsy was useful for diagnosis in 25 cases. Tubercle bacilli were detected in 4 cases. Seven cases were diagnosed by autopsy.View full abstractDownload PDF (575K) -
Kazuhiko KAMEDA1983 Volume 58 Issue 2 Pages 73-80
Published: 1983
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThere are two key drug actions in short-course chemotherapy. One is bacteriostatic or bactericidal activity, that is, inhibiting or killing dividing bacilli. Most of the antituberculous drugs possess these activities. An other is sterilizing activity, that is, killing the so-called “persisters” which are scarcely metabolizing and much less dividing.
RFP has special abilities to eliminate “persisters”.Elimination of persisters is the most important key in relation to the relapse occurring after the completion of the short-course chemotherapy.
Relapse is defined as 2 or more positive cultures of tubercle bacilli each with more than 20 colonies found after the completion of treatment. Bacteriological relapse is divided into two types, one is early relapse, which occurs within 1 year after completing treatment, and the other is late relapse, which occurs 2-3 years or more after completing treatment.
It is very difficult to analyze clinically the factors relating to relapse after completing the chemotherapy because the rate of relapse after modern chemotherapy with regimens including RFP is very very low. Relapse is considered to occur in relation to the impairment of immunity.
General concept of relapse in tuberculosis and further important topics in relation to clinical diagnosis of relapse were discussed in this paper.View full abstractDownload PDF (1189K) -
[in Japanese]1983 Volume 58 Issue 2 Pages 81-86
Published: 1983
Released on J-STAGE: May 24, 2011
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Yoshio GYOTEN, Chiekoh KINO, Takashi TERAMATSU, Akira SATO, Kenichi NA ...1983 Volume 58 Issue 2 Pages 87-103
Published: 1983
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe are now facing the following three major problems in general health care of Japan; a rapid aging of the population, a flood of informations and revolutional advances in technology, and an introduction of financial considerations to the cost of medical care. In accordance with the rapid decline of mortality and prolongation of the average span of life, the proportion of persons aged 65 and more to the total population has been increasing rapidly. It was less than 5% in 1930 and increased to 7% in 1970, and by the year 2000, it is estimated to exceed 14%. It took 80 to 200 years in developed countries that the proportion of persons aged 65 years and more raised from 7% to 14%, while in the case of Japan, it will occur in about 30 years. Such a rapid increase of the aged population has never been experienced in any country of the world, and it directs the future medical care from “cure” of patients to “care” of patients.
A flood of informations brought out by computer and other revolutional advances in technology involved medical care, and there has been a woory that the good human relations between doctors and patients might be lost. Doctors have to notice now that the decision-making based on several informations is a responsibility of a doctor, and he should not be ruled by a computer.
Based on a concept that a life of human being is heavier than the weight of earth, the increas ing cost for medical care has been covered mainly by various health insurance schemes and partly by public funds. However, slow-down of the development of Japanese economy has made it difficult to meet with the rapid increase of the cost for medical care, and financial considerations have been introduced into the cost of medical care.
Future direction of tuberculosis programme must be discussed taking into account the above three major problems, and doctors have to make decision on the evaluation of real magnitude of tuberculosis problem and how much help we can give to the existing patients.View full abstractDownload PDF (2711K)
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