We examined physical and blood statuses of 24 patients with pulmonary M. avium complexdisease who entered our hospital from April 1993 to March 1997. Ten patients (41.7%) were diagnosed as primary infection type and 14 patients (58.3%) as secondary infection type. Twenty-four patients were classified to the following two groups: Group A was 14 patients who converted to MAC negative within six months after the admissionand group B was 10 patients who continued to excrete MAC for more than six months after the admission. We made a comparison between group A and group B as to the re -sults of physical and blood examinations on admission. Mean value of %IBW in group B was significantly lower (group B: 74.4±8.9%, group A: 82.9±12.7%, p<0.05) thanthat of group A. The level of serum albumin in group B was significantly lower (group B: 3.39±0.53g/dl, group A: 3.99±0.45g/dl, p<0.01) than that of group A. ChE in group B was significantly lower (group B: 321.2±94.5IU/l, group A: 442.9±148.4IU/l, p<0.05) than that of group A. Group B was nutritionally depleted than group A. In conclusion, these findings suggested that nutritional support should be taken into consideration incombination with conventional chemotherapy in treating chronic, intractable MAC disease.

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In order to assess the clinical features and clinical courses of endobronchial tuberculosis, which included trachea to segmental bronchus, we studied 34 cases of patients whowere admitted to TB ward of International Medical Center of Japan from 1994 to 1997. We noticed a higher incidence in females and in the main bronchus. Cough was the mostcommon complaint seen in 97% of cases. The duration of symptoms before the initiationof antituberculous chemotherapy was long (on the average 6 months), and they wereoften treated as bronchial asthma or bronchitis. Bronchoscopic examination is necessaryfor diagnosis. The scars sometimes gave rise to severe stenosis, especially when the lesiondeveloped to an advanced stage or circumscribed the lumen before treatment. We tried INH inhalation with systemic chemotherapy. Although rapid improvement was suggestedby this method, yet no significant difference was seen in the results for the efficaciousprevention of stenosis. Five cases required surgical intervension (bronchoplasty and lobectomy) in order to avoid atelectasis or secondary infection. Early diagnosis and appropriatetreatment are most important, and bronchoscopic examination is essencial inearly diagnosis.

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The incidence of tuberculosis in Japan, 33.7 per 100, 000 in 1997, is very high comparedwith USA or Western European countries. The decrease in the incidence has slowed downfrom the early 1980s, and the average annual rate of decrease has been 3.8% in the last5 years. About 9 percent of tuberculosis patients defaulted from the nine month regimen (6HRS or E/3HR) in urban areas. Regimens shorter than nine month are needed to achievehigh effectiveness of tuberculous chemotherapy. Out of 1128 new pulmonary tuberculosispatients, six-hundred twenty started treatment with six-month (2HRZS or E/4HRE) in Fukujuji Hospital, JATA, in Tokyo from January 1991 to December 1996. Out of 620, four-hundred twenty eight were both smear and culture positive, 136 were smear negativeand culture positive and 56 were bacilli negative. Out of 564 bacilli positive cases, 530were susceptible to INH and RFP. Out of 530 drug susceptible cases three hundred ninetythreepatients completed the regimen. Ninety-three percent of these patients had convertedto negative at two months of chemotherapy and all of them at five months. Outof 450, two-hundred ninety five completed 6 month regimen, one-hundred fifty-fivewere changed their regimen or prolonged duration of chemotherapy. Out of 295, nine patients (3.1%) relapsed after the completion of 6-month chemotherapy. Mean follow? upperiod was 17.2 months and the median was 15.5 months. The relapse rate was 2.2 per 100person-years. Six of the relapsed cases were complicated with Diabetes Mellitus. Relapserate was higher in patients with Diabetes Mellitus than in patients without (6/54, 7.9 per 100person-years vs 3/237, 0.8 per 100 person-years) (p<0.001). Drug-induced hepatotoxicity was defined as elevated serum transaminase level with clinical symptoms of hepatitis orelevated serum transaminase level more than 5 times of upper limit of normal range withor without symptoms. Drug-induced hepatotoxicity developed in 43 (8.0%) of 535 withinitial normal liver function test results, this rate was similar to that in patients treatedwith nine-month regimen (34/420, 8.1%). But the frequency of hepatotoxicity of morethan 400 IU/m/ of serum transaminase level was higher in patients treated with PZA-containingregimen than with nine-month regimen (16/536, 3.0% vs 4/420, 1.0%), but this deferencewas not statistically significant. Hepatotoxicity developed in 13/85 (15.3%) ofpatients treated with PZA-containing regimen with abnormal liver function tests at thebeginning of chemotherapy, and this frequency was similar to 7/65 (10.8%) in patientswith nine-month regimen. The relapse rate in patients with Diabetes Mellitus was statisticallyhigher than in without Diabetes Mellitus (7.9 νs 0.8 per 100 person-years). Weconcluded that the six-month regimen was highly effective, but the frequency of severehepatotoxicity was relatively higher than in nine-month regimen and the duration of chemotherapywas not enough for patients complicated with Diabetes Mellitus. Furtherstudy is needed for sufficient chemotherapy in patients with Diabetes Mellitus.

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A 45 year old man did not visit a doctor in spite of his complains, cough and sputumlasting, for six months, and he finally could not eat without beer, and as a result, helost his body weight and currently 52 kg. He became unconsciousness, was carried to ahospital, and was reffered to our hospital. His sputum examination for acid fast bacilliwas smear positive, Gaffky 6, for M. tuberculosis. His chest roentogenogram revealedlarge cavitary lesions in bilateral lung fields. On blood examination, WBC was 1100/μL, RBC was 256×10⁴/μL and PLT was 13.4×10⁴/μL. Total protein was 4.7g/dl, albuminwas 1.9mg/dl, and total cholesterol was 65mg/dl. We tried to aspirate bone marrowfrom his sternum, but it was impossible. Hence we did biopsy of his ilium. The pathologyof his bone marrow revealed gelatinous transformation. It was thought that themarked delay in visiting a doctor caused general consumption and loss of apetite, thusled to gelatinous transformation and finally pancytopenia.

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