Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) werestudied to clarify whether or not nocturnal oxyhemoglobin desaturation (NOD) could relateto acute exacerbation of chronic respiratory failure (AE). All patients had been untreatedwith home oxygen therapy, because they were not severely hypoxic. We performed sleepstudies, pulmonary function tests and arterial blood gas analysis and investigated pasthistory about AE in each patient.
Twelve patients had experienced AE with right heart failure and they were classified as CHF (congestive heart failure) group. The rest was classified as Non-CHF group. These twogroups were compared as for each variables examined.
There was no difference between the two groups in age, body weight, %VC, FEV1.0%, andawake Pao2. Awake Paco, was significantly higher in CHF group. Although no differencewas observed in baseline Sao2, the degree of NOD was significantly greater in CHF groupwhen evaluated by lowest Sao2 during sleep and 85% desaturation time (total time spentwith Sao2 less than 85%).
Moreover, 21 of Non-CHF and 6 of CHF were studied for cardiac parameters usingright side cardiac catheterization. While the differences of mean pulmonary arterialpressure and cardiac output between the two groups were not significant, pulmonaryarteriolar resistance was higher in CHF group.
We concluded that NOD in TB seq. had a major role in AE with right heart failure. Wespeculated that AE might be caused, at least partly, by pulmonary vasopressor response torecurrent NOD.

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We studied the usefulness of percutaneous instillation of antifungal agents fortreatment of pulmonary aspergilloma. The subjects were six patients, four males and twofemales, with a mean age of 69 years (range, 45 to 90 years). In all cases, radiographyrevealed a fungus ball or thickened cavity wall in residual tuberculous cavities. The patientshad clinical symptoms including hemoptysis, fever, cough and sputum, and most of themshowed severe emaciation, anemia, hypoalbuminemia and hypoxia. Miconazole orfluconazole was instilled through an indwelling catheter inserted percutaneously into thecavity from the anterior chest wall or parascapular region under fluoroscopic observation.
After treatment with a total dose of 610 to 2070mg over a period of 6 to 18 weeks, clinicalsymptoms were diminished in all patients and radiographic findings were improved in five.
Furthermore, Aspergillus fumigatus, which had been isolated from sputum samples of threepatients, was eradicated. According to evaluation of the overall therapeutic effects, thistherapy was considered to be effective in five patients, giving an efficacy rate of 83%. Norecurrence has been detected in six patients during a mean follow-up of 13 months aftertreatment. Since percutaneous instillation involves less pain and stress than other kinds oftherapy, it can be applied for patients who are elderly or in poor general conditions. And itseffect is definite, as demonstrated by our study, it is concluded that this therapy is usefulfor the treatment of pulmonary aspergilloma in inoperable cases.

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The development of specific chemotherapeutic agents revolutionally improved theprognosis of tuberculosis and markedly shortened the duration of the treatment. Evidenceof successful treatment with short-course regimens for pulmonary tuberculosis has beenaccumulated. But, the duration of hospitalization tends to be determined empirically andvarys among hospitals and clinicians. Generally speaking, the duration of hospitalization islonger in Japan than in the United States and Europian countries.
We investigated retrospectively the duration of hospitalization, treatment period, andrecurrence rate of the disease for patients with pulmonary tuberculosis who admitted to the Tokyo Metropolitan Fuchu Hospital in the years 1984, 1988, and 1991.
Patients who had been previously treated for more than 2 weeks and/or, had severecomplications, such as malignancy and miliary tuberculosis were excluded from the study.
Cases who died during the hospitalization and discharged without permission were alsoexcluded.
Numbers of subjects in each year were 114, 114, and 115 in 1984, 1988, and 1991, respectively. A total of 343 patients (M; 254, F; 89) were enrolled to the study and theiraverage age was 49.4 yrold. A number of patients with both smear and culture positive insputum bacteriology was 210 (61.2%), and 42 cases (12.2%) were smear negative and culturepositive.
The results are as follows:
(1) Mean duration of hospitalization in the years 1984, 1988, and 1991 were 141, 102, and 72 days, respectively. That is, a mean hospitalization period was shortened to abouthalf during these seven years.
(2) According to the chest x-ray classification (Group A; I, II3, B; II 1, II2, III3, C; III1, III 2), mean durations of hospitalization were 186 days for group A, 143 days forgroup B, and 108 days for group C in 1984, and 96 days, 76 days, and 59 days in 1991, respectively.
(3) According to sputum bacteriology, mean durations of hospitalization were 169 daysfor (S+/C+) cases, 105 days for (S-/C+) cases, and 90 days for (S-/C-) cases in 1984, and 83 days, 67 days, and 41 days in 1991, respectively.
(4) Mean duration of treatment was also shortened by years. The difference oftreatment periods among groups classified by X-ray findings was relatively small incomparison with that of hospitalization periods.
(5) Of 220 cases who completed treatment and were subsequently followed in ourhospital, 52 cases were followed for less than six months, 47 cases for 6-12 months, and 121cases over one year after the end of treatment. During these observation periods, relapsehas occurred in two patients. In addition to these relapse cases, one patient turned to bebacteriologically positive in sputum again during treatment and the one more patient withorganisms resistant to both isoniazid and rifampicin did not become sputum negativedespite of the treatment.
The principal aims of hospitalization for patients with pulmonary tuberculosis areinduction of intense chemotherapy and treatment for complications. On the basis of the lowfrequency of multi-drug resistant case, we concluded that the duration of hospitalizationcould be shortened for the patients who have no history of previous treatment and havegood compliance to current regimen.

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A 43 Year old female smoker was admitted to our hospital for evaluation of solitarypulmonarynodule (SPN). She had no symptoms, and no past history or family history thatmight suggest compromised defense against pulmonary infections. Physical examinationand laboratory findings including humoral and cell-mediated immunity revealed noabnormality. The chest radiography taken 2 years ago looked normal, but those onadmission showed SPN in a left lower field. Computed tomography (CT) revealed solitaryelipsoid nodule in S5. Because two trials of transbronchial biopsy, brushing and washingcould not give any diagnostic findings, thoracotomy was performed under tentativedaignosis of lung cancer. The lesion was located in the outer portion of S5 and was found toconsis of 2 elastic hard nodule surrounded by a atelectasis with inflammation. The nodulehad supprative substance with several acid fast bacilli, and its intrapoerative pathologyrevealed epitheloid cell granulomas. The lesion was resected completely. In a mean while, seventysmooth colonies grew on an Ogawa egg medium, which was identified as M. aviumbythe probe analysis using SNAP TEST (R). The final diagnosis of pulmonary M. aviumdisease was made, and the patient was administered RFP, EB, OFLX, and CAM in aoutpatient clinic. Some discussions were also made about CT findings of pulmonary M. avium complex disease developed in patients without any predisposing conditions

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A 22 year-old woman was admitted to our hospital complaining of subtle fever andproductive cough. She did not smoke and had no underlying disease. Her chest radiographshowed infilltration in the right upper lung field. A diagnosis of Mycobacterium fortuitumpulmonary disease was made on the basis of isolation of M. fortuitum from repeatedsputum cultures. On admission, we administered standard antimycobacterial agents, butfound the M. fortuitum isolated in this case to be completely resistant to them. We thenadministered antibiotics including 600mg of ciprofloxacin and 200mg of doxycycline. Thepneumonic findings on chest X-ray and her clinical symptoms gradually improvedthereafter. The in vitro susceptibility tests confirmed the efficacy of ciprofloxacin anddoxycycline. We concluded that these drugs contributed significantly to improve the disease.

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