[The diagnostic value of thoracoscopic examinations in tuberculous pleurisy].

We evaluated the diagnostic value of thoracoscopic examinations in eleven patients who had pleural effusion and were diagnosed as tuberculous pleurisy. The characteristic white or yellowish-white micronodules were observed by thoracoscopy in eight patients and all their biopsied tissue were compatible with tuberculosis. We had some cases which were not determined as tuberculous pleurisy from bacteriological examinations and were determined only from the thoracoscopic findings.

[A case of miliary tuberculosis during pregnancy in a patient on hemodialysis].

A 33-year-old woman had been on hemodialysis since she was 25 years old. In September, 1993, she had cough, which gradually increased in severity, and was accompanied by slight fever. No abnormality was observed on the chest radiography taken on November 2. However, bilateral diffuse miliary shadows were observed on the radiograph taken on November 30. Tubercle bacilli were detected by the examination of sputum smear. As she was pregnant 20 weeks, therapeutic abortion was done on December 8. A case of miliary tuberculosis occurring during pregnancy in a patient on hemodialysis has not been documented in Japan to date, and the first case in Japan was reported with a review of the literature.

[A case of alveolar microlithiasis which developed spontaneous pneumothorax due to progression of emphysematous bullae during 34 years after established diagnosis].

The patient was a 46-year-old man who was taxi driver. He had received therapy for miliary tuberculosis from nine years old, and the diagnosis of alveolar microlithiasis was made by open lung biopsy at twelve years of age in 1956. At that time, there were no emphysematous bullae, and slight alveolar wall thickening was observed histopathologically. After a 34 year interval, he developed spontaneous pneumothorax with sudden dyspnea. Multiple emphysematous bullae were found at thoracoscopy performed to treat the pneumothorax. Arterial blood gas analysis after resolution of the pneumothorax showed hypoxia with a PO2 of 65.4 torr, and lung function tests revealed restrictive disorder. Thus, in this patient, emphysematous bullae progressed resulting in a pneumothorax, and lung fibrosis also developed 34 years after the diagnosis of alveolar microlithiasis. Alveolar microlithiasis is occasionally misdiagnosed as miliary tuberculosis. The authors stress that the chest roentgenographic finding of ari-bronchogram demonstrating intra-alveolar foci is an important sign in the differential diagnosis.

[Clinical backgrounds of six cases of childhood tuberculosis].

Clinical backgrounds of six children who entered Matsue National chest Hospital due to pulmonary tuberculosis and tuberculous pleuritis were investigated and the following results were obtained. 1) Of six children five had not received BCG vaccination. 2) There were two children who developed tuberculosis after the completion of chemoprophylaxis. 3) None was detected by the examination of the household of the source cases. 4) Both patients and doctors were responsible for the delay in detecting the source, which ranged between five and seventeen months in total. 5) Among the source cases there were two patients who were smear-negative but culture-positive. In view of the above observations it is suggested that BCG vaccination is important for the prevention of tuberculosis in children and that follow-up examinations should be continued after the completion of chemoprophylaxis. It should also be emphasized that early detection of the source case is imperative for the prevention of tuberculosis.