This study has been done to evaluate serum calcium, phosphorus (P), magnesium, parathyroid hormone (PTH), calcitonin (CT), and cyclic adenosine monophosphate (cAMP) in recently diagnosed pulmonary tuberculous patient, (n=61) and the results were compared with the healthy control group (n=22).Twenty four hours urine was collected for estimation of these electrolytes as well as cAMP.Nephrogenous cAMP (NcAMP) was calculated.Serum Ca and PTH were significantly reduced in TB groups, but CT was elevated.Serum Mg, P and cAMP as well as urinary Ca and Mg in TB groups were similar to that of the control group.Urinary P, cAMP NcAMP were increased in patient groups compared with the control.
The reduced serum Ca could be due to impaired intestinal absorption of Ca, or deficient intake as a result of anorexia, decreased plasma albumin, decreased active metabolites of vitamin D or elevated CT. The rise in serum CT in TB might be due to increased CT secreted from the bronchial K-cells.Increased NcAMP might be due to the associated increase in serum antidiuretic hormone (ADH).The elevated urinary P in TB could be attributed to tissue breakdown, decreased serum PTH or increased CT.

抄録全体を表示

Determination of serum rifampicin (RFP) after dose of the drug is often requested not only for the clinical criteria on its use, but also for the check of its adverse reactions.In comparative examination on.each clinical use of 2 kinds of RFP commercial products Rifadin^® and Aptesin^®, the authors had a chance of simultaneous determinaion of serum RFP by means of 3 different assay methods: solvent extraction method (SE), biological activity method (BA) and liquid-chromatography method (LC).Ten healthy male volunteers and 19 hospital patients (14 males and 5 females) with lung tuberculosis cooperated for this investigations.RFP blood samples were taken serially after oral administration of 450mg RFP, at 1, 2, 3, 4, 6, 8, 12 and 24 hours in the volunteers, and at 2 and 4 hours in the patients.
The serum RFP concentrations determined by the present methods showed generally a good correlation between each other, but there was a considerable difference in their quantity.The highest diterminations were presented by the SE, which was devised as total assay method determining desacetyl RFP and 3-formyl rifamycin SV besides free RFP. The lowest determinations were brought about by the LC, which was devised fundamentally for the assy of free RFP.Thus the difference between both determinations by SE and LC was caused by RFP metabolites.This explanation was further proved by the fact that the difference rate, namely (SE-LC) /SE, increased clearly with the lapse of time, and could be used as an index of serial pattern of RFP metabolism.The serum determinations by BAappeared to be useful to monitor clinical efficacy of the drug, but seemed to be out of the absolute estimation.Incidentally the determination by BA was always ranked between both determinations by SE and LC figures.The detailed analysis of two examinations at ten-day intervals in the same volunteers revealed that the RFP determinations by SE appeared to show much better reproducibilty than those by BA and LC.By the present assay methods, nearly no difference was demonstrated in the blood level of 2 RFP products.
Some attensions were called to the practical estimation of the serum RFP concentrations: Clear individual differences were found in the serum RFP concentrations after dose of the drug, and appeared to become clearer in the stage of its continuous administrations. Above all, it was noteworthy that the individual difference in the first dose of RFP was found to be decided by the grade of absorption withtin 2 hours after the dose.The serum RFP level was satisfactorily high in the first administration, while in its repeated administrations the level markedly deminished due to active enzyme induction for the drug metabolism.The appropriate determination of serum RFP concentration was recommended to do at two time-points, 4 and 6 hours after the dose, as the RFP level in serum shows almost a linear and slow decline after 4 hours following the dose, and the variation of serum RFP concentrations was least at 3 to 4 hours after the dose.

抄録全体を表示

In order to determine the clinical features of patients whose tubercle bacilli were found after admission, the characteristics of23cases (17 males, 6 females) diagnosed after admission (Group I) were compared with16other cases (12 males, 4 females) diagnosed before admission (Group II).The patients in Group I were more elderly and had severer underlying diseases than those in Group II.In addition, the majority of the patients of Group I showed manifestations of respiratory infections similar to bacterial pneumonia. Therefore, 14cases (61%) in Group I were diagnosed as bacterial pneumonia on admission. Radiological findings showed that less than half of Group I showed typical X-ray findings of tuberculosis such as locasion of lesions in the apex and upper lung field, cavity formation, and mixture of or new and old infiltrative lesions.Also on the PPD skin test, 7cases (30%) of Group I were negative.Due to the above results, in many cases it took more than 10days from admission to make a final diagnosis as tuberculosis.There were several differences in findings between two groups, but there was no definite signs to diagnose all patients at the OPD.It is therefore considered to be important to keep in mind the following to prevent admission of open tuberculosis patients into a general hospital:
(1) Admission of patients suspected to have open tuberculosis at the OPD should be postponed until their smears are proven negative.
(2) Sputum examinations for AFB always should be carried out in patients with respiratory symptoms.

抄録全体を表示

To evaluate cell-mediated immune responses in patients infected with atypical mycobacteria (AM), mononuclear cells from patients were examined in vitro for purified protein derivatives (PPD) induced lymphocyte proliferation using combination of monoclonal antibodies and flowcytometry.
Those from normal tuberculin-positive controls and chronic excreters with tuberculosis (chronics) were also examined.
The results obtained were as follows:
1) In normal controls, PPD-S induced a significant proliferation of activated T cell subsets (Leu4⁺DR⁺, IL2-R⁺ Leu 3⁺ and IL2-R⁺Leu2⁺).A significant increase in pan T cells (Leu 4⁺), helper T cells (Leu3⁺8^-), suppressor T cells (Leu2⁺15⁺) and B cells (Leu 4^-DR⁺) was also observed.
2) In chronics, the pattern and degree of lymphocyte proliferation by PPD-S were similar to that observed in normal controls.
3) In AM, we found a significant proliferation of activated T cells (Leu4⁺DR⁺, IL2-R⁺Leu3⁺, IL2-R⁺Leu2⁺) and B cells (Leu4^-DR⁺) by PPD-S.However, the degree of lymphocyte proliferation in AM was clearly depressed as compared to normal controls and chronics.
4) In chronics, lymphocyte proliferation by PPD-S was significantly higher than that by PPD-B.In contrast, lymphocyte response by PPD-S was almost same as that by PPD-B in AM.

抄録全体を表示

Treatment of nontuberculous mycobacterial infection should be carried out by the chemotherapeutic regimens most suitable for each species.We performed in-vitro susceptibility tests for various species and determined the probability in which the mycobacteria of each species are inhibited by blood concentrations attainable by the dosages usually used.From such determinations, the following regimens have been recommended 1) M. avium-M.intracellulare complex, Rifampicin+Enviomycin+Ethambutol;2) M.kansasii, Ofloxacin+Enviomycin+Rifampicin;3) M.szulgai, Enviomycin+Ethambutol+Isoniazid; 4) M.fortuitum, Ofloxacin.The effectiveness of the treatment of the infection caused by M.avium complex is less than 15% even using the above regimen, while it is high in the treatment of infections caused by M.kansasii and M.szulgai.There are no effective regimens for the treatment of infection caused by M.chelonae or M.simiae. The above recommendations are useful in practice, because, at present, reliable susceptibility testing of nontuberculous mycobacteria is not yet done commonly.

抄録全体を表示

A 27 Year-old female with pulmonary tuberculosis in right upper lobe developed right pericostal abscess during the course of antituberculous chemotherapy.
The chest x-ray films on first admission showed infiltration with cavity formation and nodular shadows in the right upper lung field.
Seven months after starting the antituberculous therapy with INH, RFP and EB, a new tumorous shadow appeared in the right chest wall.Microscopic examination of the specimen obtained by needle aspiration biopsy disclosed positive acid-fast bacilli.
Because of the ineffectiveness of drug therapy on lesions in the right chest wall, surgical treatment was performed and the disease was diagnosed as pericostal abscess.

抄録全体を表示

Acid-fast staining is broadly used for the detection of mycobacteria in smears or pathological preparations, but it does not distinguish viable and non-viable bacteria. Enzymatic hydrolysis of fluorescein diacetate (FDA) was reported as a tool to detect viable mammalian cells or protozoa.We have applied this method to mycobacteria samples to detect viable or non-viable bacteria in the smear.Mycobacterium bovis BCG (Tokyo), 20 mg/ml suspension of standard vaccine, was used as the sample of viable bacteria.A part of the same suspension was heated at 100°C for 30 min and used as the sample of nonviable bacteria.Three samples, viable, non-viable, and 1: 1 mixture of the two, were stained with acid-fast staining and FDA-EB (ethidium bromide) mixture, respectively. For FDA/EB staining, stock solution of FDA (5mg/mlacetone) was diluted 1: 50 in PBS and 25μl of FDA and 25μl of EB (20μg/ml PBS) were mixed with 50μl of bacterial suspension.Preparations were observed with either light or fluorescein microscope.Living bacteria were stained in yellow green in FDA/EB staining while non-viable bacteria were red.Mixed sample of live and dead bacilli showed differential staining with green or red in FDA/EB staining, but no difference was shown in acid-fast staining between viable and non-viable bacteria.

抄録全体を表示