巻号一覧
67 巻, 11 号
選択された号の論文の7件中1～7を表示しています
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乾 健二, カレッド レシャード, 高橋 豊, 神頭 徹, 高嶋 義光, 和田 洋巳1992 年 67 巻 11 号 p. 705-708
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーFourteen patients underwent pneumonectomy for destroyed lung or tuberculous empyema at the Shimada Municipal Hospital from September 1980 to December 1985. Mean age was 61 and ten patients were males. Cough and sputum (in 12 cases) and hemosputum or hemoptysis (in 8 cases) were common complaints. Three patients had complications in the immediate postoperative period: hemorrhagic shock, pulmonary embolism and contralateral pneumothorax. They were treated conservatively. The postoperative course was uneventfull in the other patients and all complaints were reduced or disappeared. And lung function improved in 3 cases with chronic empyema compressing the mediastinum. In conclusion, pneumonectomy is one of the radical operation for destroyed lung or chronic tuberculous empyema with low pulmonary function and complaints. And the critical level are 40 % of %VC and 25 % of FEV1.0/pr. %VC in preoperative pulmonary function.抄録全体を表示PDF形式でダウンロード (600K) -
吉山 崇, 森 亨1992 年 67 巻 11 号 p. 709-713
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーThe frequency of the modes of bacteriological examinations other than direct sputum smear were observed for a total of 955 “smear-positive” pulmonary tuberculosis cases which were notified at 7 health centres in the Metropolitan and suburban areas during 1986-1990. Of them 21 cases (2.2 %) were examined for the specimens obtained by bronchofiberscopic procedures, and in 4 cases (0.4 %) gastric juice was taken. The proportion of the non-sputum positivity as seen above was higher in females than in males, but it was uniform across all age group. Non-cavitary cases showed higher proportion of the nonsputum positivity than cavitary cases. There was wide variation in the frequency of these aggressive modes of examination among health centres, probably indicating the difference in the extent to which hospitals are interested in these modes of examination in each health center area.
In addition to the above observed cases, there were 60 cases with direct smear positive finding of mycobacteria other than tuberculosis (MOTT). They account for 5.9 % of all of 1, 015 new notifications of AFB-smear positive cases.
It is possible that these non-sputum “smear positive” cases, as well as the MOTT smear positive cases may be underestimated in our study, because of the notification form not necessarily requesting to enter the type of bacteriological examinations. They may contribute to the recent upward trend of incidence rate of smear positive tuberculosis in Japan to a considerable extent.
For the sake of quality surveillance, these cases which are not confirmed by sputum examination, having apparently different epidemiological significance, should be entered separately in the register and reporting of the mode of examination and differentiation of the bacilli should be obligated to the reporting physicians.抄録全体を表示PDF形式でダウンロード (727K) -
池上 為一, 杉浦 信之, 税所 宏光, 江原 正明, 角南 祐子, 志村 昭光1992 年 67 巻 11 号 p. 715-719
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーFive patients with abdominal tuberculous lymphadenitis were studied by ultrasound, The final diagnosis of tuberculosis was based on open biopsy in 2 patients, neck lymph node biopsy in 1, needle biopsy under ultrasound control in 2.
Low-echoic and iso-echoic abdominal lymph nodes were seen in all patients and a mixed echoic lymph node was found in one of them. Enlarged, round or oval, lymph nodes were conglomeratically observed along the common hepatic artery, in the hepatoduodenal ligament and along the abdominal aorta. The size of the lymph node was found to be 20-70 mm. In one case, compression of the portal trunk and the common bile duct due to a large lymph node was observed, and arterioportography showed hepatopetal collateral veins. In the other case, multiple mass lesions in the liver and the spleen were observed. In the 4 patients who were observed by ultrasound at 2 months after anti-tuberculosis therapy, enlarged lymph nodes decreased and 3 of them changed from low-echo to iso-echo in the echo pattern. Of the 4 patients who were followed for more than 4 months, lymph nodes disappered in 2 at 4 months and in one at 12 months. The remaining patient showed residual nodes which decreased in half at 8 months.
Ultrasound is now used commonly in the examination of the abdomen, and there are cases of abdominal lymph nodes swelling due to varied diseases. In this study, there were no characteristic ultrasonographic findings in abdominal tuberculous lymphadenitis. So, it is difficult to diagnose the cause of abdominal lymph node swelling by only ultrasound. In the final diagnosis of lymph node swelling, open biopsy for final diagnosis has ever been performed. And recently, thin needle biopsy under ultrasound control is a less invasive procedure than it and seemes to be valuable.
When abdominal lymph node swelling is observed by ultrasound, we should consider that it may be due to tuberculosis and there are rare cases with obstructive jaundice or portal hypertension due to tuberculous lymphadenitis.
Ultrasound examination was useful to detect and follow up abdominal tuberculous lymphadenitis.抄録全体を表示PDF形式でダウンロード (1754K) -
坪坂 誠司, 佐々木 文彦, 飴島 慎吾, 高橋 秀房, 貴志 洋一, 石崎 武志, 中井 継彦, 宮保 進, 今村 好章, 福田 優1992 年 67 巻 11 号 p. 721-728
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーWe had a sixty-five year old male patient who suddenly complained of dyspnea and fever with pulmonary tuberculosis, severe respiratory failure, disseminated intravascular coagulation (DIC) and intractable bilateral pneumothoraces. From the first hospital day severe hypoxemia which did not respond to conventional oxygen therapy developed with a diffuse ill-defined reticulo-nodular shadow in the plain chest x-ray film. On the 2 nd hospital day mechanical ventilation with 2 cmH20 PEEP was introduced. Antituberculous agents as well as corticosteroids were started suspecting acute interstitial pneumonia with pulmonary tuberculosis and adult respiratory distress syndrome (ARDS). Medication was followed by the treatment of Gabexate mesilate and heparin against DIC on laboratory data. Though clinical findings and pulmonary infiltrate on chest x-ray film transiently improved, right pneumothorax occurred suddenly on the 6 th day followed with left pneumothorax on the 36 th day. Tube drainage of both pleural spaces and repeated instillation of thrombin-rich oxycel cotton via bronchofiberscope failed to stop air leakage. He ultimately expired on 49 th hospital day. At postmortem lung had multiple bilateral bulla several of which ruptured to the pleural site and caseating necrotic area containing bachilli positively stained with Ziel-Nielsen stain in the bilateral upper lobe. No typical caseating necrotic lesion, however, was found in the other lung tissue. Therefore, it seemed to show a chronic phase of diffuse alveolar damage (DAD).抄録全体を表示PDF形式でダウンロード (9032K) -
吉田 英里, 米田 尚弘, 森川 暁, 阿児 博文, 吉川 雅則, 塚口 勝彦, 成田 亘啓1992 年 67 巻 11 号 p. 729-733
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーWe reported a case who had suffered from severe pulmonary tuberculosis in association with severe malnutrition. A 19-year-old man was admitted complaining of high fever, productive cough and body weight loss. Before admission, he worked as a cook for long hours a day and had meals irregularly. On admission, he was cachexic. Coarse crackles were auscultated on the both lung field, and the liver was enlarged. Chest X-ray revealed multiple ringed and mottled shadows mainly in bilateral upper and middle lung field. Laboratory examination revealed inflammatory reaction defined by an increase of white blood cells, accelerated erythrocyte sedimentation rate and positive CRP, impairment of liver function and cell-mediated immunity, hypoxemia and restrictive lung dysfunction. Ziehl-Neelsen stain of sputum showed a large number of acid fast bacilli.
The assessment of his nutritional status showed decrease in anthropometric measure ments, visceral proteins and the Fischer ratio, which suggested that he was in the status of protein-calorie mulnutrition in association with amino acid imbalance.
He was treated with nutritional therapy in addition to antituberculous drugs, which improved his clinical symptoms, laboratory data and nutritional assessment.
These results suggested the importance of nutritional assessment and nutritional therapy based on it.抄録全体を表示PDF形式でダウンロード (3210K) -
小川 賢二, 三輪 太郎, 笹本 基秀, 佐々木 智康, 津田 美奈子, 本多 康希, 古井 秀彦, 鳥居 啓三, 高木 健三1992 年 67 巻 11 号 p. 735-738
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーMycobacterium avium and M. intracellulare were isolated from the sputum of patients infected with atypical mycobacteria using 1% Ogawa medium and identified by the DNA probe test. Then the MICs of various kinds of drugs against these mycobacterial species were determined on Dubos agar medium, and the drug susceptibilities were also determined on 1% Ogawa medium in parallel. The drugs tested were new macrolides, such as clarithromycin (CAM) and roxithromycin (RXM), new quinolones, such as ofloxacin (OFLX) and ciprofloxacin (CPFX), and antituberculous drugs, such as isoniazid (INH), rifampicin (PFP), streptomycin (SM), and ethambutol (EB). The MICs of the drugs tested, especially those of CAM, OFLX, and RFP, when determined on Dubos agar medium, were generally lower against M. intracellulare than against M. avium. The susceptibilities of the mycobacterial isolates tested to RFP and SM determined on Dubos agar medium were markedly different from those determined on 1% Ogawa medium. Such discrepancies may be accounted for by absorption of these drugs to the egg medium and instability of RFP in the egg medium. Overall, our results indicate that the new macrolides and new quinolones are effective against atypical mycobacteria.抄録全体を表示PDF形式でダウンロード (535K) -
肺と健康-世界における肺疾患の現状中嶋 宏1992 年 67 巻 11 号 p. 739-745
発行日: 1992/11/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (884K)
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