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Volume 59, Issue 8
Displaying 1-4 of 4 articles from this issue
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Takuya KURASAWA, Mitsuru KAWAI, Fumiyuki KUZE, Michiyasu NAKANISHI, No ...1984 Volume 59 Issue 8 Pages 443-449
Published: August 15, 1984
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA total of eleven cases of tracheobronchial tuberculosis, 2 male and 9 female patients, were evaluated for their clinical features.
The main subjective symptoms at onset were severe paroxysmal cough and small amount of sputum, but as the disease progressed, more expectoration, fever and wheezing were noted. Although the chest roentgenograms at onset were almost normal in three patients, atelectasis became the most frequent finding on admission.
There were few abnormaliies in laboratory tests except for a high rate of positive sputum for tubercle bacilli, moderate acceleration of erythrocyte sedimentation rate, and positive PPD skin test.
The lesions observed during bronchoscopy were identified mainly in right and left main bronchi, followed by right and left upper lobe bronchi.
For correct diagnosis, careful evaluation of the air column of trachea and major bronchi in chest roentgenograms and search for tubercle bacilli were essential, and moreover, bronchoscopy was mandatory to differentiate tracheobronchial tuberculosis from bronchitis, pneumonia, bronchial asthma, lung cancer and the others.
The efficacy of antituberculous chemotherapy was good, and the rate of negative conversion of tubercle bacilli in tracheobronchial tuberculosis did not differ from that in pulmonary tuberculosis. But marked stenosis and/or total obstructions of proximal bronchi progressed during chemotherapy in some cases and remained after chemotherapy.
The ultimate course of the disease was thought to depend on location, extension, and depth of the lesion. Marked circumferential lesions at onset tended to lead to bronchial stenosis and/or total obstruction.View full abstractDownload PDF (1002K) -
Michio TSUKAMURA, Haruo TOYAMA1984 Volume 59 Issue 8 Pages 451-459
Published: August 15, 1984
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESS1. Effect of chemotherapy on the appearance of smear-positive and culture-negative acid-fast organisms (SPCN).
The rate of SPCN specimens was higher in hospitalized patients who were receiving antituberculous agents than in newly hospitalized patients before starting chemotherapy (Tablesl-3). The administration of chemotherapy is likely to produce more SPCN specimens, although single administration itself did not influence the rate of SPCN (Table 4).
2. Influence of the medium used for isolating acid-fast organisms.
When compared with the Ogawa egg medium, the use of “Tween egg medium” reduced the rate of SPCN specimens (Tables 2, 5 and 6).
3. Patients excreting SPCN organisms for a long time.
Out of 17 patients who showed 3 times or more the SPCN specimens, 6 were shown to excrete the SPCN organisms frequently and the other 11 showed the SPCN specimens only in the course of ‘complete’ negative conversion (Table 7). The mode of excretion of acid fast organisms in these 6 patients are shown in Table 8, and their background in Table 9. These patients showed positive cultures of Mycobacterium tuberculosis in the further long-term observation. One example is shown in Table 10.
From the results of the present study, the majority of SPCN organisms are considered as dead bacteria, although a part of them may be alive as seen from the fact that the rate of SPCN specimens has been decreased by an improvement of medium. The SPCN phenomenon appeared usually in the course of negative conversion, but, in a few cases, the phenomenon persisted. These patients showed, when observed for long time, positive cultures of M. tuberculosis. The continuous excretion of the SPCN specimens is interpreted as excretion of dead bacteria from a lesion where M. tuberculosis organisms are growing continuously but slowly.View full abstractDownload PDF (1222K) -
Kenji NAKAMURA, Kenji SAWAMURA, Akinori AKASHI, Akihiko ICHIMIYA, Taka ...1984 Volume 59 Issue 8 Pages 461-465
Published: August 15, 1984
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIncrease of complicated cases of chronic thoracic empyema such as the aged or those with impaired pulmonary function made it difficult to follow the same selection of the mode of surgical treatments in the established papers.
Since Jan. 1977 through Dec. 1981, we applied decortication on 12 patients, “Extraperiosteal Air Plombage” on 41, and fenestration with or without some additional procedure on 8 out of 61 patients with chronic thoracic empyema, in the National Kinki Central Hospital for Chest Diseases.
As the result, the success rate was 95%, and 82% were cured by an one-stage operation. Based on the result, a flow chart for selection of surgical procedures on chronic thoracic empyema is proposed.
In the flow chart, the selection is made by the following factors; glid lung (destroyed lung with multiple bronchopleural fistulae), active pulmonary inflammation, bronchopleural or pleurocutaneous fistula, results of thoracenthesis or drainage, presence and type of microorganism in the pleural space. The flow chart is useful not only in the selection of surgical procedures but also in clarifying the background factors relating to the severity of cases.View full abstractDownload PDF (634K) -
A comparative study between preoperative culture positive and negative casesTeruo AOYAGI, Hiroshi ANNO1984 Volume 59 Issue 8 Pages 467-474
Published: August 15, 1984
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIndication of surgical treatment for pulmonary tuberculosis in recent years has changed remarkably due to the development of initial intensive chemotherapy containing RFP, and it seems that more difficult cases to cure has increased because of the increase of preoperative sputum positive cases which are resistant case to potent drugs such as SM, INH and RFP. This study was carried out to clarify present status of surgical treatment for pulmonary tuberculosis and its results by preoperative culture findings of tubercle bacilli.
Study subjects were 968 cases of pulmonary tuberculosis in which culture findings of tubercle bacilli in sputum within two months prior to surgical treatment was available and surgical treatment was carried out in 53 institutions belonging to Tuberculosis Research Committee during the period of 6 years from 1976 to 1981.
Number of cases operated in 1976 was 251, and since then, it has decreased year by year and fell down to 113 in 1981.
Culture positive cavitary cases have increased year by year, while culture negative cavitary cases have decreased. Culture negative noncavitary cases have increased to some extent and about one thirds of them were operated because of suspicion of lung cancer.
Resistant cases to more than three drugs including RFP have also increased and reached 57% in 1981.
Cases with FEV1/VCpr “Index” less than 40 have decreased.
Observing the mode of operation, lobectomy occupied more than half of all operated cases in both culture positive and culture negative cases, followed by thoracoplasty and pneumonectomy in culture positive cases, and other resections excluding pneumonectomy and lobectomy in culture negative cases.
Observing the mode of operation employed showed that thoracoplasty and pneumonectomy decreased in 1980 but again increased in 1981, in culture positive cases, and pneumonectomy increased again in 1981 in culture negative cases. These changes suggest the increase of cases more difficult to treat.
The results of surgical treatment were as follows: In culture positive cases, success was 84.6%, negative bacilli 87.9%, positive bacilli 9.3%, death 2.8% and postoperative complica tions 11.1%. In culture negative cases, success was 96.8%, negative bacilli 98.6%, positive bacilli 1.1%, death 0.3% and postoperative complications 1.4%. These results were better than those obtained during the period of 6 years from 1963 to 1968.
Observing annual trend of the results, it was best in 1979 in culture positive cases, and the results such as the rates of success and negative bacilli have dropped and those of positive bacilli and complications have elevated gradually in 1980 and 1981. In culture negative cases, the best result was obtained in 1980 and it dropped in 1981.View full abstractDownload PDF (1143K)
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