[LEGACIES OF SURGERY FOR TUBERCULOSIS AND SUCCESSION TO THE NEXT GENERATION].

A symposium entitled "Legacies of surgery for tuberculosis and succession to the next generation" was held at the 89th annual meeting of The Japanese Society for Tuberculosis in Gifu. The purpose of the symposium was to look back at the history of surgery for tuberculosis and development of surgical techniques. The contribution of those techniques to the next generation was also discussed.

[The role and landscape of surgical treatment for mycobacteriosis].

[Surgery for pulmonary multi-drug resistant (MDR) tuberculosis] For pulmonary MDR tuberculosis the author (me) had been operating many cases in Fukujuji Hospital JATA in fifteen years. For treatment, the points of operations are as follows: 1) Surgery is one of many treatable events, 2) The strategy is that cavitary foci as major sites of tuberculous expectoration have to be removed and other small foci are treated by not strong chemotherapies, 3) Final goal of surgical treatments is set up preoperatively, and its procedures are stepped up gradually. [Surgery for pulmonary non-tuberculous mycobacteriosis (NTM)] Major sites of pulmonary NTM expectorations are cavitary foci and bronchiectases.

Risk factors that affect the surgical outcome in the management of focal bronchiectasis in a developed country.

Background: The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed country.

Methods: Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years.

[Evaluation of tuberculosis treatment including levofloxacin (LVFX) in cases who could not continue standard regimen].

Objective: The purpose of this study was to evaluate tuberculosis treatment including levofloxacin (LVFX) and to investigate the effectiveness of changing drug regimens at our hospital.

Subjects And Methods: A retrospective study was conducted on 331 patients with tuberculosis admitted to Tokyo National Hospital in 2005. Out of these 331 patients, LVFX was used in 48 (14.

[A case of tuberculous pleurisy developing contralateral effusion during anti-tuberculosis chemotherapy].

A 55-year-old woman was admitted to our hospital because of chest pain, fever, and right pleural effusion that was exudative and lymphocyte-dominant with a high level of adenosine deaminase (ADA). Since her blood QuantiFERON-TB 3G test (QFT) was positive, she was diagnosed with tuberculous pleurisy. After initiation of anti-tuberculosis chemotherapy with isoniazid, rifampicin, ethambutol, and pyrazinamide, her symptoms improved.

[Invasive pulmonary aspergillosis with hemoptysis; a resected case whose bleeding point is detected pathologically].

A 55-year-old man, who presented with recurrent episodes of hemoptysis, was referred to our hospital under the diagnosis of invasive aspergillosis with a cavity in the right lung. Computed tomography showed a large thick-walled cavity in the right upper lung. He underwent right upper lobectomy.

[Malignant lymphoma of lung with hypersensitivity pneumonitis].

We report a resected case of malignant lymphoma with hypersensitivity pneumonitis. A 62-year-old woman, who presented with fever, wheeze and dry cough was referred to our department under the diagnosis of malignant B cell lymphoma in lower lobe of the left lung and hypersensitivity pneumonitis. She underwent left lower lobectomy as a therapy for malignant lymphoma.

Reversion rates of QuantiFERON-TB Gold are related to pre-treatment IFN-gamma levels.

Objective: The quantitative interferon (IFN)-gamma in response to Mycobacterium tuberculosis-specific antigens declines in tuberculosis patients after starting treatment, however, in some cases remains high despite clinical improvements. Our aim was to evaluate clinical parameters associated with remaining QuantiFERON-TB Gold (QFT-G) positive after treatment.

Methods: A prospective cohort study of 101 culture-positive, positive QFT-G, HIV-uninfected patients with pulmonary tuberculosis.

Stratified Threshold Values of QuantiFERON Assay for Diagnosing Tuberculosis Infection in Immunocompromised Populations.

Background. The detection of latent tuberculosis (TB) is essential for TB control, but T-cell assay might be influenced by degree of immunosuppression. The relationship between immunocompetence and interferon (IFN)-γ response in QuantiFERON-TB Gold (QFT) is uncertain, especially in HIV-negative populations.

Combined typical carcinoid and acinic cell tumor of the lung.

We report a case of combined typical carcinoid and acinic cell tumor of the lung in a 55-year-old female. A chest radiograph revealed an abnormal shadow. Computed tomography (CT) showed a tumor in the S3 segment of the right lung.

[A case of cold abscess of the chest wall due to thoracic drainage for tuberculous pleuritis].

A 56-year-old man underwent thoracic drainage for two weeks for tuberculous pleuritis. He was put on antituberculosis chemotherapy with INH (400 mg), RFP (450 mg), and EB (750 mg). Two months later, he developed an elastic hard subcutaneous mass in the area of the previous thoracic drainage.

[Clinical investigation among elderly patients with tuberculosis].

Objectives: We discussed the factors which may confuse diagnosis and treatment of tuberculosis (TB) in elderly patients, in order to improve the situation.

Subjects And Methods: 414 patients who were hospitalized for active tuberculosis in Tokyo National Hospital were divided into three groups according to their ages (in years): less than 65, 65 to 74, and greater than 75. The three groups were compared in terms of performance status (PS), serum albumin level (whether over 3 g/dl or not), underlying diseases, symptoms at onset, sputum smear findings for acid-fast bacilli, presence or absence of cavitary lesion, regimen of treatment, adverse reaction to medications, and treatment outcome.

[Review of pulmonary Mycobacterium xenopi infection cases: 11 cases of our own and 18 other cases reported in Japan].

Objective: To investigate clinical features of patients with pulmonary Mycobacterium xenopi infection treated at our hospital.

Subjects And Methods: We diagnosed 11 cases of M. xenopi infection at Tokyo National Hospital between 2000 and 2008 and recorded the drug susceptibility, patient characteristics, radiographic findings, treatments given and clinical courses.

Impact of peripheral lymphocyte count on the sensitivity of 2 IFN-gamma release assays, QFT-G and ELISPOT, in patients with pulmonary tuberculosis.

Objective: This study evaluated the effect of peripheral lymphocyte count on 2 interferon-gamma release assays [QuantiFERON TB-Gold (QFT-G) and enzyme-linked immunospot (ELISPOT)] and their sensitivity in patients with pulmonary tuberculosis, including HIV-negative immunocompromised patients.

Patients And Methods: Two hundred thirty patients with microbiologically confirmed active pulmonary tuberculosis were subjected to the tests. Lymphocyte counts were analyzed simultaneously.

[Pulmonary histoplasmosis diagnosed by transbronchial lung biopsy].

A 34-year-old Japanese man working in Mexico City since April 2004, was referred to our hospital in December 2005 because of a nodule in the left lingular bronchus, first pointed out in September 2005. Transbronchial lung biopsy (TBLB) revealed coagulation necrosis, which contained yeast-like cells stained with fungiflora Y stain. We diagnosed pulmonary histoplasmosis (histoplasmoma type) based on the shape of the fungi and on his residential history.

[A case of tuberculosis with multiple lung nodules, abdominal lymphadenopathy, and splenomegaly].

Abdominal tuberculous lymphadenitis is very rare. We report a case of pulmonary tuberculosis showing marked abdominal lymphadenopathy and splenomegaly. A 95-year-old man was admitted to our hospital because of abnormal chest X-ray and body weight loss in last 6 months.

[Usefulness of bronchofiberscopy for the diagnosis of pulmonary non-tuberculous mycobacteriosis--an analysis mainly on pulmonary M. avium complex disease].

Objectives: The aim of this study was to evaluate the usefulness of bronchofiberscopy (BFS) in the diagnosis of pulmonary non-tuberculous mycobacteriosis (PNTM).

Materials And Methods: Among 909 PNTM patients admitted to our hospital during the period from 1995 to 2006, BFS was performed for the diagnosis of PNTM in 107 patients (12%) who had either a negative sputum-smear for acid-fast bacilli (AFB) (n = 100) or from whom it had been impossible to collect sputum (n =7). For these 107 cases, we retrospectively compared and analyzed the findings from specimens obtained by BFS, such as smears, cultures, polymerase-chain reaction (PCR), and transbronchial lung biopsy (TBLB), with clinical, radiological, and sputum examination disease, was also seen in the positive ratios of other nontuberculous mycobacteriosis cases.

[Results of repeated QFT-2G checkings at two-year interval and their comparison with TST results introduced into infection control program for staffs working at a hospital with isolation wards for tuberculosis].

Objective: In Fukujuji Hospital, we have been conducting TST to tuberculosis (TB) non-infected staffs to find new latent TB Infection (LTBI) every year, although almost of them were BCG vaccinated, and the reliability of TST is controversial in BCG vaccinated group. Recently, a new technique, QFT-2G, is evaluated highly to detect TB infection, especially in BCG vaccinated individuals. We examined hospital staffs twice at two-year interval using QFT-2G and TST, and compared these data.

Diagnosis of active tuberculous serositis by antigen-specific interferon-gamma response of cavity fluid cells.

Background: To develop a more accurate methodology for diagnosing active tuberculous pleurisy, as well as peritonitis and pericardits of tuberculous origin, we established an antigen-specific interferon gamma (IFN-gamma)-based assay that uses cavity fluid specimens.

Methods: Over a 19-month period, 155 consecutive, nonselected patients with any cavity effusion were evaluated. Study subjects were 28 patients with bacteriologically confirmed active tuberculous serositis and 47 patients with definitive nontuberculous etiology.

[Surgical treatment of mycobacteriosis].

The pulmonary resection plays an important role in the management of tuberculosis, especially MDRTB, or non-tuberculous mycobacteriosis. For the satisfactory outcome, pre- and postoperative chemotherapy is mandatory. On the same time, resected specimens should be examined bacteriologically to evaluate preoperative chemotherapy.

[Case of multi-drug resistant pulmonary tuberculosis with bilateral cavitary lesions successfully treated by surgical treatment].

A case was 38 years old male. He was pointed out abnormal shadow on chest X-ray and complained respiratory infection symptoms. He had not past history of tuberculosis.

[Features of bronchial tuberculosis--an analysis of 103 cases].

Objectives: The aim of this study is to clarify the features of bronchial tuberculosis.

Materials And Methods: We analyzed the clinicopathological data from 103 out of 4467 (2.3%) cases of culture positive tuberculosis admitted to the National Hospital Organization Tokyo National Hospital in the period from 1993 to 2004 in which bronchial tuberculosis was confirmed by bronchofiberscopy.

[Coexisting lung cancer and active pulmonary mycobacteriosis].

We reviewed 72 patients with coexisting lung cancer and pulmonary mycobacteriosis, and discuss the features and transition of these coexistent cases. There were 56 pulmonary tuberculosis (PTB) cases and 16 non-tuberculous mycobacteriosis (PNTM) cases, 62 men and 10 women, with a mean age of 69 years. In 43 cases, both diseases were concurrently detected, lung cancer was first detected in 19 cases, and mycobacteriosis was first detected in 10 cases.

[A case of multidrug-resistant pulmonary tuberculosis cured by the regimen including thiacetazone].

A 30 years-old-male was referred to our hospital for surgical treatment of multidrug-resistant tuberculosis in April 1998, three years after diagnosis of tuberculosis. All first-line anti-tuberculosis drugs and second-line anti-tuberculosis drugs were resistant on drug susceptibility tests by Ogawa medium. The right upper lobectomy was done because of massive hemoptysis and enlargement of cavitary lesion in June 1998, but this surgical operation was complicated with, bronchial fistula and chronic empyema.