巻号一覧
61 巻, 1 号
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荒井 他嘉司, 平田 正信, 木村 荘一, 稲垣 敬三, 門倉 光隆, 品田 純, 林 康史, 鈴木 恒雄, 大谷 直史, 中野 昭, 松田 ...1986 年 61 巻 1 号 p. 1-7
発行日: 1986/01/15
公開日: 2011/05/24
ジャーナル フリーTo find a clue for solving difficulties in differential diagnosis between lung cancer and pulmonary tuberculoma, 32 tuberculomas diagnosed by exploratory excision during the last 9 years were analysed from clinical, bacteriological and pathological standpoint.
The sex was male in 23 patients and female in 9. The average age was 53.5 years old.
The lesion was found by mass-survey in 14, during the treatment of other diseases in 11, meanwhile by subjective symptoms in only 7 (21.9%).
Rentgenological size of the tuberculoma was between 0.9 and 4.0cm in diameter; the average diameter was 2.25cm. Rentgenological findings reveled a sharply demarcated margine in 84.4%, a lack of satelite lesions in 81.3%, indentation of the visceral pleura in 31.3%, notching in 25.0%, spicula in 9.4%, cavitation in 9.4%, and calcification in 12.5%. One or more rentgenological signs which were indicative of either malignant or benign tumor, such as notch, indentation of the visceral pleura, spicula, and a lack of satelite lesion, were seen in most of the cases.
Concerning preoperative diagnosis, 18 out of 32 cases were strongly suspected of lung cancer, because of false positive of cancer cells by sputum or biopsy, growing tendency of the shadow, positive result of 197H g scintigraphy and rentgenological signs. The other 8 out of 32 cases had a slight suspecion of lung cancer, and the remaining 6 cases were diagnosed as benign tumor rather than lung cancer mainly by rentgenological findings.
Tubercle bacilli in the resected specimens were examined in 29 out of 32 cases, and it was positive in only 15 cases (51.7%). This result suggests that there is a limitation in making preoperative diagnosis of tuberculoma by demonstrating tubercle bacilli.
Lobectomy was performed in 14 cases, 13 of which were strongly suspected of lung cancer and one was suspected of benign tumor. Segmentectomy was performed in 2, and partial resection in 16. Looking back, however, partial resection was more suitable in most of the cases which underwent lobectomy. Partial resection followed by frozen section examination should be the standard technique for exploration, because of less complications.
It is our policy to do exploratory excision positively in the patients who could not be proved, but not be denied, to have a lung cancer by routine diagnostic methods. On the other hand, in case tuberculoma is strongly suspected by routine examinations, diagnostic anti-tuberculosis chemotherapy is also indicated rather then exploratory thoracotomy. The duration of diagnostic antituberculosis chemotherapy should not be longer than two months before it is re-discussed whether its diagnosis is correct or not.抄録全体を表示PDF形式でダウンロード (828K) -
国療化研第26次B研究報告佐々木 ヨリ子, 望月 孝二, 重藤 エリコ, 小西池 穣一1986 年 61 巻 1 号 p. 9-13
発行日: 1986/01/15
公開日: 2011/05/24
ジャーナル フリーThis report reviews 82 patients of urinary tuberculosis on the present status and chemotherapy in 48 institutions of national sanatoria between 1978 and 1982. The data were collected from 39 institutions.
Forty-two cases were male and 40 were female, ranging age between 20 to 80 years; high incidence was observed in 40 to 59 year in male and 40 to 49 year in female
Thirty-nine cases (47.6%) had previous history of tuberculosis; pulmonary tuberculosis or pleuritis were most popular.
All the patients were treated with regimens in which isoniazid and rifampicin were included as major drugs. The average terms of chemotherapy in the hospital was 9.2 months in cases without pulmonary lesion and 10.9 months in those with pulmonary lesion. 36 cases (43.0%) were complicated with pulmonary tuberculosis.
In operative cases, the duration of chemotherapy preceding operation in patients with, : at pulmonary lesion and with pulmonary lesion was 3.1 months and 10.5 months respectively.
In 76.6% of the patients treated with initial chemotherapy (without operation), their condition improved satisfactorily.抄録全体を表示PDF形式でダウンロード (585K) -
束村 道雄, 吉井 才司, 安田 行信, 斉藤 博1986 年 61 巻 1 号 p. 15-17
発行日: 1986/01/15
公開日: 2011/05/24
ジャーナル フリーSeventeen patients with caviatry lung tuberculosis previously not treated by antituber culosis agent were treated by a triple chemotherapy with ofloxacin+rifampicin+isoniazid.
By this regimen, negative conversion occurred, in average, after 1.8 months. This time required for the negative conversion was the same as occurred by regimens with strepto mycin+rifampicin+isoniazid or ethambutol+rifampicin+isoniazid. The regimen including ofloxacin seemed to be as effective as two commonly used triple chemotherapy regimens and showed no side effect.抄録全体を表示PDF形式でダウンロード (356K) -
本田 泰人, 池田 裕次, 水戸 史子, 坂井 英一, 桑島 核, 藤田 昌宏1986 年 61 巻 1 号 p. 19-21
発行日: 1986/01/15
公開日: 2011/05/24
ジャーナル フリーTo assess the usefulness of transbronchial lung biopsy (TBLB) for diagnosis of pulmonary tuberculosis, we analyzed 117 patients who had undergone TBLB from Nov. 1982 to Oct. 1984 at National Dohoku Hospital.
In 19 out of 117 cases the diagnosis of pulmonary tuberculosis was made during the period of hospitalization. However, in these 19 cases no acid-fast bacilli was detected in the sputum smears at the time of admission. In 6 out of 19 cases of pulmonary tuberculosis, pathological examination of lung tissues obtained by TBLB showed epitheloid - granulomas microscopically. In 2 out of 2 cases in which chest X-ray showed diffuse infiltra-tion, the diagnosis of miliary tuberculosis was made because epitheloid granulomas were obser ved. In 4 out of the 19 cases of pulmonary tuberculosis, excepting the 2 cases of miliary tuberculosis, we diagnosed pulmonary tuberculosis by TBLB. A diagnostic rate of 24% (4/17) cases of pulmonary tuberculosis was achieved. In 2 cases chest X-ray film disclosed an increase in density of lesions and cavity formation after TBLB was performed. We speculated that pulmonary tuberculosis was complicated by such exacervation after examination of TBLB.
The usefulness of TBLB in differentiating lung cancer from pulmonary tuberculosis should be considered. However, the invasive examination should be carefully performed for diagnosis of pulmonary tuberculosis because pulmonary tuberculosis is an inflammatory disease. If pulmonary tuberculosis cannot be diagnosed by the presence of acid-fast bacilli in sputum smears, then the collection method, i. e. brushing, washing or TBLB by fiberoptic bronchoscopy shoud be chosen carefully because these procedures sometimes exacerbate pulmonary tuberculous lesions.抄録全体を表示PDF形式でダウンロード (1974K) -
鈴木 明, 大泉 耕太郎1986 年 61 巻 1 号 p. 23-51
発行日: 1986/01/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (3551K)
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