巻号一覧
75 巻, 6 号
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日本の臨床医との相違増山 英則, 青木 正和2000 年 75 巻 6 号 p. 413-422
発行日: 2000/06/15
公開日: 2011/05/24
ジャーナル フリーPeculiarity of TB treatment in Japan is a higher rate and duration of hospitalization than in other developed countries. Improvement of the TB control policy in Japan necessitates reexamination of the issue of treatment policy, which requires consideration of recognition and understanding of the concept of TB infection, human rights and the protection of patients as well as the society. Therefore, this study aims at clarifying and analyzing the differences in TB treatment policies in Japan and the US. For the US, a questionnaire was sent to TB Directors of states and large cities in order to analyze TB control policies. Moreover, the author attended the NTCA meeting held in Chicago to interview 16 TB Directors. In Japan, the author sent the same questionnaire translated into Japanese to medical doctors in 54 National TB sanatoria. The hospitalization rates of new smear-positive TB patients were 100% (median) in Japan and 59% in the US. The periods of hospitalization of these patients were 150 days (median) in Japan and 10 days in the US. The total expenses of TB diagnosis and treatment per capita were approximately US$ 25000 and 20000, respectively in Japan and the US. If the DOT strategy were applied to the new smear-positive TB cases in Japan, those total expenses would be reduced to half. On the measures against the TB patients who pose a threat to the public, the US has the series of TB control strategies which contain the reporting system, home isolation, incarceration and penalties for violation, while Japan has only the strategy of hospitalization. The TB policies of Japan in future would need to focus more selectively and carry out thoroughly as seen in the US. The recommended TB policies for Japan obtained from this study are to set TB policies adapted to regional characteristics and to review the strategy against patients posing a threat to the public.抄録全体を表示PDF形式でダウンロード (1253K) -
佐々木 結花, 山岸 文雄, 八木 毅典, 山谷 英樹, 黒田 文伸, 庄田 英明2000 年 75 巻 6 号 p. 423-427
発行日: 2000/06/15
公開日: 2011/05/24
ジャーナル フリーThe complication with tuberculosis of the central nervous system (CNS) were studied in 16 patients with miliary tuberculosis who were admitted to our hospital during a period of two years from April, 1997 to March, 1999, and were examined by head MRI. Twelve cases (75%) were diagnosed as having tuberculosis of CNS. Six cases had tuberculosis of CNS which was found during the screening of miliary tuberculosis cases, and all had only cerebral tuberculoma. Meningeal irritative symptoms led to the discovery of tuberculosis of CNS in the remaining six cases, in which cerebral tuberculoma was complicated with tuberculous meningitis.
Of these cases of meningitis, three cases showing disturbance of consciousness died, but no cases of death was found in cases by the screening. The length of time from the onset of symptoms to the diagnosis of tuberculosis was long in many of the cases complicated with tuberculosis of CNS compared with the cases without such a complication.
In the cases of miliary tuberculosis, the rate of complication with tuberculosis of CNS is high, and the possibility of patients developing serious symptoms suddenly even when they were asymptomatic at the time of diagnosis and the paradoxical expansion that becomes intensified after initiation of treatment have been reported. Therefore, it is necessary to make a close checkup of CNS when the diagnosis of miliary tuberculosis has been made.抄録全体を表示PDF形式でダウンロード (638K) -
中尾 祥子, 武田 昭範, 松本 博之, 佐々木 伸彦, 佐藤 和恵, 藤田 結花, 山崎 泰宏, 飛世 克之2000 年 75 巻 6 号 p. 429-434
発行日: 2000/06/15
公開日: 2011/05/24
ジャーナル フリーA 29-year-old male complaining of fever and general fatigue was admitted to our hospital. On admission chest X-ray showed infiltrative shadows with cavities in the bilateral lung apical areas, and sputum examination for acid fast bacilli was smear positive, Gaffky 1. He was treated as pulmonary tuberculosis (TB), and chest X-ray findings and sputum examination improved after a few months of treatment with antituberculous chemotherapy (INH, RFP, EB, PZA). However, tuberculous cold abscess appeared in retropharyngeal area, subcutaneous tissue of thoracic cage and retroperitoneal space, and shortly later, bone and joint TB were recognized in shoulder and wrist joints and vertebrae. The findings of vertebral foci were not recognized by a simple X-ray picture of vertebrae at that time, but MRI of vertebrae showed low intensity areas with ring enhancement in the cervical, thoracic and lumbar vertebrae. Despite treatment with antituberculous agents, new bone and joint TB had developed in many tissues and had accompanied with cold abscess in adjacent tissue, whereas pulmonary TB had improved after the initial transient worsening. The appearance of bone and joint TB was most probably caused by the initial transient worsening of hidden bone and joint TB as a part of the initial systemic transient worsening of tuberculosis. After treatment for 4 months, pulmonary TB as well as bone and joints TB had improved.
Tuberculous cold abscess in retropharyngeal may be secondary to cervical vertebral TB but is now rarely seen. In this case, involvement in many tissues such as retropharyngeal area, subcutaneous tissue of thoracic cage and retroperitoneal space were seen, and these findings are now uncommon and usually represents involvement secondary to contiguous infection.抄録全体を表示PDF形式でダウンロード (1462K) -
山岸 文雄, 佐々木 結花, 八木 毅典, 山谷 英樹, 黒田 文伸, 庄田 英明2000 年 75 巻 6 号 p. 435-437
発行日: 2000/06/15
公開日: 2011/05/24
ジャーナル フリーThe frequency of complication of diabetes mellitus in patients with pulmonary tuberculosis is high, and the presence of diabetes mellitus plays an important role in the development of pulmonary tuberculosis. We studied the frequency of complication of diabetes mellitus by year, sex and age among patients with pulmonary tuberculosis who were discharged from our hospital during a period of 12 years from 1987 to 1998.
The number of diabetic cases in patients with pulmonary tuberculosis was 588, namely 14.1% out of 4169 patients during the 12 years from 1987 to 1998. The frequency of complication of diabetes in every four years period showed an increasing trend 144 cases (11.8%) out of 1225 cases from 1987 to 1990, 208 cases (14.5%) out of 1434 cases from 1991 to 1994, and 236 cases (15.6%) out of 1510 cases from 1995 to 1998.
By sex, the frequency of complication with diabetes mellitus in male was about twice that of female, with 501 cases (16.0%) out of 3127 cases in male and 87 cases (8.3%) out of 1042 cases in female.
By age, the frequency of complication of diabetes mellitus showed a peak in the 40s and 50s in male, being 21.3% and 23.4% respectively. In female, it showed a peak in the 60s, being 18.5%.
In conclusion, in the 12 years the frequency of complication of diabetes mellitus in tuberculosis cases has been increasing, and the presence of diabetes mellitus has been playing more important role in the development of pulmonary tuberculosis.抄録全体を表示PDF形式でダウンロード (368K)
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