(Vol.73 No.8 August 1998) <1> Kekkaku Vol.73,No.8:501-506,1998 EFFECT OF HALF-SIZED SECRETORY LEUKOCYTE PROTEASE INHIBITOR AND CHINESE TRADITIONAL MEDICINES,YOKUININ AND MAO-BUSHI-SAISHIN-TO,ON THERAPEUTIC EFFICACIES OF BENZOXAZINORIFAMYCIN KRM-1648 AGAINST MYCOBACTERIUM AVIUM COMPLEX INFECTION INDUCED IN MICE Katsumasa SATO,Toshiaki SHIMIZU,Haruaki TOMIOKA* and Shin KAWAHARA We examined the effects of such drugs having anti-inflammatory activity as half-sized secretory leukocyte protease inhibitor (1/2 SLPI) and Chinese traditional medicines,Yokuinin(YOK) and Mao-Bushi-Saishin-To(MBST),on therapeutic efficacies of benzoxazinorifamycin KRM-1648 against Mycobacterium avium complex(MAC) infection induced in mice, since it is possible that these agents inhibit the increase in tissue levels of immunosuppressive cytokines due to MAC infection. *From the Department of Microbiology and Immunology, Shimane Medical University, Izumo, Shimane 693-8501 Japan. (Received 16 Feb. 1998/ Accepted 2 Apr. 1998) <2> Kekkaku Vol.73,No.8:507-511,1998 CLINICAL EVALUATION ON CAUSES OF DEATH IN PATIENTS WITH PULMONARY TUBERCULOSIS DURING THE PAST 3 YEARS (1994 TO 1996) Tetsuro INOUE*,NOBUAKI IKEDA,Takuya KURASAWA,Atsuo SATO,KohichiNAKATANI,Takeshi IKEDA,Harukazu YOSHIMATSU We evaluated the cause of death in patients with pulmonary tuberculosis during the past 3 years(1994 to 1996). Of 502 tuberculosis patients,58(11.6%) patients died. Most of them were aged or under poor nutritional conditions. *From the Department of Respiratory Medicine, National Minami-Kyoto Hospita, 11 Naka-ashihara, Joyo,Kyoto 610-0113 Japan. (Received 12 Feb. 1998/ Accepted 8 Apr. 1998) <3> Kekkaku Vol.73,No.8:513-517,1998 TUBERCULOSIS OF THE CENTRAL NERVOUS SYSTEM EXPERIENCED AT THE INTERNATIONAL MEDICAL CENTER OF JAPAN Nobuyuki KOBAYASHI*, Emiko TOYOTA, Makoto TAKAHARA, Atsuto YOSHIZAWA, Naoshito SUZUKI, Hiroshi KAWADA, Tsuneo SUZUKI and Koichiro KUDO In spite of recent advances in diagnosis and chemotherapy of tuberculosis,prognosis of tuberculosis of the central nervous system (CNS) is still poor. We evaluated clinical characteristics of 14 patients with the CNS tuberculosis (10 male and 4 female, 21 to 71 years of age) who were hospitalized at IMCJ from 1988 to 1997. Twelve patients had tuberculous meningitis (2 of them had also intractanial tuberculoma), 1 had intracranial tuberculoma and 1 had spinal cord tuberculosis. For the acid-jast bacilli, the smears of cerebrospinal fluids (CSF) were all negative but the cultures for M.tuberculosis were positive in 5. Using PCR method, M. tubersulosis was identified from CSF specimens in 2 out of 9 culture negative patients, thus suggesting the usefulness of the PCR for the rapid diagnosis of CNS tuberculosis. The adenosine deaminase (ADA) levels in CSF may provide another diagnostic clue because the were elevated in 8 out to 19 cases. It is to be noted that there were three patients who developed clinical manifestations of CNS tu- berculosis after the initiation of chemotherapy for pulmonary tuberculosis. In the last five cases, four-drug regimen which included PZA, was used with a good result. The suc- cess could be related to the addition of PZA which penetrates blood-brain barrier just as hood as INH. Two patients died and one remains unconscious with severe neurological sequelae. The present study indicates that positive CSF culture, hydrocephalus and con- sciousness disturbance are important factors in determining poor prognosis of the CVS tuberculosis. Key word : Tuberculous menigitis, Central nervous system, Cerespinal fluid (CSF), Polymerase chain reaction (PCR), Prognostic factor *From the Department of Pulmonary Medicine, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655 Japan. (Received 6 Feb. 1998/ Accepted 22 Apr. 1998) <4> Kekkaku Vol.73,No.8:519-523, 1998 A CASE OF MILIARY TUBERCULOSIS WITH MULTIPLE CEREBRAL TUBERCULOMA AND SPlNAL TUBERCULOSIS OWlNG TO TOTAL DELAY Seiichiro SAKAO*, Yuka SASAKI, Fumio YAMAGISHI, Takenori YAGI, Funio MIZUTANl and Yuji TADA We reported a case of miliary tuberculosis with multiple cerebral tuberculoma and spi- nal tuberculosis. The case was a 37 year old man. In the last sixteen months to the first visit to a hospital, he has been suffering from low grade fever, cough, and back pain, but he beared his symptoms without any therapy. At a hospital he first visited, he was told that he might have a malignant disease, which prevented him to visit the hospital be- cause of a fear for his disease. Six months later, he was admitted to other hospital be- cause of severe back pain. At last, he was diagnosed as tuberculosis and referred to our hospital. By the examinations on admission he was diagnosed as multiple cereberal tuberculoma and spinal tuberculosis, and anti-tuberculous therapy was started. It is thought that his severe disease status on admission is caused by the total delay, namely the delay in visiting a doctor and the doctor's delay in making diagnosis. Key words : Miliary tuberculosis, Multiple intracranial tuberculous nodules, Spinal caries, Total delay *From the Division of Thoracic Disease, National Chiva-Higashi Hospital, Chu-ou ku, Nitona cho 673,Chiba City, Chiba 260-8712 Japan. (Received 2 May. 1998/ Accepted 27 Apr. 1998) <5> Kekkaku Vol.73,No.8:525-529,1998 THE COEXISTENCE OF PULMONARY TUBERCULOSIS AND THYMOMA A CASE REPORT Osamu MURAKAMI, Hiroaki SATOH*, Morio OHTSUKA, Yasunori FUNAYAMA, Shizuo HASEGAWA, Hiroichi ISHIKAWA, Takashi NAITO, Takuya YAZAWA, Masachika FUJIWARA, Hiroshi KAMMA A 33-year-old male was admitted with complaints of cough, dysphagia, and swelling of face and upper extremities. Chest X-ray and CT scan revealed a large mediastinal mass and infiltrates in the right upper lobe. Percutaneous biopsy proved the mediastinal tumor as thymoma with cellular atypia. After irradiation, the tumor was surgically re- moved. Caseous epitheloid granulomas were found in the dissected mediastinal lymph nodes. AFB (Acid fast bacillus) stain of the patient's gastric fluid was positive for Mycobacterium. The coexistence of these two diseases was incidental, however, this case suggested that clinicians should perform careful evaluation of lung parenchyma as well as mediastinum on chest X-ray to identify occult diseases including pulmonary tuberculosis in patients with mediastinal mass lesion. Key words : Thymoma, Pulmonary tuberculosis CT scan *From the Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoday, Tsukuba, Ibaraki 305-8575 Japan. (Received 24 Dec. 1997/ Accepted 28 May 1998)