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69 巻, 4 号
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大友 幸二, 坂本 祥一, 海野 剛, 青木 俊明, 福島 一雄, 河端 美則, 岩井 和郎, 河又 國士, 中島 由槻1994 年 69 巻 4 号 p. 295-300
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーFor the purpose to know the pathogenesis of caseous necrosis in tuberculous lesion, authors compared the presence and the number of mycobacteria in the pulmonary tubercles of various histological types. Forty pulmonary tubercles obtained from 16 patients (9 males, 7 females mean age 51) were examined.
By Ziehl-Neelsen (ZN) method, acid-fast bacilli were detected in 40% of 5 proliferative, in 12.5% of 24 productive and none of 11 sclerotic granulomas. By immunohistological staining with anti-BCG antiserum, positive staining was observed in 60%, 87.5% and 91% of each type of granuloma, respectively.
Types of necrosis were classified by silver-staining as necrosis after exudative reactions (EN), necrosis after productive reactions (PN) and filled materials after softening and liquification of necrotic lesions (LN). EN was observed in 24 tubercles, and mycobac teria were staind in 8% of EN by ZN method and in 75% by immunohistological method. PN was observed in 21 tubercles, and mycobacteria were detected in none and 5% of such type of necrosis by respective method. LN was observed in 28 tubercles, and mycobacteria were detected in 11% and 71% of these lesions by respective method. So, positive ratio by immunochemical method was significantly higher in EN and LN than in PN. Further, mycobacteria were stained with anti-BCG antiserum as granules and the number of such granules were much more numerous in EN and LN than in PN (p<0.01).
From these results, it was suggested that necrosis might occur by different mechanisms in exudative reactions and in productive reactions.抄録全体を表示PDF形式でダウンロード (1737K) -
和田 雅子, 吉山 崇, 杉江 琢美, 中園 智昭, 尾形 英雄, 杉田 博宣1994 年 69 巻 4 号 p. 301-306
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーIn 1986, the regimen with isoniazid, rifampicin and streptomycin or ethambutol for 9 or 6 months was introduced as the standard therapy for the initial treatment of pulmonary tuberculosis in Japan. Since then, several reports have been published on the relapse rate after such standard regimen, but follow-up observation was limited to relatively short period in these studies, except one study. Further, none of these studies reported overall efficacy rate of the treatment which was the most important index to evaluate the regimen. So we investigated the deaths, defaults, treatment failures, and relapses during and after the initial treatment of pulmonary tuberculosis patients to calculate the efficacy rate. Three hundred and six patients with newly diagnosed pulmonary tuberculosis, who had admitted to Fukujuji Hospital and started initial treatment with standard regimen, were followed-up, retrospectively. At the start of the initial treatment, mean age of the male patients were 47.0 and those of the female patients were 42.2 years old (male: 232 cases, female: 74 cases). Of the total 306 patients, 84.5% were bacillaly positive and 50.7% were cavitary tuberculosis.
Resistance to isoniazid, rifampicin, streptomycin and ethambutol was noticed in 3.5%, 0.4%, 4.3% and 0.4% of the patients tested.
Their medical records in Fukujuji Hospital were reviewed, and for the patients who had not visited the hospital more than one year letters were sent to request to visit the hospital and to answer to questionaire. The questionaire were also sent to the referred hospitals and the concerned health-centers. Of 306 patients enrolled in the present investigation, 7 have dropped out. Of 306 patients enrolled in the present investigation, 280 were eligible to evaluate the long-term efficacy. There were 17 unsuccessful cases including 8 death of tuberculosis, 7 defaults, 2 treatment failure (one of which had died and was included in death cases, too) and 1 bacteriological relapse. From these results, the efficacy rate of the initial treatment with standard regimen was calculated as 93.9% (263/280). This figure does not reach to the target efficacy rate of 95% suggested by WHO. Further efforts will be needed to improve the efficacy rate, especially by reducing the number of defaults.抄録全体を表示PDF形式でダウンロード (730K) -
吉川 雅則, 米田 尚弘, 前川 純子, 塚口 勝彦, 徳山 猛, 夫 彰啓, 福岡 和也, 友田 恒一, 仲谷 宗裕, 福岡 篤彦, 山本 ...1994 年 69 巻 4 号 p. 307-316
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーA survey on the nutritional status and cell-mediated immune function of 47 hos pitalized patients with active pulmonary tuberculosis and healthy controls was conducted.
In the patients group:
1) Anthropometric measurements, such as %ideal body weight (%IBW), %arm circum ference (%AC), %arm muscle circumference (%AMC) and %triceps skin fold (%TSF), were significantly reduced.
2) Visceral proteins including serum albumin (Alb), transferrin (Tf), prealbumin (PA) and retinol binding protein (RBP) were significantly reduced.
3) The imbalance of plasma amino acids, which was characterized by the depression of Fischer ratio, a molar ratio of branched chain amino acids (BCAA) to aromatic amino acids (AAA), was observed.
Fischer ratio was significantly correlated with anthropometric measurements (YDIBW, %AC and %AMC).
Delayed-type hypersensitivity to DNCB (2, 4-dinitrochlorobenzene) and iymptiocyte transformation to phytohemagglutinin (PHA) and concanavalin A (Con A) were signifi cantly impaired in the patients group, whereas NK cell activity was higher than that of controls.
Alb, PA, RBP and Fischer ratio were significantly lower in the patients with reduced DNCB reaction than in those with normal responses. Lymphocyte transformation was signifcantly correlated with Fischer ratio, and NK cell activity was significantly correlated with Alb, PA, RBP. These data may suggest that the imbalance of plasma amino acids represented by the reduction of Fischer ratio and the depletion of visceral proteins are closely related to the impairment of lymphocyte function in the patients with active pulmonary tuberculosis.抄録全体を表示PDF形式でダウンロード (1068K) -
江森 方子, 斎藤 肇, 冨岡 治明, 瀬戸川 朝一1994 年 69 巻 4 号 p. 317-322
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーIn order to establish an animal model for disseminated M. avium complex (MAC) infections frequently encountered in AIDS patients, we studied growth of M. intracellulare in visceral organs (lungs, livers, spleens, kidneys), in blood, and in footpads of mice with defined immunodeficiencies, such as SCID mice with T and B cell-defect, BALB/c athymic nude mice with matured T cell-defect, and beige mice with NK cell-defect. In addition, Sprague-Dawley rats with acquired immunodeficiency induced by cyclosporine-treatment were also examined. The following results were obtained.
1) SCID mice: First, SCID mice were infected sc with 6.1×106 CFU of M. intracellulare N-260 (virulent SmT colonial variant) into the hind footpad. The organisms grew in the footpad remarkably during the 12 weeks after infection in SCID mice, where the growth rate was much greater than that in CB-17 strain mice with the same genotype as SCID mice and in BALB/c mice with Begs genotype (CB-17 and BALB/c mice are MAC-susceptible). Furthermore, in SCID mice, bacteremia and dissemination of organisms to the visceral organs were observed but not in the two control strains of mice.
Second, SCID mice were infected iv with 4.8×106 CFU. The bacterial loads in the viscera of SCID mice after infection were larger than those of CB-17 mice except for livers. However, the incidence and the degree of gross lung lesions were much less in SCID mice compared to CB-17 mice, presumably due to the defect in T cell-mediated immune reactions in SCID mice.
2) BALB/c athymic nude mice and beige mice: Various strains of mice (BALB/c athymic nude, beige, SCID, CB-17, BALB/c euthymic) were infected iv with 4.8×106 CFU of M. intracellulare N-260. The severity of the pulmonary lesions and the size of bacterial loads in the lungs were the greatest in beige mice. On the other hand, the bacterial loads in the spleens and kidneys of SCID mice and BALB/c athymic nude mice were similar and higher when compared to those in beige, CB-17, and BALB/c mice.
3) Cyclosporine-treated Sprague-Dawley rats: In the cyclosporine-treated rats, ivinfection with 2.1×107 CFU of M. intracellulare N-260 resulted in a slight increase in the bacterial loads in the lungs and spleens during the first 8 weeks after infection. This suggests that persistent infection was inducible in the cyclosporine-treated rats. In contrast, organisms were gradually eliminated from lungs and spleens in normal rats.
These findings indicate that a systemic infection can be induced by challenging M. intracellulare into the footpad of SCID mice. This experimental system may serve as a model for the disseminated MAC infections seen in immune compromised hosts such as AIDS patients.抄録全体を表示PDF形式でダウンロード (727K) -
藤澤 伸光, 永尾 玲子, 木元 克治, 加藤 收, 末岡 尚子, 青木 洋介, 山田 穂積1994 年 69 巻 4 号 p. 323-328
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーIn this study, we report on two patients diagnosed with active pulmonary tuberculosis who later developed complications of lung cancer. In both instances, lung cancer was not detected until after cessation of tuberculostatic drugs. Both patients were initially considered to be experiencing exacerbation of pulmonary tuberculosis.
Patient 1 was a 77-year-old female. A roentgenogram of her chest revealed a cavitary lesion with infiltration into the right lung field. Her sputum tested positive for acid-fast bacilli. Although she was treated with isoniazid (INH), rifampicin (RFP) and streptomycin sulfate (SM), the RFP and INH treatments had to be discontinued due to liver dysfunction. Her general condition was deteriorated, and pleural effusion appeared on a subsequent chest roentgenogram. Primary squamous-cell lung cancer was confirmed by conducting a trans bronchial biopsy.
Patient 2 was a 59-year-old male. A roentgenogram of his chest revealed multiple cavitary lesions with infiltration into the bilateral lung field. His sputum also tested positive, for acid-fast bacilli. Although he was treated with INH, RFP and SM, INH and RFP treatment had to be discontinued due to liver dysfunction and high fever. The shadow infiltrating the left lung field subsided, but a massive shadow appeared in the right lung field. Primary small-cell lung cancer was coofirmed after conducting a sputum cytology. Patient 2 was a 59-year-old male. A roentgenogram of his chest revealed multiple cavitary lesions with infiltration into the bilateral lung field. His sputum also tested positive, for acid-fast bacilli. Although he was treated with INH, RFP and SM, INH and RFP treatment had to be discontinued due to liver dysfunction and high fever. The shadow infiltrating the left lung field subsided, but a massive shadow appeared in the right lung field. Primary small-cell lung cancer was coofirmed after conducting a sputum cytology.
Active pulmonary tuberculosis may be complicated by immunosuppression due to anticancer drugs. Therefore great care must be paid toward the initiation of cancer treatment. However, concomitant lung cancer should be actively treated during the use of effective tuberculostatic drugs if the treatment is expected to effectively control the lung cancer.抄録全体を表示PDF形式でダウンロード (1342K) -
厚生省保健医療局エイズ結核感染症課編1994 年 69 巻 4 号 p. 335-343
発行日: 1994/04/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (1045K)
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