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60 巻, 4 号
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佐々木 昌子, 大泉 耕太郎, 佐藤 博, 渡辺 彰, 今野 淳1985 年 60 巻 4 号 p. 241-245
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーYearly changes in the number of patients excreting tubercle bacilli and the proportion of patients excreting drug-resistant tubercle bacilli from 1972 to 1982 were examined, and the clinical courses of drug-resistant tuberculosis cases in 1982 were examined.
The number of tuberculous patients excreting tubercle bacilli in these 11 years has decreased from 172 in 1972 to 121 in 1982, and the proportion of drug-resistant cases in 1982 (42.9%) was comparatively higher than that in 1972 (33.7%) or in 1977 (30.8%). The proportion of EB and RFP resistant cases in 1982 was significantly higher than in 1972 and 1977.
Out of 52 drug-resistant cases in 1982, 13 cases (25%) were newly diagnosed in the year, 8 cases (15.4%) were also diagnosed in the year with past history of tuberculosis and the remaining 31 (59.6%) were cases under treatment with antituberculous drugs. The proportion of RFP resistant cases was higher than that of cases resistant to other drugs. The drug-resistant cases newly diagnosed in 1982 including cases with past history of tuberculosis treatment were occupied mainly by single drug resistant cases (18/21; 85.7%) and the prognosis of these resistant cases was good in 19 cases. The drug-resistant cases under treatment with antituberculous drugs were occupied mainly by multiple drugs resistant cases (29/31; 93.5%), and the prognosis of these cases was not good in 28 cases. Four drug-resistant tuberculous patients under treatment died during the observation period. Most of patients showing good prognosis were treated with INH, EB, plus RFP or INH, EB, RFP plus aminoglycosides. The time required for negative conversion of drug-resistant tubercle bacilli was 3.8 months on the average, and it correlated with the amounts of pre-treatment bacilli discharge.
In the present study, therapeutical effects of newly diagnosed tuberculosis were very good, and no increase in the number of drug-resistant tuberculosis under treatment was observed. These facts suggest that increase of drug-resistant tuberculosis may most unlikely take place.抄録全体を表示PDF形式でダウンロード (608K) -
青柳 昭雄, 青木 正和, 芳賀 敏彦, 松宮 恒夫, 山口 智道1985 年 60 巻 4 号 p. 247-253
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーThe Research Committee for Tuberculosis, RYOKEN, conducted the cooperative study on the background factors of tuberculosis patients staying for long period in 55 hospitals or sanatoria belonging to the Committee.
First the duration of admission of pulmonary tuberculosis patients admitted in 55 institutions on June 30, 1981 was surveyed. (Part 1) Thereafter the background factors of patients staying for 3 years or more were studied. (Part 2)
The results in part 1 were summarized as follows:
1) The duration of stay of 7, 255 tuberculosis patients was less than 1 year in 65.2% and 3 years and longer in 18.6%.
2) The number of patients with positive tubercle bacilli was 467 (36.6%), and the factors related to bacilli positivity were surveyed. It was noted that the positivity was higher among cases with, far advanced lesions on X-Ray, with the duration of treatment for 5 to 10 years before admittance, 1.0-2 years with the use of RFP for 1 to 2 years and among cases in which spirometry was impossible due to impaired pulmonary function.
3) The results of sensitivity test of antituberculous drugs showed that 69% of tubercle bacilli isolated from these patients were completely resistant to RFP or INH.
4) 49.8% of these patients had respiratory complications, including empyema (10%), pulmonary emphysema (9.1%) and bronchial asthma (8.5%).
5) 43.0% of these patients had some complications other than respiratory disease, including cardiac diseases (7.8%), hypertension (7.3%), diabetes mellitus (7.5%) and liver diseases (4.6%).
6) 24.1% of cases had already been treated with surgical treatment, and among operated cases, the majority was occupied by thoracoplasty.
7) The extra-pulmonary tuberculosis was seen in 56 cases (4.4%) at the time of the survey, and most common disease was osteo-articular tuberculosis.抄録全体を表示PDF形式でダウンロード (770K) -
国療化研第26次B研究報告小西池 穣一, 児玉 長久, 森 隆1985 年 60 巻 4 号 p. 255-263
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーClinical studies on the actual condition and chemotherapy for extrapulmonary tuberculo sis in the 48 institutions of national sanatoria were carried out as the B series of 26th controlled study of chemotherapy during the past five years (1978-1982).
The number of extrapulmonary tuberculous patients during the above period was 1, 313 which corresponded to 3.09% of total admitted tuberculous patients in the same period.
Out of 741 cases in 39 institutions of national sanatoria, in which the clinical individual cards were available, 248 cases (31.3%) were tuberculous lymphadenitis.
Tuberculous lymphadenitis located most frequently at cervical area, then at hilar, axillar, mediastinal, inguinal and submandibular, etc.
Among 168 cases of tuberculous cervical lymphadenitis, 77 were male and 91 were female, and the average age was 36.7 years old and, 82 cases (48.8%) were complicated with pulmonary tuberculosis and 24 cases (14.3%) also with other extrapulmonary tuberculosis.
The therapeutic effects of the regimens including RFP and INH for tuberculous cervical lymphadenitis were observed.
Response to these treatment is evaluated as excellent with marked regression of the nodes for non-operative cases and the optimum duration of chemotherapy is considered to he about ten months.
Even in operated cases, a good response to chemotherapy was observed. Therefore, it is advisable to give effective therapy containing RFP, INH for about 2 to 3 months preoper atively and 6 to 8 months post operatively.
In cases complicated with pulmonary tuberculosis, however, the duration of chemother apy should be prolonged to some extent both in non-operated and operated cases, compared with cases without complication.
Fifty six cases (male 31, female 25) were hilar lymphnodes tuberculosis and the average age was 4.1 years old.
Chemotherapy containing RFP and INH was continued for 10.4 months in average in cases without complication of pulmonary tuberculosis and for 12.4 months in average in cases complicated with pulmonary tuberculosis.
The results of chemotherapy revealed marked improvement in the majority of cases.抄録全体を表示PDF形式でダウンロード (1101K) -
束村 道雄1985 年 60 巻 4 号 p. 265-275
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーNumerical classification of strains received as Mycobacterium nonchromogenicum, Mycobacterium terrae and Mycobacterium triviale (Table 1) was carried out, using 81 characters (Table 4) and matching coefficients. The dendrogram prepared by single linkage-clustering showed two “centroid clusters” (Fig. 1 and 2); one consisting of M. nonchromogenicum strains, including type strain NCTC 10424, and another of M. terrae and M. triviale strains, including type strains ATCC 15755 and ATCC 23292. The range of these clusters were determined by the method previously described (Tsukamura, M.: J. Gen. Microbiol., 95: 207-212, 1976) (Table 2), and strains placed outside the centroid clusters were tested whether they enter either or both of these ranges. By this method, 9 strains were identified as M. nonchromogenicum and 8 strains as M. terrae-M. triviale (Table 3). Thus, in total, 33 strains were classified to M. nonchromogenicum and 43 strains to M. terrae- M. triviale. These results well agreed with the results obtained by a M value matrix (Fig. 3). In conclusion, the majority of the strains tested were classified as either M. nonchromogenicum or M. terrae-M. triviale. The strains received as M. terrae or M. triviale formed one cluster and regarded as one taxonomic unit.
The characters of the M. nonchromogenicum and M. terrae-M. triviale thus classified are shown in Table 4. Among these characters, four characters shown in Table 5 were considered as highly useful for differentiating between M. nonchromogenicum and M. terrae-M. triviale. All M. nonchromogenicum strains showed positive reaction in three or more of these four characters, while all M. terrae-M. triviale strains, except for only one strain, showed negative reaction in three or more of these four (Table 6). M. nonchromogenicum strains are clearly differentiated from M. terrae-M. triviale strains by a combination of these four characters.抄録全体を表示PDF形式でダウンロード (1269K) -
宮地 純樹, 小須田 達夫, 日高 紀子, 滝沢 始, 久富 龍夫, 正井 秀雄1985 年 60 巻 4 号 p. 277-281
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーIn May 1973, a 45 years old female underwent right radical mastectomy for breast cancer, received radiation therapy and developed radiation pneumonitis. In July 1978, she began to experience occasional episodes of fever up to 38°C and cough. Chest X-ray revealed small infiltrations in the fibrotic right upper lung. In April 1978, 38°C fever began to persist, she also expectorated large quantities of yellow sputa. Chest X-ray demonstrated a large cavity in the right upper lung. She was admitted to this hospital on 27th April. Sputa examination yielded large quantities (more than 100 colonies) of Mycobacterium fortuitum five times in the first month after the admission.
Anti-tuberculous drugs including IN H, SM, KM, RFP, EB, 1314TH and various antimi crobial drugs (DOTC, MINO, AMK, GM, β-lactam antibiotics, macrolides, CP and sul phonamides) were tried. But she continued to produce M. fortuitum in the sputa (93 times during the 6 years) and her lung lesions deteriolated slowly, resulting in respiratory failure and cor pulmonale.
Her recent blood gas data during 0.41 oxygen inhalation by nasal cannula are PaO268 and PaCO266.抄録全体を表示PDF形式でダウンロード (1327K) -
中村 利彦1985 年 60 巻 4 号 p. 283-285
発行日: 1985/04/15
公開日: 2011/05/24
ジャーナル フリーAnnual roentgenological survey in the occupational groups in Tokyo area, with the population of 44, 000, covered 84% of 262 newly diagnosed active pulmonary tuberculosis in 1971 to 1982.
Though the average annual rate of response to the survey had been more than 99% of the total population, 16% of new cases had been detected at clinics because of symptoms.
For the purpose to clarify the cause that the mass survey had failed to discover whole new cases, previous miniature films were reexamined for the 94% of total cases and compared with the status at the time of detection.
These cases were classified into two groups according to whether active lesion had been confirmed or not in the previous films.
Each group were divided into five categories by the status at the time of detection: 1. Extent is minimal by old N TA definition 2. Extent is moderate without cavitation 3. Cavitary 4. Culture positive 5. Smear positive.
In 166 cases (68%), previous films were normal and 83% of these cases had been detected at the next survery. In this group, 66 cases (40%) belonged to the categories 2 to 5. It is interpreted that 27% of newly discovered cases had been developed to the advanced type of tuberculosis within a year.
One-third of these rapidly developed cases had been found at clinics and it corresponds to 60% of total cases discovered at clinics.
Bacteriologically, 76% of total smear positive cases had been discovered at clinics and two-third of these were rapid cases which mentioned above.
The results suggest the limitation in the efficiency of the indiscriminative mass survey.抄録全体を表示PDF形式でダウンロード (345K)
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