Original Article Abstract Key words

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specialists tended to pay attention to pulmonary tuberculosis as a possible complication during periodic health examination, further intensive education regarding pulmonary tuberculosis is required for doctors who treat malignant or psychosomatic diseases at special hospitals because TB patients who were smear positive when they were detected may cause outbreak of tuberculosis in the hospital.

Key words : Pulmonary tuberculosis, Underlying disease, Malignant disease, Psychosomatic disease, Diabetes mellitus

1_{Division of Respiratory Diseases, Department of Medicine,}

Kawasaki Medical School, 2_{Division of Respiratory Diseases,}

Department of Medicine, Kawasaki Medical School Kawasaki Hospital, 3_{Department of Internal Medicine, Asahigaoka}

Hospital

Correspondence to : Yoshihiro Kobashi, Division of Respira-tory Diseases, Department of Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki-shi, Okayama 701_0192 Japan. (E-mail : resp＠med.kawasaki-m.ac.jp)

−−−−−−−− Original Article −−−−−−−−

CLINICAL ANALYSIS OF PULMONARY TUBERCULOSIS DETECTED

DURING FOLLOW-UP OF OTHER UNDERLYING DISEASES

1_{Yoshihiro KOBASHI,}1_{Naoyuki MIYASHITA,}1_{Yoshihito NIKI,}2_{Niro OKIMOTO,} 3_{Yoshito HARA, and}1_{Toshiharu MATSUSHIMA}

Abstract [Objective] The objects of this study were to ana-lyze clinically the outpatients and inpatients who were diag-nosed as pulmonary tuberculosis during the follow-up of other underlying diseases at our afﬁliated hospitals and to review the past problems and to discuss how to improve the situation. [Methods] Sixty five outpatients or inpatients diagnosed as pulmonary tuberculosis during the follow-up of other under-lying diseases were collected from 508 patients with pulmo-nary tuberculosis at our afﬁliated hospitals over the past 10 years.

[Results] The proportion of elderly patients over 65 years old among 65 index cases was signiﬁcantly higher as com-pared to the control group. Forty three of these index patients were outpatients and 22 were inpatients. The most frequent underlying diseases excluding respiratory diseases were malig-nant diseases followed by diabetes mellitus, gastrointestinal diseases and psychosomatic diseases in order. Pulmonary tuberculosis without clinical symptoms was detected by periodic chest X-ray in 21 cases (32％). There were some severe TB cases caused by the doctor’s delay who were followed for malignant or psychosomatic diseases.

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Key words : Lymphocyte stimulation test (LST), Antituber-culosis drugs

1_{Department of Pulmonary Medicine, National Matsue}

Hospi-tal, 2_{Research Institute of Tuberculosis, Japan}

Anti-Tubercu-losis Association

Correspondence to : Shuichi Yano, Department of Pulmonary Medicine, National Matsue Hospital, 5_8_31, Agenogi, Matsue-shi, Shimane 690_8556 Japan.

(E-mail : yano＠matsue. hosp.go.jp) −−−−−−−− Original Article −−−−−−−−

THE USEFULNESS OF LYMPHOCYTE STIMULATION TEST (LST)

IN SIDE EFFECTS OF ANTITUBERCULOSIS DRUGS

1_{Shuichi YANO,}1_{Kanako KOBAYASHI,}1_{Kazuhiro KATO,}1_{Toshiyuki TATSUKAWA,}

and 2_{Shinji SHISHIDO}

10 結核第79巻第 1 号 2004年 1 月

Abstract [Purpose] The usefulness of the lymphocyte stimulation test (LST) was examined in patients who arose side effects to antituberculosis drugs.

[Methods] The usefulness of LST was examined in 36 patients from January, 1999 to July, 2002.

[Results] There were 11 LST positive patients, and the LST positive rate was 30.6％. The causing agents determined by the LST positive patients were INH in 7, RFP in 3 and EB in one. The sensitivity of LST was 46.2％ and the speciﬁcity of LST was 76.6％.

[Conclusion] LST positive rate of antituberculosis drugs was low and it was difﬁcult to determine the causing drugs by LST.

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proved. Both masses were discontinuous with pulmonary tuberculosis and the possibility of lymphogenous spread of organism was speculated as its etiology. We assumed that both masses were due to paradoxical response to the anti-tuberculosis chemotherapy.

Key words : Pulmonary tuberculosis, Tuberculosis of bilateral cervical lymphadenopathy, Exacerbated pericostal abscess, Paradoxical response

Department of Respiratory Diseases, National Higashi-Nagoya Hospital

Correspondence to : Noritaka Yamada, Department of Respi-ratory Diseases, National Higashi-Nagoya Hospital, 5_101, Umemorizaka, Meito-ku, Nagoya-shi, Aichi 465_8620 Japan. −−−−−−−− Case Report −−−−−−−−

A CASE OF PULMONARY TUBERCULOSIS COMPLICATED WITH

TUBERCULOSIS OF BILATERAL CERVICAL LYMPH NODES

AND EXACERBATED PERICOSTAL ABSCESS

Noritaka YAMADA, Yuko ITO, Kunihiko GOTO, Takayuki ANDO,

Yukio SUDO, Kenji OGAWA, and Masao TANO Abstract_{A 23-year-old man was admitted to our hospital}

because of cough and sputum in April 2001. A chest roent-genogram revealed inﬁltrative shadow with cavity formation in the bilateral lung fields. He was treated with sensitive anti-tuberculous drugs. After starting the antianti-tuberculous therapy with INH, RFP, EB and PZA, bilateral cervical lymphade-nopathy developed. Three months later, pericostal abscess appeared in the left anterior chest wall. Microscopic examina-tion of the specimen obtained by needle aspiraexamina-tion biopsy disclosed positive for acid-fast bacilli. Smears of the pus showed acidfast bacilli identiﬁed as Mycobacterium tubercu-losis by DNA-DNA PCR method. He developed tuberculous bilateral cervical lymphadenopathy and pericostal abscess during the course of antituberculosis chemotherapy. Drug sensitivity test revealed that tubercle bacilli in this case were sensitive. One year after the administration of chemotherapy, cervical lymphadenopathy and pericostal abscess were

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also in the entire city. As a result, the treatment outcomes improved, and incidence rate of TB began to decrease. Key words : Tuberculosis control, Urban tuberculosis, Home-less persons, Assured treatment, DOT (directly observed therapy)

1_{Infectious Disease Surveillance Center, National Institute}

of Infectious Diseases, 2_{Research Institute of Tuberculosis,}

Japan Anti-Tuberculosis Association, 3_{Health Welfare Center,}

Kawasaki-ku, Kawasaki City

Correspondence to : Yuki Tada, Infectious Disease Surveil-lance Center, National Institute of Infectious Diseases,1_23_1, Toyama, Shinjuku-ku, Tokyo 162_8640 Japan.

(E-mail : yukit＠nih.go.jp) −−−−−−−− Field Activities −−−−−−−−

TUBERCULOSIS CONTROL IN KAWASAKI CITY

｜ Promoting the DOT Program｜

1_{Yuki TADA,}2_{Masako OHMORI,}2_{Kunihiko ITO, and}3_{Michiko FUJIU}

24 結核第79巻第 1 号 2004年 1 月

Abstract_{Kawasaki City initiated the DOT (Directly} Ob-served Therapy) program in 2000 to improve tuberculosis (TB) control in the homeless persons and individuals living in temporary subsidized housing. The program was implemented as an additional program to the city’s control policy of mass TB screenings for these groups. The DOT program was imple-mented through participation of numerous agencies sharing common goals. Through coordination and cooperation, a strat-egy suitable for the regional level was developed. Sectors involved were not only the TB control staff within the public health centers but also the entire public health centers, the welfare administrative division, the city’s TB task force and homeless task force, and regional medical institutions. With the implementation of the DOT program, proper medical treatment, improved patient care, and various other measures were performed, and this led to the strengthening of TB control not only in designated DOT-implemented areas but

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Abstract Diabetes and tuberculosis are bad companions each other. In this clinical review article on diabetes, the pathophysiology of diabetes is documented from the view-point of both insulin secretory dynamics and insulin action on various target organs. The mechanisms why atherosclerosis is accelerated in diabetes is also mentioned.

Nowadays, there are many modalities to correct the derang-ed glucose fluxes, thus it is not difﬁcult to maintain near-normal glycemic excursions in diabetic patients. Strict glyce-mic regulation is obligatory if the patient with tuberculosis has diabetes.

Key words : Diabetes, Glucose ﬂux, Insulin secretory dynam-ics, Insulin action, Atherosclerosis

Department of Medicine, Metabolism & Endocrinology, Juntendo University School of Medicine

Correspondence to : Ryuzo Kawamori, Department of Medi-cine, Metabolism & Endocrinology, Juntendo University School of Medicine, 2_1_1, Hongo, Bunkyo-ku, Tokyo 113_ 8421 Japan. (E-mail : kawamori＠med.juntendo.ac.jp) −−−−−−−− The 78th Annual Meeting Special Lecture −−−−−−−−

DIABETES AND TUBERCULOSIS ｜ BAD COMPANIONS ｜

Ryuzo KAWAMORI

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