In numerical classification, four species of the Mycobacterium nonchromogenicum complex, Mycobacterium nonchromogenicum, M. terrae, M. novum, and M. triviale, formed one cluster. These four species ...appeared to be reduced to one species, Mycobacterium nonchromogenicum. Furthermore, relationships between the species were numerically analyzed by using the hypothetical median organism pattern. The results showed that the M. nonchromogenicum complex can be divided into two subgroups: M. nonchromogenicum and the other three. These two subgroups were differentiated from each other by scores based on two or more positive reactions in the following three characteristics: resistance to bleomycin (5 μg/ml); heat‐stable acid phosphatase activity; nicotinamidase or pyrazinamidase activity or both activities. M. nonchromogenicum gave two or three positive reactions among these three, and M. terrae, M. novum, and M. triviale gave two or three negative reactions.
Three cases of lung infection due to M. nonchromogenicum, as well as three other cases of probable lung infection due to M. nonchromogenicum, were observed in this study. Only one organism isolated from one doubtful case was M. terrae. Up to now, M. nonchromogenicum was considered a nonpathogen. It was shown, however, that this organism causes lung infection in humans.
High-resolution computed tomography (HRCT) was performed in seven inflated and fixed postmortem lungs from seven asbestos-exposed patients with pathologically proved asbestosis. The parenchymal ...abnormalities seen at in vitro HRCT included thickened intralobular lines (n = 7), thickened interlobular lines (n = 7), pleural-based opacities (n = 7), parenchymal fibrous bands (n = 5), subpleural curvilinear shadows (n = 4), ground-glass appearance (n = 4), traction bronchiectasis (n = 4), and honeycombing (n = 2). The thickened intralobular lines were shown histologically to be due to peribronchiolar fibrosis. Thickened interlobular lines were due mainly to interlobular fibrotic thickening in four lungs and edema in three. The peribronchiolar fibrosis was most severe in the subpleural lung regions, creating curvilinear line shadows and pleural-based areas of opacity. Some subpleural fibrosis extended proximally along the bronchovascular sheath to create bandlike lesions. Areas of ground-glass appearance on HRCT scans were shown to be the result of mild alveolar wall and interlobular septal thickening due to fibrosis or edema. Postmortem HRCT findings were similar to premortem HRCT findings and correlated well with the pathologic findings of asbestosis.
As we consider the public hospitals in our country as clusters in terms of their scales, the group of National Hospitals and Sanatoriums will be certainly ranked well with those of University ...Hospitals, Red-cross and Saiseikai Hospitals, and local community hospitals. The University Hospitals make their raison d'être for education and research works, The Red-cross and Saiseikai Hospitals take part in the medical services lined with the nature of social welfares. The local community hospitals put more emphasis on the regional health care services including emergency cases. What should be, then, the raison d'être or purpose of National Hospitals? In answering to this question, we may refer that the National Cancer Center, the National Cardiovascular Center, and the National Center of Neurology and Psychiatry have established their highly admirable reputation as pioneers of the specific medical fields and will continue to be the leading medical institutions both domestically and internationally. However, nearly all the National Hospitals and Sanatoriums fall one step behind the Red-cross Hospitals or the local community hospitals not only in the regional health activities but also in the emergency medical services. They seem to be somehow passe, mere government-attached facilities or affiliated hospitals of the universities. They appeared to be dominated by the University Hospitals in the aspects of medical research works and even personnel and educational administration. In 1985, the Medical Service Law was amended to start the regional medical plans and to regulate available numbers of beds in each prefecture based on the population. Furthermore, according to the second Amendment of the Medical Service Law in 1992, the National Hospitals, the nature of which is between the wings of “hospitals for highly specialized medical service” and “hospitals for long-term medical service ” are enforced to clarify its functional status, performance and future respect. So far as National Hospitals are concerned to be medical service organizations, they should not be deviated or aloof from any regional medical activeties. On the other hand, they should have some different characteristics from the regional medical facilities in order to play the leading roles for the advanced medical care. They should also pursue for the role of guiding the related regional medical service. What then are they actually involved in? The environmental conditions around the regional medical services have been increasingly changed since the last few years, and the medical business has been severely deteriorated. Under such circumstance, the time has come to a crucial point at which the National Hospitals must decide on what a role it has to play in the regional medical services, and what kind of philosophy and principle it has to abide by at the stage of entering the coming 21st century. The most important point of stepping forward practically for this object may be found in the making of one model national hospital, which will achieve its own innovation and to which direction is to be destined. Preparations for obtaining consensus among the national hospitals and for stepwise planning are required as a matter of urgency. In this symposium, Mr. Ito, the Director of the Health Planning Division in the Health Policy Bureau of the Ministry of Health and Welfare, mentioned as one of the medical planners, that the drastic reorganization of the National Hospitals and Sanatoriums will be expected to play a supplementary role in the secondary medical area in each prefecture. From the standpoint of a system planner, Mr. Sueyoshi, the Director of the Division of Human Environment Research at the Mitsubishi General Research Institute, advised that first of all National Hospitals should establish a definite geopolitical goal for several service areas such as “Kinki region”, “Hokkaido region” and so o
To determine the earliest stage at which lesions in asbestosis can be diagnosed and to assess their progression, 23 asbestos-exposed patients with minimal or no abnormalities at plain radiography ...were examined with high-resolution computed tomography (HRCT) twice, with an interval of 12-37 months between examinations. In 21 of the patients, parenchymal abnormalities were found. Major parenchymal features seen at CT included thickened intralobular and interlobular lines, subpleural curvilinear lines, pleural-based nodular irregularities, hazy patches of increased attenuation, small cystic spaces, and small areas of low attenuation. At paired serial CT, subpleural isolated dots or branching structures connected with the most peripheral branch of the pulmonary artery started to appear in lower subpleural zones and then became confluent to create pleural-based nodular irregularities. CT-pathologic correlation led to the conclusion that the confluence of subpleural peribronchiolar fibrosis creates subpleural fibrosis.
Biological characteristics of three M. gordonae strains which caused infection in humans were compared with those of the strains considered as non-pathogenic. Two strains were isolated from patients ...with lung infection and another strain from left metacarpophalangeal joint abscess. These three strains were compared in respect to 91 characters with 22 strains recieved as M. gordonae. Of the three pathogenic strains, 1) two strains showed rough colonies, 2) all three strains were resistant to NH 2 OH (500 μg/ml), 3) no strain utilized pyruvate as the sole source of carbon in the presence of ammoniacal nitrogen, and 4) only one strain utilized urea and pyrazinamide, and no strain utilized nicotinamide as the sole source of nitrogen. In contrast, of the 22 non-pathogenic strains, 1) only 4 strains (18%) showed rough colonies, 2) only 5 strains (23%) were resistant to NH2 OH (500 μg/m l), 3) 16 strains (73%) utilized pyruvate as the sole source of carbon, and 4) 21, 22 and 19 strains utilized urea, pyrazina mide and nicotinamide, respectively, as the sole source of nitrogen.
From April1985to March1988, 1, 005patients underwent bronchoscopic examination with chest X-ray findings suggesting possibility of tuberculosis, yet the sputum was negative for acid-fast-bacilli on ...repeated smear examination. In the first two years, forty-nine patients out of 660 were subsequently proven to have active disease. Among these 49 positive cases, a clinical flare-up was found in five patients with aggravated pulmonary lesions. All of these 5 aggravated lesions happened to be located in right upper lobe. In the latter one year, 345 patients underwent bronchoscopy were given postmedications with isoniazid and ofloxacine, which resulted in hardly any patient out of sixteen active cases showed aggravation of tuberculosis except one who had not taken the medicines as indicated. Our observations suggest that the exacerbation of pulmonary tuberculosis may occur with bronchoscopic examination, and the postmedication with a few supplemental drugs would be very effective to prevent these exacerbation after bronchoscopy.
A joint clinico-epidemiologic study on pulmonary infections due to Mycoplasma pneumoniae has been carried out in Kinki area from September 1987 to March 1989. A total of 93 patients were found to be ...suffered from Mycoplasma pneumonia in 10 National Sanatoriums during this period. A high-grade fever, occasionally over 40°C, and severe cough were the most common symptoms as described in textbooks. The white blood cell counts in the peripheral blood were normal or decreased, and the Mantoux reversion was found in the half of the patients. The titers of anti-mycoplasma antibody in the serum were very high in most of patients. The X-ray shadows of pneumonia were frequently found in the lower half of the lungs. It is infrequent in the case of pulmonary tuberculosis.
Ofloxacin, a synthetic antibacterial pyridone-carboxylic acid derivative, was used in the treatment of intractable pulmonary tuberculosis. In this study, the therapeutic effect of Ofloxacin on ...pulmonary tuberculosis and Ofloxacin resistance were analyzed. All patients had been hospitalized in eight national sanatoria in Kinki district, and were excreting tubercle bacilli resistant to various anti-tuberculosis drugs agents. Ofloxacin was given to 118 patients orally at a daily dose of 300mg to 600mg for more than 3 months. A few anti-tuberculosis drugs, which had failed in the negative conversion of bacilli previously, were used in combination. By Ofloxacin, 23 patients (19.5%) showed negative conversion of tubercle bacilli in sputum culture within 5 months, and they remained culturenegative for at least 6 months after conversion. Side-effects were observed in 2 patients. One complained of arthralgia and the other felt abdominal fullness. But both were not serious. From these results, it was concluded that Ofloxacin was effective for intractable pulmonary tuberculosis. The resistance of tubercle bacilli to Ofloxacin increased significantly after it was used.
Back ground of the patients who died within 1 year after admission to the hospitals in kinki district were analyzed. 90 patients out of 1459 newly admitted patients were dead within 1 year after ...admission to the hospital. Among these 90 cases, 42.2% were dead within 1 month, and 71.1% were dead within 3 mounth after admission. 49 patients (54.5%) of 90 dead cases were older than 70 years. As concerns with the cause of death, about one third of the patients were died of tuberculosis and the remaining two third were died of other than tuberculosis. The most frequent cause of death was pulmonary tuberculosis (38.9%), and then lung cancer(15.6%), chronic respiratory failure (13.3%)and pneumonia (12.2%). Many patients were suffered from tuberculosis during the chemotherapy for malignant disease resulting in immunocompromized condition. It should be emphasized that the prevention in such patients from falling to tuberculosis is extraordinary important.
We experienced a case of miliary tuberculosis (diagnosed as an acute pancreatitis prior to the surgery), which was found at the time of operation (lung miliary tuberculosis was found almost at the ...same time). About six months later, we performed liver biopsy again under the laparatomy and compared with the previous specimens. The results were as follows: 1. By way of using SM, INH, KM and EB at the same time, improvements in both chestgrams and liver specimens were quite significant. 2. Liver function tests (ZnTT, Co R, Alkaline phosphatase, γ-globulin) showed improvement after treatment for liver miliary tuberculosis. 3. In this case, steroid hormon was used prior to the establishment of diagnosis of miliary tuberculosis. Therefore prudent considerations required for the use of steroid hormon to tuberculosis or other infectious diseases.
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