In two cases of tuberculous lymphadenitis (one is active, another is inactive) and one case of pulmonary tuberculosis (coin lesion), the cellular composition of tuberculous granuloma was investigated by application of monoclonal antibodies (MoA) against T and B lymphocytes and macrophage to the cryostat sections.In active tuberculous lymph adenitis, the newly developed epithelioid cell granuloma adjacent to a large central necrosis consisted of centrally placed OKM 1⁺, OKDR⁺, and OKT 9⁺ epithelioid cells with OKT 4⁺ helper / inducer and OKT 8⁺suppressor/cytotoxic lymphocytes.OKT 4⁺lymphocytes (34.9±3.7 percent of total cells in a granuloma) were distributed throughout the granuloma.On the other hand, OKT 8⁺lymphocytes (16.9±4.7 percent of total cells in a granuloma) were distributed at periphery of the granuloma.In inactive tuberculous lymphadenitis, the lesion has a large central necrosis with encircled fibrosis and lacks newly developed granuloma, thus T lymphocyte subsets in a granuloma was not calculated.Most of T lymphocytes in both the active and inactive tuberculous lesions were distributed in paracortical areas of the lymph nodes, and 18.8 ±4.3 percent and 35.6±3.2 percent of paracortical lymphocytes were stained with OKT 8 MoA in active and inactive lesions, respectively.In pulmonary tuberculous lesion, the cellular composition of granuloma was same as that of the granuloma in tuberculous lymph node but the border betweenperigranulomatous cuff and epithelioid cell granuloma was not defined clearly.OKT 4⁺ lymphocytes (22.3±2.0 percent of total inflammatory cells in a area) were distributed evenly in the lesion and OKT 8⁺lymphocytes (25.0±1.7 percent of total inflammatory cells in a area) were distributed in a circle surrounding the epithelioid cell mass.OKB 7⁺ lymphocytes (B lymphocytes) were distributed near to the epithelioid cell granuloma as a mass of B lymphocytes in active tuberculous lymph node, while they were not found in pulmonary tuberculous lesion. The results suggest that OKT 4⁺lymphocytes are dominant in active tuberculous lesion, and OKT8⁺lymphocytes are dominant in inactive or stable lesions.Accordingly, OKT8⁺lymphocytes may play an important role in the healing process of delayted-type hypersensitivity reactions.

抄録全体を表示

In oder to investigate the immunological peculiarity in patients with chronic, intractable pulmonary tuberculosis ('chronics'), NK cell activity and other parameters of cellmediated immunity were examined in the spectrum of 29 chronics.
The results were as follows:
1) NK cell activity in chronics was significantly higher (p<0.001) than that in healthy controls.
2) NK cell activity in chronics was not significantly different from that in newly diagnosed patients, and significantly lower (p<0.05) than that in treated patients.
3) PPD reaction was positive in all patients studied. On the other hand, decrease of DNCB reaction was found in 37.9%.
4) Chronics could be classified into two polar groups, based on the combination of NK cell activity and DNCB reaction-high reacting type (with high NK cell activity, normal DNCB reaction), and low reacting type (with low NK cell activity, reduced DNCB reaction).
The intermediate group showed characteristics of the neighbouring polar groups.
5) Most patients of high reacting type were characterized by moderate and stable roentgenographic lesions, while most patients of low reacting type were characterized by far advanced and aggravated lesions.
We could demonstrate the exisistence of a spectrum of immune response defined by NK cell activity and DNCB reaction, and the intense relationship between the immune spectrum and clinical state in chronics.

抄録全体を表示

On the assumption that the annual indiscriminate mass miniature radiography (MMR) is abolished, the auther tried to estimate changes in a trend of incidence of pulmonary tuberculosis mathematically in an occupational group.
Among the subject group, eighty per cent of the pulmonary tuberculosis have been detected by MMR annually in the past thirty years.
The new cases are classified into the three groups by extent of their roentgenological lesions at detection.According to the natural dynamics of tuberculosis, each case is devided into five stages at the present socio-medical settings;healed, improved, unchanged, deteriorated, and detected at clinics.With these categories, an epidemiological model was built, and a prospective yearly change was presumed by the use of Markovian chain model.
The transition probabilities among each category were estimated from the data of the subject group in the past ten years, referring to some releveant studies.
The result shows that, as far as the incidence of tuberculosis continues to decrease, the number of the new cases detected at clinics after abolition of MMR will not exceed those detected by MMR.
On the other hand, some of the new cases detected at clinics will be more serious and infectious than they would be detected by MMR which may affect a decrease of tuber culosis incidence.

抄録全体を表示

An enzyme-linked immunosorbent assay (ELISA) was used for detection of IgG antibodies to purified protein derivative (PPD) and specific substance of mycobacterium (SSM) in sera of patients with pulmonary tuberculosis.The antibody levels were determined by ELISA on 36 specimens from patients with pulmonary tuberculosis and 24 specimens from healthy tuberuclin-positive individuals.The antibody levels were obtained by the use of serial dilution of given reference positive serum to prepare a calibration scale of general validity.The mean IgG antibody levels were significantly higher in the patients than in the control subjects.The covariation of the ELISA results with the two antigens (PPD, SSM) was highly interdependent.
SSM was used for passive hemagglutination assay to test sera from patients and from contorol subjects.The serologic discrimination between patients and healthy skin test-positive subjects was better in ELISA than in passive hemagglutination

抄録全体を表示

The main objectives of this study is to evaluate whether the 9-month chemotherapy with rifampicin and isoniazid, supplemented with streptomycin, ethambutol or pyrazina mide, might show the same relapse rate as reported in many publications, even if the ma jority of patients consisting of far advanced disease with huge cavities.
A total of 124 patients were allocated at random to the following four regimens: 9 RHE and 1 RHES/8 RHE, each with 39 cases, from January, 1976 to November, 1978 ; 9 RHS with 14 cases and 2 RHZE/7 RHZ with 32 cases, from November, 1978 to August, 1982. Conditions of the admittance to the trial were as follows: Patients should be admitted to our hospital, be aged 15 years old or more, have pulmonary tuberculosis with huge cavities, be smear positive, and be previously untreated or treated for less than 15 days.Drug daily dosage was RFP 450 mg in all patients, INH 0.3-0.6g, SM and EB 1.0g, and PZA 1.5g.
After excluding patients who did not meet the protocol requirements, 91 patients remained for the final analysis (Table 1).They were divided into two groups, A and B, according to whether they satisfied the following conditions (A) or not (B): i) Sensitive to all drugs used, ii) treatment was completed as scheduled or, if not, RFP was not interrupted for longer than 2 weeks, and iii) no complications with diabetes mellitus or tuberculous empyema.
The background factors of Group A are shown in Fig.1.They all had cavities and were all far advanced cases.Eighty-four percent of them had a cavity of more than 4 cm in size and among them 12 percent with cavity size 8 cm or more.The conversion rate at 8 weeks was 18-68 %, an average of 41% (Table 2).The rate was much lower compared with our former study with RHE (60 %) and with results in many other publications.In thisconnection, it is interesting to note that the conversion rate changes with the more thebacilli count at the onset of chemotherapy (Fig.2).Seventy-three percent and 75 % of cavities in Groups A and B, respectively, remainedopen at the end of chemotherapy (Table 4).In Group A, there was no bacteriological relapseamong 58 patients up to 5 years after the end of treatment, after which, one case relapsed.This patient had two cavities at the onset of chemotherapy, the size of the largest one beingless than 5 cm, and the original cavities had completely disappeared when the treatmentwas completed (Table 7).In Group B, 3 bacteriological relapses were observed, occurring at 3 months, 5 months, and 2 years after the end of chemotherapy.Two of them were complicated with diabetesmellitus and the administration of rifampicin was interrupted for forty days in the thirdcase.There was no relapse in cases treated with the regimen of RHZE (Tables 7, 8&9).Thirty-five percent of the patients suffered from side-effects, 10.5% being liverdysfunction, determined solely by the elevation of transaminase (Table 5).Although theincidence of side-effects was quite high, they were all transitory and disappeared when thedrugs concerned were discontinued.Most of these cases could be re-treated successfully ifboth RFP and INH are could be used.In our study, the combined use of RFP and INH wastried in 32 cases and they all succeeded in completing the 9-month chemotherapy.Out ofthese cases, 2 cases relapsed including one diabetic.Conclusion.

抄録全体を表示