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Volume 72, Issue 2
Displaying 1-5 of 5 articles from this issue
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Terumi KIMOTO, Tetsuji KAWAMURA, Yasuharu NAKAHARA, Yoshirou MOCHIZUKI1997 Volume 72 Issue 2 Pages 61-65
Published: February 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSFrom 1988 to 1995, a bronchial washing was performed on 118 cases of middle lobe syndrome at the National Himeji Hospital. Twenty cases (16.9%) were positive for Mycobacterium avium complex (MAC). All cases were middle-aged (mean age 54.8), nonsmoking women. Fourteen cases were asymptomatic and showed only abnormal shadow on chest X-ray film, while others complained cough, sputum or hemosputum. CT examinations were done on 13 patients, and pulmonary infiltrations were found in addition toright middle lobe or lingula in many cases. It is important to note that MAC infection might be one of causes of middle lobe syndrome.View full abstractDownload PDF (4981K) -
CURRENT PROBLEMS OF MEDICAL CAREAkira FUJITA, Akira SUZUKI, Tomoko HAMAOKA, Hirokazu TOJIMA1997 Volume 72 Issue 2 Pages 67-72
Published: February 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTo clarify the problems of medical care of HIV-infected tuberculosis patients, we investigated clinical course of six cases admitted to our tuberculosis isolation ward.
All cases were sputum smear positive for tubercle bacilli at the time of diagnosis of tuberculosis. HIV-positive was confirmed at the same time or soon after the diagnosis of tuberculosis in four cases. CD4+ cell count was on the average 21/mm3 on admission, and all cases were defined as acquired immunodeficiency syndrome (AIDS) by the criteria. of AIDS surveillance committee in Japan. Two patients presented with miliary tuberculosis and five documented evidence for intrathoracic and/or cervical lymphnode involvement.
All cases but one responded well to antituberculosis drugs, and sputum smears and cultures became negative soon after the initiation of therapy. However, the patients were still needed to be hospitalized for the treatment and control of complications other than tuberculosis after sputum negative conversion, and they stayed in the isolation rooms of our tuberculosis ward for 110±49 days.
During the treatment for tuberculosis, each patient developed 3 to 8 complications of HIV infection such as pneumocystis carinii pneumonia (PCP) (four cases), bacterial infection (four cases), neuropathy (four cases), and HIV encephalpathy (three cases). The last two complication worsened active daily life.
White blood cell count was more likely to fall when sulfamethoxazole/trimethoprim mixture for the prevention of PCP and antituberculosis drugs were administered together. In three cases, ST mixture could not be continued, then two patients developed PCP after changing to an alternative pentamidine inhalation.
Although three patients discharged from our tuberculosis ward, four died of AIDS related complications other than tuberculosis, one died of tuberculosis (mutidrug-resistant
M. tuberculosis strain was not documented initially but was detected five months later), one died of tuberculosis meningitis after the discharge, and one was lost because he returned to his own country. The survival time between the start of treatment and deathranged from 90 to 244 days in five cases.
Integrated medical care system both for HIV and tuberculosis is warranted for the management of HIV-infected tuberculosis patients since they suffer many complication in addition to tuberculosis. A guideline of methods and duration of isolation for tuberculosis is needed for the most effective care of HIV-infected tuberculosis patients in Japan.View full abstractDownload PDF (850K) -
Hirotaka OHSE, Takefumi SAITO, Kennosuke KADONO, Kuniyoshi HIRANO, Sad ...1997 Volume 72 Issue 2 Pages 73-77
Published: February 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 46-year old man was admitted to a hospital because of cough and dyspnea. He was diagnosed as interstitial pneumonia and was treated with prednisolone (PSL) and antibiotics. The symptoms improved temporarily but he soon developed acute respiratory failure and was transferred to our hospital. Chest X-ray and CT revealed ground-glass opacities in both lung fields. He was treated with methyl PSL, antibiotics, and antimycobacterial drugs but he died on the fourth hospital day. Retrospectively, hematologic laboratory examinations revealed that CD 4+ cell count was 0/μl and serological tests for HIV were positive by both EIA and Western blot methods. The culture of the bone marrow specimens was positive for mycobacteria other than M. tuberculosis, and the bacilli were identified as Mycobacterium avium. Thus, his disease was eventually diagnosed as disseminated Mycobacterium avium complex (MAC) infection.
In the past reports, the diagnosis of disseminated MAC infection was most often made by blood cultures, however, the isolation of MAC from bone marrow is another sensitive and specific method for the diagnosis of this infection. Insome cases, bone marrow examination would be useful to diagnose disseminated MAC infection.View full abstractDownload PDF (3219K) -
Ryozo YONEDA1997 Volume 72 Issue 2 Pages 79-131
Published: February 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (34362K) -
1997 Volume 72 Issue 2 Pages 135-137
Published: February 15, 1997
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (383K)
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