Fourty-five sputum specimens collected at the National Sanatorium Hiroshima Hospital were subjected to cultivation using either BACTEC 460 TB System (BACTEC method; Becton Dickinson Co., Towson, Md., U.S.A.) or 3% Ogawa egg medium. Test suptum was treated with four volumes of 4% NaOH for approximately two minutes, after which 0.1ml of the treated sputum was immediately inoculated onto 3% Ogawa egg medium. After neutralizing the remaining pretreated sputum with 1N HCl, and diluting with 1/15 M phosphate buffer PB; pH 6.8), it was then centrifuged at 3, 000rpm for 20min and the sediment was suspended in 1.5 ml of PB. Volumes of 0.5 ml each were inoculated into BACTEC 12B medium (4ml), containing PANTA for prevention of contamination and POES for promoting the growth of mycobacteria.
In the BBCTEC method, bacterial growth was measured in terms of increases in the Growth Index (GI) values which were determined by the amount of ¹⁴CO₂ released from the ¹⁴C -labelled palmitate during cultivation at 37°C (positive growth;GI≤50). Moreover, ρInitro-α-acetylamino-β-hydroxy-propiophenone (NAP)-sensitivity testing was done by transferring a part of the BACTEC 12B culture showing positive growth to a NAP vial, and thereafter subjected to further cultivation.
Among the 45 sputum specimens, the number of positive specimens for mycobacterial growth in the afore mentioned cultivation methods and time required for growth were as follows: 3% Ogawa egg medium, 12 specimens (27%), seven M. tuberculosis complex strains at 12-35 days (average 21 days), five M. avium complex strains at 14-21 days (average 18 days): BACTEC method, 18 specimens (40%), 11 M. tuberculosis complex strains at 3-28 days (average 14 days), six M. avium complex strains at 3-10 days (average 6 days) and one M. scrofulaceum strain at 28 days. There were no specimens that tested positive for mycobacterial growth on 3% Ogawa egg medium but negative in BACTEC 12B medium. The BACTEC method was most efficacious in cultivating acid-fast bacilli from smear-negative
When NAP-sensitivity testing was done using the BACTEC method, mycobacteria in 11 test sputa were deteremined as NAP-sensitive, thereby belonging to M. tuberculosis complex. The fact that all of the organisms determined as NAP-sensitive using the BACTEC method were rough and nonphotochromogenic, and identified as M. tuberculosis complex by AccuProbeTM testing, confirmed the reliability of NAP-testing. sputa.
The mycobacteria in seven sputum specimens detected using the BACTEC method were determined as NAP-resistant. Six of them were smooth and nonphotochromogenic, and identified as M. avium complex by AccuProbe testing. The one remaining strain was a scotochromogen with a smooth colony morphology, and had no reaction to either the M. tuberculosis complex- or M. avium complex-AccuProbe tests. This strain was identified as M. scrofulaceum using an α-antigen analysis.
These results indicate the usefulness of the BACTEC 460 TB system in the rapid diagnosis of mycobacteria including M. tuberculosis complex and M. avium complex.

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The effect of the culture filtrate Gemella haemolysans in enhancing mycobacterial growth has been previously demonstrated. In the present studies, an attempt was made to confirm whether the addition of the filtrate into the medium would be an effective method to promote the rapid detection of mycobacteria in sputum specimens of patients.
One-hundred and one sputum specimens pretreated with NaOH were inoculated with various media (Dubos, Dubos-agar, 1% Ogawa, Kudo PD, and Middlebrook 7H9) supplemented with the culture filtrate of Gemella haemolysans grown in blood-BHI or blood-HEM at the dilutions of 1/32 or 1/64. Addition of the filtrate reduced the amount of time required to detect mycobacterial growth (Mycobacterium tuberculosis, M. avium complex, and M. kansassi) by an average of 60-70%. The media containing the filtrate formed significantly larger numbers of colonies compared with the control media, and those colonies inoculated developed more rapidly in size.
The findings clearly indicated that the culture filtrate promotes the effective growth of mycobacteria which cannot or only slowly grows in ordinary media. Also indicate d was that the addition of the culture filtrate of Gemella haemolysans into media provides as a useful tool to allow the rapid diagnosis of mycobacterial diseases.

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Nine patients were diagnosed as suffering from localized pulmonary aspergillosis associated with restrictive ventilatory impairment. Eight cases reportedly received a combination of thoracoplasty and cavernoplasty, while one case received only cavernoplasty.
The following postoperative courses were observed in these nine patients: of the eight patients having combined thoracoplasty and cavernoplasty, seven patients were cured as the result of successful cavity closures. Cavernotomy was required for the remaining patient whose cavity failed to close.
An attempt was made to close the cavity of the one patient reported to have only cavernoplasty, but the cavity failed to close on the first attempt. The cavity was successfully closed in a later attempt using thoracoplasty.
Although the application of thoracoplasty and cavernoplasty is useful and safe to the treatment of patients being unable to undergo resection and/or having pulmonaly dysfunction, it is very important to reduce the number of ribs being resected because pulmonaly function may be more worsened after operation. A combination of extraperiosteal detachment and cavernoplasty seems to be a useful alternative. A lower limitation of the postoperative ventilation function, evaluated as a ratio of FEVLo/VCpr is thought to be 20%.

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Two-hundred sputum specimens from tuberculosis patients were examined for viable or non-viable mycobacteria by a combination of fluorescein diaectate ethidium. bromide (FDA/EB) staining, Ziehl-Neelsen staining, and the use of cultures in 3% Ogawa egg medium. The sputum specimens were treated with 3% NaOH for 10min and washed in PBS. The bacteria was then harvested by centrifugation at 6, 000 rpm for 5min. Each sample was subjected to FDA/EB staining, Ziehl-Neelsen staining and cultures to compare the staining-method results and the results of colony formation.
Ziehl-Neelsen staining method revealed acid-fast bacteria in the specimens, distributed from Gaffky 1 to Gaffky 8. The number of FDA-positive specimens and culture-positive specimens were identical in all Gaffky grades, suggesting that the FDA staining method well reflected the presence of viable mycobacteria in the specimens.
We concluded that FDA staining is a valuable method to detect viable mycobacteria in sputum specimens on the first day of examination. It is therefore advantageous for doctors and patients to be immediately informed of culture results rather than waiting for several weeks.

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Twenty-two patients were diagnosed as coexisting active pulmonary tuberculosis and lung cancer during last ten years until 1989.
They were nineteen men and three women and their age ranged from 61 to 84 years with a mean age of 71.3. Six patients had history of tuberculosis, three had undergone gastrectomy and four patients were complicated with diabetes mellitus. Histological types of lung cancer were epidermoid cell carcinoma in 13, adenocarcinoma in 3, large cell carcinoma in 2, and small cell carcinoma in 4 and clinical stages were “stage I” in 2, “stage II” in 2, “stage III A”in 5, “stage MB” in 4 and “stage IV” in 7, except 2 patients after surgical treatment. Localizations of lesions of cancer and tuberculosis were in the same lobes in 6, in ipsilateral lung in 6, and in contralateral lung in 6, except 4 cases, whose lesion of tuberculosis was not detectable roentgenologically and all cancers of “same lobe” cases were peripheral origins. Although, the prognosis was poor, which reflects the prognosis of lung cancer as a whole, the efficacy of anti-tuberculous chemotherapy was as good as patients without lung cancer.We mainly discussed the diagnostic points to detect the coexitence of lung cancer and pulmonary tuberculosis at early stage.

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A 27-year old patient was diagnosed as having post-primary hilar lymph node tuber culosis. First being admitted to the hospital with a high fever, a chest x-ray examination revealed a swelling of the left hilar lymph nodes and a sputum smear tested positive for acid-fast bacilli. Neither regular clinical examination or investigation had reported abnormality.
The acid-fast bacilli was successfully treated through treatment using INH RFP SM. However, after two months, swelling was observed in the right para-tracheal lymph nodes, Further, a bronchoscopic examination revealed polyp-like tumors at the left upper and lower bifurcation. The swelling of the para-tracheal lymph nodes was considerably reduced and the tumors non-existent after five months. These lymph node reactions could have likely been a part of the so called early exacerbation.
The polyp-like tumors were not found during the bronchoscopy performed during admission to the hospital. It is therefore suspected that the cause was perforation of the hilar lymph node into the bronchus.

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