All issues
Volume 77, Issue 12
Displaying 1-9 of 9 articles from this issue
- |<
- <
- 1
- >
- >|
-
Yoshihiro KOBASHI, Toshiharu MATSUSHIMA, Niro OKIMOTO, Yoshihito HARA2002 Volume 77 Issue 12 Pages 771-775
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe made a clinical analysis of the cause of death of forty deceased patients with active pulmonary tuberculosis who were admitted to Kawasaki Medical School Hospital, Kawasaki Medical School Kawasaki Hospital, and Asahigaoka Hospital during the period from January 1996 to December 2001
The age of 40 deceased patients (29 males/11 females) ranged from 55 to 93 years old, and were mostly bedridden. Underlying diseases existed in all except one case, and they were respiratory diseases in 9 patients and non-respiratory diseases in 34 patients. Laboratory findings revealed poor nutritional conditions. The diagnosis of pulmonary tuberculosis was established within one month from the appearance of symptoms in over half of these patients because most of them were smear positive for Mycobacterium tuberculosis. None of the strains of Mycobacterium tuberculosis isolated from these patients were multidrug resistant for antituberculous drugs and only one strain was completely resistant for Rifampicin. Radiological findings of the tuberculosis were bilateral in 30 patients. Consolidation shadows without cavity were noted in 22 patients, and extension within the unilateral lung field was observed in 24 patients. Regarding the cause of death, advanced pulmonary tuberculosis was the cause in 17 patients and non-tuberculous diseases were the cause in 23 patients. There were 15 patients with bacterial superinfections such as bacterial pneumonia, 4 with malignancy, and 4 with other disease.
The number of pulmonary tuberculosis patients in poor general and nutritional condition has been increasing with the aging of the Japanese population. Treatment for pulmonary tuberculosis has been successful in most cases, however, the number of the deaths unrelated to tuberculosis including those due to bacterial superinfection has been increasing. Therefore, treatment should be considered against resistant microorganisms such as MRSA.View full abstractDownload PDF (772K) -
Shin SASAKI, Yoshirou MOCHIZUKI, Yasuharu NAKAHARA, Akira TANAKA, Tets ...2002 Volume 77 Issue 12 Pages 777-782
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSIn Japan, patients with smear-positive pulmonary tuberculosis (SPTB) are hospitalized in a sanatorium because of the law for the prevention of tuberculosis, and not in a general hospital. According to our experience, however, some of the patients with SPTB are hospitalized in a general hospital.
In order to study if it is possible to prevent the admission of patients with SPTB to a general hospital, we retrospectively reviewed and compared the medical records of pulmonary TB patients whose sputum was smear-positive for Mycobacterium tuberculosis at our outpatient clinic (Group B; n=61), and patients whose sputum was smear-positive after the admission to our hospital (Group A; n=17).
The Group A patients were significantly older than the Group B patients [mean age, Group A, 67 years vs Group B, 56 years; (p =0.01)]. Compared with the Group B patients, the Group A patients more often suffered from underlying diseases [percentage of patients with underlying disease, Group A, 88.2 % vs Group B, 37.7%; p<0.001]; more often showed atypical infiltrative patterns of pulmonary tuberculosis [percentage of cases showing atypical chest roentgenograms, 70.6 % vs 19.7 %; p<0.001]; and were in a more serious condition [percentage of deaths during treatment, 47.1% vs 1.7%; p<0.001].
We conclude that hospitalization of SPTB patients in general hospitals is inevitable, because SPTB can not always be accurately diagnosed before admission, and because it is sometimes difficult to send severely ill SPTB patients to a sanatorium which is inconveniently located in the countryside. We propose to provide facilities for the treatment of SPTB at all general hospitals in Japan.View full abstractDownload PDF (1435K) -
A Study on Isolates of M tuberculosis in Southern Half of Osaka PrefectureHiromi ANO, Yoshio MORIYAMA, Tomoshige MATSUMOTO, Nobuko TANIGAWA, Hir ...2002 Volume 77 Issue 12 Pages 783-788
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSAbstract Restriction fragment length polymorphism, RFLP or DNA fingerprinting technique provides a very useful tool for the study of epidemiology of tuberculosis transmission in human.
We performed RFLP analysis with the IS6110 insertion sequence of the organisms isolated from culture-positive patients who visited our Hospital during the period from January to December 2001. Our Hospital covers patients living in southern half of Osaka Prefecture including a part of Osaka City, which is the highest TB prevalence area in Japan.
The number of copies of IS6110 per isolate ranged from 1 to 21. Most isolates (67 %) carried 10 to 15 copies.
Of 410 available isolates during the year of 2001, 131 (32 %) belonged to a cluster and 279 (68 %) did not. The clusters comprised one matching isolate in minimum to 13 isolates irmaximum and had a total of 49 distinct RFLP patterns. The average age of the clustered cases was 52.1 years and 64% cases belonged to patients with ages younger than 60 years.
Above findings suggest that many cases of tuberculosis in southern part of Osaka Prefecture result from recent transmission. It remains to be elucidated, however, how and where these recent infections occurred in these clustered cases.View full abstractDownload PDF (859K) -
Fuminobu KURODA, Fumio YAMAGISHI, Yuka SASAKI, Takenori YAGI, Tomoko H ...2002 Volume 77 Issue 12 Pages 789-793
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSThe subjects consisted of 42 patients aged over 60 years, whose performance status (PS) was grade 3 or 4, and who had been admitted for pulmonary tuberculosis at National Chiba-Higashi Hospital between 1997 and 1998. The average age (±SD) of the 34 men and 8 women was 77.6 (±8.5) years (range, 60-91 years). The mean stay in the hospital of the improved patients was 166.6 days (range, 57-303 days), and the mean survival period from admission to death was 43.4 days (range, 2-179 days in died patients). On admission to our hospital, 26 cases were sputum smear positive, 8 cases were smear negative and culture positive, and 8 were negative both on smear and culture. The cavity was observed in 30 cases (71.4 %) on the chest X-ray. The laboratory data on admission revealed low nutritional condition. The mean serum total protein, albumin, and cholesterol level on admission were 6.2 (±0.82) g/dl, 2.7 (±0.62) g/dl, and 143.0 (±41.9) mg/d/. Most of the patients had a difficulty in taking foods, and 20 cases (47.6 %) were performed parenteral nutrition by central venous catheter. 23 cases (54.8 %) received oxygen therapy by facial mask or nasal tube. The most common cause of low PS on admission was pulmonary tuberculosis in 14 cases (33.3 %), followed by cerebrovascular diseases in 11 cases, and orthopedic disease in 8 cases. The proportion of patients whose cause of low PS was not due to lung tuberculosis increased with age. Observing the mortality by the route of administration of antituberculosis medications on admission, 19 (55.9 %) of 34 cases who could take drugs per oral route died. One (50.0 %) of 2 cases who were administered drugs through gastric tube died, and all (100.0 %) of 5 cases who could not take drugs per oral route and were injected isoniazid and streptomycin died. One case who could not administer any drug died. 16 cases improved and 26 cases died, of whom the most common cause of death was pulmonary tuberculosis in 11 cases (42.3 %), followed by bacterial pneumonia in 5 cases, and cerebrovascular disease in 3 cases. The mortality by the PS on admission were as follows: 10 (47.6 %) of 21 cases with PS 3 died. 16 (76.2 %) of 21 cases with PS 4 died. 16 (6.4 %) of 249 cases aged over 60 years with PS 0, 1 or 2, and were admitted for pulmonary tuberculosis at the same hospital during the same period died.
This study confirms that the prognosis of low performance status patients of pulmonary tuberculosis in the elderly was significantly poor. We have to detect tuberculosis patients in the early stage, and give them antituberculosis medications per oral route as far as possible.View full abstractDownload PDF (679K) -
Shinichi MATSUNAGA, Hideaki NAGAI, Shinobu AKAGAWA, Atsuyuki KURASHIMA ...2002 Volume 77 Issue 12 Pages 795-798
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSA 30-year old man of Myanmar origin was admitted to our hospital because of productive cough, anorexia, weight loss and fever. Sputum smear was strongly positive for M tuberculosis (Gaffky 6) and sputum culture proved M. tuberculosis. Caseous necrosis with Langhans giant cells was observed in the biopsied specimens of the liver and bone marrow. He was diagnosed as miliary tuberculosis.
Treatment with combined use of isoniazid, rifampicin, ethambutol and streptomycin was started. After one month, his cough resolved, fever subsided and chest X-ray findings improved. Two months later, non-productive cough and fever recurred. Chest radiograph and computed tomographic scan of the chest revealed diffuse ground-glass opacity. Specimens taken by transbronchial biopsy showed pneumocystis carinii in alveoli. Pulsed use of methyprednisolone with Trimethoprim-sulfamethoxazole was started. The symptoms and chest X-ray findings disappeared and he recovered uneventfully.
Tests for HIV infection were negative. Anti-HTLV antibody was negative. There were no other suggestive evidences of immune suppression. CD4+T cell count was low, when Pneumocystis carinii pneumonia occurred. The relation between miliary tuberculosis, Pneumocystis carinii pneumonia and CD4-T lymphocytopenia has remained unelucidated.View full abstractDownload PDF (1129K) -
Fumio YAMAGISHI2002 Volume 77 Issue 12 Pages 799-804
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSWe describe the actual situation of and measures for medical risk factors of tuberculosis in compromised hosts and elderly people. Cases of diabetes mellitus, collagen desease and lung cancer administered corticosteroid preparations are taken up as compromised hosts.
The frequency of TB patients having diabetes mellitus concurrently tends to increase, and the relative risk of diabetics developing tuberculosis is also high. Physicians giving diagnosis and treatment of diabetes mellitus should understand that diabetics belong to the high risk group of developing tuberculosis and perform chest X-ray examination periodically. In order to prevent the development of tuberculosis from diabetics, it is considered preferable to give chemoprophylaxis where there is no history of TB treatment and healing of TB has been found on the chest X-ray films.
Where corticosteroid preparation, more than 10 mg in terms of prednisolone is administered over a long period of time for collagen deseases except rheumatoid arthritis and lung cancer, chemoprophylaxis is considered desirable.
As for the present situation of the elderly TB patients among in-patients at our hospital, the elderly often had serious complications, their prognosis was poor and they often died of the diseases other than tuberculosis.
To strengthen the measures to deal with tuberculosis in the elderly, early discovery and prophylaxis of pulmonary tuberculosis are considered. For the early discovery when the patient is symptomatic, the examination of sputum along with chest X-ray examination is important. As for the periodical health examination, the patients with the risk of infection to those around them being high need to undergo the health examination for sure. As the prophylactic measures, chemoprophylaxis is recommended where there is no history of TB treatment and healing of tuberculosis has been found on chest X-ray films.View full abstractDownload PDF (1096K) -
Atsuyuki KURASHIMA2002 Volume 77 Issue 12 Pages 805-821
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSPulmonary non-tuberculous mycobacteriosis in Japan occurs more than about 5, 000 cases annually. Among them, about 70% are occupied by Mycobacterium avium complex (MAC) infection. Considering the frequency and the difficulty of treatment, we discuss mainly on pulmonary MAC infection on this report.
At National Tokyo hospital, secondary MAC infection after tuberculosis sequelae were 46.5 % out of 170 pulmonary MAC cases since 1969 to 1985, but it decreased to 19.4% out of 268 cases since 1986 to 2000. In this same period, a type of MAC infection like middle lobe syndrome without recognizing preceding pulmonary disease, increased to 69.8 % out of all pulmonary MAC cases (Fig. 1).
Recently, this type of pulmonary MAC infection, which consists with scattered nodular lesion and local bronchiectasis in middle lobe or lingula, attracts attention. Why is there much frequency in women? Why does it originate from middle lobe or lingula? Although, it shows a characteristic X-ray pattern, ant it is still an interesting problem, the origin of the disease cannot be clarified.
First diagnostic standard of non-tuberculous mycobacteriosis in Japan was submitted in 1967, and the current diagnostic standard was made in 1985, through several times improvements. These contents are almost similar to that of American diagnostic standard in 1997, but the new revision that reflected chest CT findings and bronchoscopic sampling etc, is pressed now.
In the treatment, INH or PZA, which is a key drug in tuberculous chemotherapy, is not a key drug in MAC chemotherapy. MAC chemotherapy is multidrugs combination chemotherapy including EB, CAM, RFP, and aminoglycosides. However, it is difficult to achieve complete regression with current drugs combinations, and an early surgical resection is the most effective in case of localized MAC lesion.
We propose a guidance of treatment selection with age and disease severity (Table). Fig. 2 shows survival curves of 104 cases pulmonary MAC infection at National Tokyo Hospital.View full abstractDownload PDF (2676K) -
Chiyoji ABE, Tetsuya TAKASHIMA2002 Volume 77 Issue 12 Pages 823-826
Published: December 15, 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (575K) -
2002 Volume 77 Issue 12 Pages 838
Published: 2002
Released on J-STAGE: May 24, 2011
JOURNAL FREE ACCESSDownload PDF (30K)
- |<
- <
- 1
- >
- >|