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Volume 74, Issue 1
Displaying 1-6 of 6 articles from this issue
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Masashi MORI1999 Volume 74 Issue 1 Pages 1-4
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSTuberculosis had been the leading cause of death in Japan until 1950, and in these days there were about 3 million patients with active tuberculosis every year. From about 1950 to 1960 surgery was the treatment of choice if there were cavities and the lesions were regional. The number of patients who had thoracoplasties and/or pulmonary resections at national sanatoriums during the period of 1954 to 1961 was about 200, 000. Since national sanatoriums had about 25% of the total beds for tuberculosis in Japan at that time, the total number of surgically treated patients would be around four times this number, that is 0.8 to 1.0 million. Many of those who survived suffered later from complications, which included chronic respiratory failures, chronic hepatitis (hepatitis C), liver cirrhosis and/or hepatic cell carcinomas.
There are at least 50, 000 patients who are under home oxygen therapy (HOT) in Japan, of whom about 30% are those with pulmonary tuberculosis sequelae (TBS). The survival rate after the start of HOT in these patients was found better in those who had surgical treatments than in those who had medical treatments only. Since hypercapnea was more common in the former, better survival rates in the hypercapnic than in the normocapnic patients with TBS as a whole could be due to the fact that more of the surgically treated patients were included in the hypercapnic group. For this reason, it is premature to conclude that hypercapnea is an independent favorable prognostic factor in TBS patients with chronic respiratory failure.
Because more than one-forth of thoracoplasties and/or pulmonary resections were done in national sanatoriums, it is the responsibility of those who are now working in national hospitals to treat and support these patients with TBS who developed complications such as respiratory failures, chronic hepatitis, liver cirrhosis, and/or hepatic cell carcinomas.View full abstractDownload PDF (488K) -
Jun-ichi YASUDA, Osamu OKADA, Takayuki KURIYAMA, Keiichi NAGAO, Fumio ...1999 Volume 74 Issue 1 Pages 5-18
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe investigated pulmonary hemodynamics and chest X-ray findings to explore significance of obstructive ventilatory impairment in patients with pulmonary tuberculosis sequelae.
One hundred and two patients underwent examinations of blood gases, spirometry, and right cardiac catheterization.
The patients were divided into two groups, according to forced expiratory volume in one second as the percentage of forced vital capacity (FVC), which was expressed as FEV1%. Group A (n=38) had FEV1% of 55% or lower and Group B (n=64), FEV1% above 55%.
First, the values of blood gases and hemodynamics were compared between the two groups, regarding the percent predicted value of FVC as a covariate.
Secondly, between 26 of Group A and 42 of Group B, the change of pulmonary arteriolar resistance (PAR) before and after 100% oxygen breathing for 10 minutes was compared.
These comparisons were made by exploratory data analysis.
Lastly, we described every case with five items of chest X-ray findings and the extent of each finding we had defined. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity; pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. We explored X-ray findings influenced on airway obstruction by ridit (abbreviation for “relative to an identified distribution”) analysis, taking smoking status into consideration.
The results were as follows.
1) The patients of Group A tended to show severer hypoxemia and tissue hypoxia than the patients of Group B.
(2) The patients of Group A tended to show worse values of pulmonary hemodynamics than the patients of Group B. Under an even level of the arterial oxygen tension that was 60 Torr or lower, pulmonary artery mean pressure was higher in Group A than in Group B.
(3) PAR after oxygen breathing was less likely to decrease in Group A than in Group B.
(4) As any mean ridit was standardized and adjusted to 0.5 in Group B, every mean ridit of “emphysematous change” in Group A was the largest-0.63 in non-smokers, 0.74 in ex-smokers and 0.70 in current smokers. Therefore, “emphysematous change” was more influenced on airway obstruction than any other finding because of the largest mean ridit.
We conclude as follows.
Pulmonary hypertension is more serious in patients suffering from severe airway obstruction with pulmonary tuberculosis sequelae, and it may be attributable to reduction in capacity of anatomical pulmonary vascular bed rather than hypoxic pulmonary vasoconstriction.
Pathological changes such as “emphysematous change” on the radiograph might be considered as an important cause of obstructive ventilatory impairment.View full abstractDownload PDF (1785K) -
Setsuko TAZAWA, Kenji MARUMO, Yoshiko NAKAMURA1999 Volume 74 Issue 1 Pages 19-25
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSFifteen isolates of Mycobacterium kansasii in Showa Universty Fujigaoka Hospital between 1982 and 1995 were investigated. Comparing by gender, 13 were isolated from male patients and only two were isolated from female patients. The average of cases was 48 years old and 14 out of 15 cases (93%) were isolated from respiratory tract specimens. The rate of the smear-and culture-positives was 64%, which was significantly higher than that (26%) of M. avium complex (p<0.01 by χ2 test). All 4 isolates were susceptible to rifampicin (10 μg/ml) by drug susceptibility testing using Ogawa egg medium, and only 1 was resistant to ethambutol (2.5μg/ml). Seven out of 10 patients whose medical record was available were diagnosed as pulmonary infection with M. kansasii. Two out of 4 patients with primary infection type had underlying diseases such as diabetes mellitus and leukemia, while the remaining two patients did not have any underlying disease. Two out of 3 patients with secondary infection type had a medical history of tuberculosis and the remaining 1 patient had infected pulmonary cyst. Such as Pseudomonasaeruginosa, Enterobacter aerogenes and Flavobacterium spp., and Branhamella catarrhalis, associated with M. kansasii, bacteria more than 107 cfu/ml were isolated from the sputa of 3 patients with leukemia, infected pulmonary cyst and post-tuberculosis, respectively. M. kansasii, Stenotrophomonas maltophilia (107 cfu/ml) and Candida albicans were detected from the sputum of 1 patient with nephrosis, for which steroid (predonin) and antibiotics (piperacillin and latamoxef) were administrated, however, this patient was not diagnosed as a case of M. kansasii infection. These findings suggest the fact that M. kansasii inhabits among compromised hosts of a city hospital.View full abstractDownload PDF (868K) -
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)Kenji TSUSHIMA, Keishi KUBO1999 Volume 74 Issue 1 Pages 27-32
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 51-year-old woman was admitted to our hospital complaining of fever and general fatigue. Physical examination revealed butterfly like erythema in face, facial edema and diffuse purpura all over her body. Laboratory data showed renal dysfunction, nephrotic syndrome and active phase of SLE. She was administered first methylprednisolone (1g/day/3 days by intravenous drip) then prednisolone (60mg/day/month, orally) and had immune adsorption therapy for eight times. However, 14 days after the last session of immune adsorption, she developed fever of 39°C and mild headache, and then 3 days later, she gradually became unconscious. Brain CT showed hydrocephalus. We diagnosed her as having tuberculous meningitis based on the detection of acid-fast bacillus in cerebrospinal fluid, and began treatment with antituberculous agents. We suspected that tuberculous meningitis had caused hydrocephalus. We tried percutaneous drainage of the left ventricle for hydrocephalus. Brain MRI showed a tuberculoma depicted as a mass of low intensity in the right cerebellum on the T 1 weighted image, and of high intensity on the T 2-weighted image, and the meninx in the basal cistern was enhanced. After treatment with antituberculous agents, we performed serial brain MRI and examined cerebrospinal adenosine deaminase activity (ADA). Despite treatment with antituberculous agents, new intracerebral tuberculomas had developed in some areas, whereas they had disappeared in other areas. After treatment for 4 months, the level of cerebrospinal ADA became normal, and the patient recovered consciousness despite the presence of multiple tuberculomas.
Both the cell counts and the level of ADA in cerebrospinal fluid are the good indicators of the activity of tuberculous meningitis and reflected its clinical course. Furthermore, the level of ADA in cerebrospinal fluid changed with brain MRI image. Serial brain MRI and examination of ADA in cerebrospinal fluid were useful to know the activity of tuberculous meningitis and to evaluate the response to treatment.View full abstractDownload PDF (6551K) -
Ariyoshi KONDO1999 Volume 74 Issue 1 Pages 33-41
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDrug can cause various types of lung damages, with drug-induced pneumonitis (including acute interstitial pneumonia, usual interstitial pneumonia, desquamative interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis obliterans with organizing pneumonia, eosinophilic pneumonia and hypersensitivity pneumonitis) being the most important among them. The incidence and the causative agents of drug induced pneumonitis have varied over time. Before 1980, anticancer agents and gold salts were the main drugs, and the number of causative drugs (61) and case reports was small. Recently, pneumonitis has increasingly been caused by Chinese herbal medicines, antibiotics, chemotherapy agents, anti-inflammatory drugs, analgesics, cytokines, and gold salts, and the number of case reports and drugs involved (177) has increased.
Drug-induced pneumonitis has characteristics that depend on the causative agent. Review of our patients and reports in Japan revealed the following. Pneumonitis caused by anti-inflammatory drugs, analgesics, and antibiotics generally develops at 1-2 weeks after starting administration, and bronchoalveolar lavage and histologic examination of lung biopsies reveals the features of eosinophilic pneumonia. Such pneumonitis is associated with a high frequency of a positive drug lymphocyte stimulation test (DLST), and has a good outcome. Conversely, with pneumonitis caused by anticancer and immunosuppressive agents, the onset is often delayed and the disease has features of diffuse interstitial pneumonia and pulmonary fibrosis. The frequency of a positive DLST is low, and the outcome is generally poor. Pneumonitis induced by Chinese herbal medicines, gold salts, and antituberculosis agents has intermediate features between the above two types: i.e., it develops after 2-3 months or six months (gold salts), and resembles either eosinophilic pneumonia, BOOP or interstitial pneumonia.
For in vitro identification of causative drugs, the DLST and the leukocyte migration inhibition test (LMIT) are generally used. The latter test is superior in sensitivity, suggesting that the mechanism of this test involves cytokines such as IL-1α, IL-1β, IL-2, TNF-α, and IL-8.View full abstractDownload PDF (1091K) -
Fumiyuki KUZE, Haruaki TOMIOKA1999 Volume 74 Issue 1 Pages 43-82
Published: January 15, 1999
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (4457K)
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