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Volume 70, Issue 7
Displaying 1-6 of 6 articles from this issue
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Koichi TOMODA, Takahiro YONEDA, Katsuhiko TSUKAGUCHI, Masanori YOSHIKA ...1995 Volume 70 Issue 7 Pages 415-421
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSProduction of Interleukin-1β (IL-1β) and granulocyte macrophage-colony stimulating factor (GM-CSF) by peripheral blood monocytes (PBMs) from patients with Mycobac terium avium-intracellulare complex (MAC) infection was assesed and the relationship with their clinical course was analyzed.
PBMs were obtained from MAC-infected patients in their active stage as well as in the inactive stage and the healthy controls.
Spontaneous release of IL-1β by PBMs from patients in the active stage was higher than those by the cells in the inactive stage or the healthy controls. On the other hand, spontaneous GM-CSF release by PBMs from patients in the active stage was higher than the healthy controls. When PBMs were stimulated with MAC-derived purified protein derivatives (PPD-B), increased production of both IL-1β and GM-CSF were obtained for PBMs in their active stage.
While these enhanced production upon stimulation with PPD-B related to the persistent infection with MAC, the increased IL-1β production correlated with the exhausted nutri tional state.
Both IL-1β and GM-CSF produced by PBMs seemed to be closely related with the clinical course of human MAC infection.View full abstractDownload PDF (854K) -
Takeshi HAGIWARA, Kagehiro Amano, Daisaku SUGIMURA, Naofumi ISOGAI, Mo ...1995 Volume 70 Issue 7 Pages 423-429
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 28-year-old hemophilia A patient was admitted to our hospital in July, 1991 because of high fever, chronic diarrhea and anemia. The patient had been recognized as a asym ptomatic carrier of human immunodeficiency virus (HIV) in 1985 and had developed Pneu mocystis carinii pneumonia and had been diagnosed as acquired immunodeficiency syndrome (AIDS) in 1990.
Hematologic laboratory examinations on admission revealed pancytopenia and a CD4+cell count of 3/mm3. X-ray findings of chest and abdomen were normal and bacterial cultures of sputum, urine, blood, stool, cerebrospinal fluid and bone marrow yielded no pathogenic microorganisms. Microscopical examination of the stained specimens showed no acid-fast bacilli. On his fifth hospital day, his liver and spleen enlarged markedly and an abdominal CT scan obtained on the 13th day revealed high-grade hepatosplenomegaly. Administration of several kinds of antibiotics, antifungal agents, antiviral agents, antituberculous agents and γ-globulin medicines did not relieve the symptoms. On the 28th day the patient had developed a subarachnoid hemorrhage and died five days later.
Retrospectively all cultures for acid-fast bacilli of the specimens on his admission yielded nontuberculous mycobacteria. The bacteria were identified as Mycobacterium avium by polymerase chain reaction and his disease was eventually diagnosed as disseminated Mycobacterium avium complex (MAC) infection. The liver and spleen weighed 2, 660g and 1, 840g respectively at autopsy. Although hepatosplenomegaly is commonly recognized in AIDS patients with disseminated MAC infection, such massive and rapid enlargement has been rarely observed. This case study emphasize the importance of diagnosis and rapid treatment at the early stage of MAC infection.View full abstractDownload PDF (4724K) -
Yasumichi ARAI, Reiko SATO, Takashi KATSURA, Hirokazu KOMATSU, Kanemit ...1995 Volume 70 Issue 7 Pages 431-437
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 49-year-old Japanese male who had been imprisoned for five years then lived withother men complained of fever, constitutional symptoms and a 12 kg weight loss over fourmonth period. He was referred to us as his gastric washings were positive for acid-fast bacilli (AFB). Chest X-ray showed patchy, infiltrative small shadows primarily in the right upper lung field without hilar adenopathy.
Before transfer to our hospital, tuberculosis chemotherapy composed of SM, INH, RFP and PZA was initiated. Over the next three weeks, fever dropped, and the above described abnormal shadows on the chest X-ray improved, leaving small cystic lesions. Although a sputum smear was negative for AFB, M. tuberculosis was isolated from cultured samples and sensitive to all standard anti-tuberculous drugs. AFB were also demonstrated on a touch imprint of biopsied cervical lymph nodes.
Sputum samples turned negative one month later both on smear and culture. Moreover, high fever developed and another abnormal shadow indicative of Pneumocystis carinii (PCP) appeared in the left lung field one month after the admission. White plaque was noted in the oral cavity. Dark red nodules were observed on the upper extremities and chest wall, and diagnosed histologically as Kaposi's sarcoma. Serologic testing for HIV was positive both by PA and Western blot methods, thus AIDS was diagnosed according to the CDC surveillance case definition for AIDS with the diagnosis of tuberculosis.
The patient died of wasting syndrome on the 90th hospital day. On autopsy, small thinwalled cavities were observed in the right upper lung, correlating with earlier X-ray and CT findings. These lesions showed poor granuloma formation with lesser degree of casea tion necrosis and fibrosis than the cavitation typically seen in HIV negative patients. Densely packed AFB were demonstrated by Ziehl-Neelsen staining in the foamy macro phages within the granuloma. These cystic lesions were connected with small terminal bronchioles which may play a role in bronchial drainage. In other lung fields, Grocott staining demonstrated PCP as well as the inclusion bodies of cytomegalovirus (CMV). This CMV was also present in the adrenal glands, in which it caused partial destruction of both the cortex and medulla.View full abstractDownload PDF (7224K) -
with Special Reference to Mechanism of Formation of Pleural RetractionSeiyu HIRATA, Kensuke YAMAMOTO1995 Volume 70 Issue 7 Pages 439-444
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA case of 62-year-old male patient with tuberculosis in the lower lung field of right side was reported. The case showed a solitary lesion in S8b of 2.5×2.0cm in size and was detected by the mass survey. The case was complicated with chronic renal failure and was treated by lobectomy because of suspicion of lung cancer, as there was a marked pleural indentation on CT.
By examining the resected specimen, the following findings were revealed. The solitary exudative tuberculous lesion located in the margin of the basal segment extended both to the costal and diaphragmatic pleura, and a small triangular shaped normal lung paren chyma located at the periphery of the lesion was isolated, and the air flow from the lower lobar bronchus was cut. As a result, hyperinflation of the isolated normal lung took place through collateral air leak and check-valve mechanism (The Culiner Theory), finally the pleural constriction was formed at the boundary between the lesion where the elasticity was lost and the hyperinflated parenchyma.View full abstractDownload PDF (7959K) -
Kazuhiko KAMEDA1995 Volume 70 Issue 7 Pages 445-455
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSPyrazinamide (PZA), an antituberculosis agent, was first synthesized in 1940 by Hall and Spoerri and a clinical trial was carried out since 1949 by Yeager and others. Its usefulness as a potent antituberculosis drug was first reported by them in 1952.
PZA was once believed to be a secondary choice drug for cases with refractory tuber culosis and/or relapsed cases which are resistant to all other antituberculosis drugs. There was some hesitation among doctors to use PZA for the initial treatment of tuberculosis because of rather high incidence of liver impairment after the use of regimens with PZA. It was, however, revealed later that this was not always true as PZA was ordinarily employed for clinical use in combination with ethionamide and/or cycloserin, and the latter drugs are both known to be hepatotoxic, too.View full abstractDownload PDF (1493K) -
[in Japanese]1995 Volume 70 Issue 7 Pages 457-459
Published: July 15, 1995
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (361K)
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