A successful trimodality therapy for difficult-to-diagnose primary mediastinal dedifferentiated liposarcoma, which originated from the perihilar fat and invaded the right lungs.

A 40-year-old man with high fever, hemoptysis, and fatigue showed a 10-cm mass in the middle and lower lobes of the right lung on computed tomography. Histological examination of transbronchial biopsy specimens showed sheets of small round tumor cells and mild staining for CD99. Primary Ewing sarcoma was suspected, and a trimodality therapy consisting of chemotherapy, intensity-modulated radiation therapy, and right pneumonectomy with surrounding tissue resection was performed. In surgical specimens, negative outcome of NKX2.2 in immunostaining and EWSR1 rearrangement in fluorescence in situ hybridization did not support the diagnosis of Ewing sarcoma. Positive immunostaining for MDM2 and CDK4 led to a diagnosis of dedifferentiated liposarcoma, which probably originated from an adipose tissue of the right perihilar mediastinum, and then invaded the lungs. The postoperative course was uneventful, without recurrence for more than 16 months.

A Case of Candidemia after Long-term Presence of Urethral Foreign Bodies.

A 52-year-old man presented to our hospital complaining of general malaise, cough, and fever. Total body computed tomography revealed scattered pneumonia and urethral foreign bodies that had been inserted during adolescence. Candida glabrata was detected in blood and urine cultures. Based on these findings, the patient was diagnosed with candidemia that developed due to Candida urinary tract infection, complicated by septic pulmonary embolism and severe diabetes mellitus. Candidemia likely persisted despite the initiation of intravenous antifungal therapy and control of blood sugar level. Therefore, surgical removal of the urethral foreign bodies was performed, which resulted in resolution of the patient's symptoms. Herein, we report a rare case of candidemia complicated by Candida urinary tract infection that developed due to the long-term presence of urethral foreign bodies. A multidisciplinary therapeutic approach, including surgical removal of the infected foreign bodies, is effective in such cases. This case indicates that long-term presence of foreign bodies and acquired immune dysfunction can be risk factors for candidemia. Therefore, detailed history should be obtained and systemic examination should be performed to identify the complicating risk factors on diagnosis of candidemia.

Nontuberculous mycobacterium diseases and chronic thromboembolic pulmonary hypertension.

OBJECTIVE: We aimed to investigate the incidence and clinical characteristics of nontuberculous mycobacterial (NTM) pulmonary disease as a complication of chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: We conducted a retrospective study of 10 cases (5.6%) complicated by NTM pulmonary disease among 180 CTEPH patients. RESULTS: Isolated species of avium (n=5), kansasii (n=2), intracellulare (n=1), abscessus (n=1) and fortuitum (n=1) were detected. NTM-infected lesions were observed in 33 of 180 (18.3%) lung segments obtained from the 10 patients, and complete obstruction due to chronic pulmonary thromboembolism was detected in 65 of the 180 segmental pulmonary arteries (36.1%). The NTM-infected segments in the CTEPH patients were significantly associated with obstructed rather than unobstructed pulmonary artery segments [25 of 65 (38.5%) vs. 8 of 115 (6.9%), p<0.01]. Cavitary, nodular, ectatic and ground-glass lesions were seen in 14, 22, seven and four of the 180 segments, respectively. Thirteen of the 14 cavitary (92.9%) lesions were located in non-perfused segments. Five patients with NTM disease underwent pulmonary endarterectomy (PEA). Of the 18 assessable NTM-infected segments in six NTM-treated patients, 17 were located in non-perfused segments and one was located in a previously perfused segment. All NTM-infected segments improved among three segments reperfused with PEA. In contrast, only eight (57.1%) NTM-infected segments improved among 14 continuously non-perfused segments. A lower body mass index was found to be a significant risk factor for NTM disease in the CTEPH patients. CONCLUSION: This is the first report to document NTM-disease complications in patients with CTEPH. Reperfusion in cases of NTM lesions may improve the response to NTM drug therapy.

Role of CD69 in acute lung injury.

AIMS: CD69 is an early activation marker in lymphocytes and an important signal transmitter in inflammatory processes. However, its role in acute lung injury (ALI) is still unknown. We used a lipopolysaccharide (LPS)-induced mouse model of ALI to study the role of macrophage-surface CD69 in this condition. MAIN METHODS: We investigated bronchoalveolar lavage fluid (BALF) cell subpopulations, myeloperoxidase levels in lung homogenates, lung pathology, and lung oedema in CD69-deficient (CD69(-/-)) mice 24h after LPS instillation. We also determined cytokine/chemokine expression levels in BALF and macrophage culture supernatant from CD69(-/-) and wild type (WT) mice. Also, we investigated CD69, keratinocyte-derived chemokine (KC) and macrophage inflammatory protein (MIP)-2 localization in the lungs after LPS administration. Furthermore, we examined the effect of anti-CD69 antibody on LPS-induced cytokine/chemokine release from cultured macrophages. KEY FINDINGS: Our study shows that intratracheal instillation of LPS-induced neutrophilic infiltration, histopathological changes, myeloperoxidase positivity, and oedema in the lung to a lower degree in CD69(-/-) mice than in WT mice. The immunoreactivities for CD69, KC and MIP2 were induced in the lung of WT mice instilled with LPS and were predominantly localized to the macrophages. Moreover, the cytokine/chemokine expression profile between the two genotypes of cultured macrophages in response to LPS was similar to that observed in the BALF. In addition, anti-CD69 antibody inhibited the LPS-induced cytokine/chemokine expression. SIGNIFICANCE: These results suggest that CD69 on macrophages plays a crucial role in the progression of LPS-induced ALI and may be a potentially useful target in the therapy for ALI.

Cigarette smoke-induced pulmonary inflammation is attenuated in CD69-deficient mice.

Cluster of differentiation 69 (CD69) has been identified as a lymphocyte early activation marker, and recent studies have indicated that CD69 mediates intracellular signals and plays an important role in various inflammatory diseases. Cigarette smoke (CS) is a strong proinflammatory stimulus that induces the release of proinflammatory mediators by recruiting macrophages and neutrophils into the lung tissue, and is one of the main risk factors for a number of chronic diseases. However, the potential role of CD69 in CS-induced pulmonary inflammation has not been determined. To address to this question, CD69-deficient (KO) and wild-type (WT) mice were subjected to CS-induced acute pulmonary inflammation. After the exposure with CS, the expression of CD69 in the lung of WT mice was significantly induced, it was predominantly observed in macrophages. In conjunction with this phenomenon, neutrophil and macrophage cell counts, and expression of several cytokines were significantly higher in the bronchoalveolar lavage fluid (BALF) of CS-exposed WT mice compared with air-exposed WT mice. Likewise, the CS-induced accumulation of inflammatory cells and cytokines expression were significantly lower in CD69-KO mice than in WT mice. These results suggest that CD69 on macrophages is involved in CS-induced acute pulmonary inflammation.

Attenuation of lung inflammation and fibrosis in CD69-deficient mice after intratracheal bleomycin.

BACKGROUND: Cluster of differentiation 69 (CD69), an early activation marker antigen on T and B cells, is also expressed on activated macrophages and neutrophils, suggesting that CD69 may play a role in inflammatory diseases. To determine the effect of CD69 deficiency on bleomycin(BLM)-induced lung injury, we evaluated the inflammatory response following intratracheal BLM administration and the subsequent fibrotic changes in wild type (WT) and CD69-deficient (CD69-/-) mice. METHODS: The mice received a single dose of 3 mg/kg body weight of BLM and were sacrificed at 7 or 14 days post-instillation (dpi). Lung inflammation in the acute phase (7 dpi) was investigated by differential cell counts and cytokine array analyses of bronchoalveolar lavage fluid. In addition, lung fibrotic changes were evaluated at 14 dpi by histopathology and collagen assays. We also used reverse transcription polymerase chain reaction to measure the mRNA expression level of transforming growth factor ß1 (TGF-ß1) in the lungs of BLM-treated mice. RESULTS: CD69-/- mice exhibited less lung damage than WT mice, as shown by reductions in the following indices: (1) loss of body weight, (2) wet/dry ratio of lung, (3) cytokine levels in BALF, (4) histological evidence of lung injury, (5) lung collagen deposition, and (6) TGF-ß1 mRNA expression in the lung. CONCLUSION: The present study clearly demonstrates that CD69 plays an important role in the progression of lung injury induced by BLM.

[A case of Lemierre syndrome].

Classic Lemierre syndrome is a septic internal jugular venous thrombophlebitis secondary to oropharyngeal anaerobic infection in adolescents and young adults. Upper respiratory tract infection is the most common antecedent. We report a case of Lemierre syndrome as a rare infectious disease. A 20-year-old man complained of high fever, right neck discomfort and chest pain. Chest X-ray revealed infiltrative shadows, suggesting bacterial pneumonia. Although cefcapene pivoxil hydrochloride hydrate (CFPN-PI) was given in a local clinic, his symptoms did not improve. Then he was referred to our hospital. Chest CT findings showed bilateral multiple nodular shadows with small cavities, suggesting septic embolization. Fusobacterium necrophorum was cultured from specimen of the blood, and an enhanced neck CT scan showed thrombosis in the right internal jugular vein. These findings led us to a diagnosis of Lemierre syndrome. Four weeks of antibiotics and anticoagulants ameliorated inflammatory findings in blood, but internal jugular vein thrombosis remained. Currently, there is no consensus opinion on the use of anticoagulation in patients with Lemierre syndrome complicated by septic internal jugular thrombosis and embolism. Early and effective antibiotics therapy may prevent the development of the syndrome and its associated complication, although it is unclear whether the outcome will be favorable.

[A case of small-cell lung carcinoma accompanied by the syndrome of inappropriate secretion of antidiuretic hormone and Lambert-Eaton myasthenic syndrome].

Although the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and Lambert-Eaton myasthenic syndrome (LEMS) are often individually accompanied by small-cell lung carcinoma, simultaneous occurrence of the 2 syndromes is rare. A 61-year-old man was admitted to our hospital because of fatigue and myasthenia in the extremities, and small-cell lung carcinoma with pulmonary metastasis was diagnosed, together with SIADH and LEMS. These syndromes markedly ameliorated following tumor shrinkage, with 4 cycles of chemotherapy consisting of carboplatin and etoposide. On progression of the tumor thereafter, neither syndrome recurred. A literature review disclosed that these syndromes frequently resolve with tumor shrinkage.

[Case of benign asbestos pleurisy with diffuse pleural thickening confirmed on autopsy].

We report a 65-year-old man with a 35-year history of occupational asbestos exposure. He presented at a nearby hospital with a complaint of dyspnea in 2002. Bilateral pleural effusion was revealed on a chest x-ray film. Chest CT revealed diffuse thickening of the pleura, bilateral pleural effusions and cardiac effusion, but no abnormal findings in the lung fields. Both pleural effusions were exudative, and lymphocytes were predominant. Antituberculous chemotherapy had no effect on the exudates. Thoracoscopic pleural biopsy was conducted to exclude malignant mesothelioma. No evidence of malignancy was found in pleural samples. The patient's condition was diagnosed as benign asbestos pleurisy with diffuse pleural thickening. He was referred to our hospital in June 2008. Bilateral pleural effusions continued to progress despite pleurodesis and frequent drainage of his pleural effusion. He suffered from respiratory failure and died in December 2008. We investigated the concentration of asbestos bodies in his lung tissue. There were 462 asbestos bodies per 1 g of dry lung tissue, which was relatively low considering the time of asbestos exposure. We report a rare case of benign asbestos pleurisy with diffuse pleural thickening confirmed by autopsy.

[Case of thymic carcinoid associated with multiple endocrine neoplasia type I treated effectively with chemotherapy].

A 53-year-old man was referred to our hospital due to a mediastinal mass found during a medical checkup in July 2009. He had a past history of hyperparathyroidism, for which he underwent surgery in 1994, and also had a family history in that his sister had multiple endocrine neoplasia type 1 (MEN1). He was given a diagnosis of MEN I on genetic testing. Chest CT revealed a mediastinal mass 4 cm in maximum dimension, and an atypical carcinoid was diagnosed according to mediastinal biopsy findings. Bone metastasis was detected and he was given cisplatin and etoposide. The tumor decreased in size by 30%, and was evaluated as showing partial response. Although there are some cases of MEN-related thymoma treated by surgery, a case which successfully responded to chemotherapy alone is thought to be extremely rare.

Immunogenicity of a monovalent pandemic influenza A H1N1 vaccine in health-care workers of a university hospital in Japan.

A phase III observational study evaluating a single-dose of an inactivated, split-virus, unadjuvanted AH1pdm vaccine in HCW was conducted. A safe and effective vaccine was needed after the emergence of AH1pdm in April 2009. We analyzed the immunogenicity and safety of the vaccine. A total of 409 subjects were enrolled and given 15 µg hemagglutinin antigen by s.c. injection. Antibody titers were measured using hemagglutination-inhibition antibody assays before vaccination and 28 days after. The co-primary immunogenicity end-points were the proportion of subjects with antibody titers of 1:40 or more, the proportion of subjects with either seroconversion or a significant increase in antibody titer, and the factor increase in geometric mean titer. We collected 389 pair samples. Antibody titers of 1:40 or more were observed in 148 of 389 subjects (38.0%, 95% CI: 33.2-42.9). The immunogenicity was also confirmed in other end-points, but was not sufficient and was lower than in previous reports. A total of 96 of adverse events was reported: 51 local events and 57 systemic events. There were 12 subjects with both local and systemic events. Nearly all events were mild to moderate except in four subjects. A single 15-µg dose of AH1pdm vaccine did not induce sufficient immunogenicity in HCW, with mild-to-moderate vaccine-associated adverse events. We need to consider further improvement of the AH1pdm vaccine program in HCW for the prevention of nosocomial infection, as well as for the benefit of HCW.

[A rare case of large cell neuroendocrine carcinoma of the thymus].

A 46-year-old man presented with chest pain at a local hospital in July 2007. Chest computed tomography (CT) showed a 48-mm mass in the anterior mediastinum. CT-guided percutaneous tumor biopsy demonstrated large cell neuroendocrine carcinoma of the thymus. He was referred to our hospital in August 2007. Because the tumor had already progressed to stage IVb according to the Masaoka classification of thymic epithelial tumors, the patient was treated with combination chemotherapy of cisplatin and irinotecan, which achieved a partial response. However, the tumor relapsed in February 2008. He died, despite 2 separate cycles of chemotherapy with docetaxel only and amrubicin only in August 2008. We encountered a rare case of large cell neuroendocrine carcinoma of the thymus treated with combination chemotherapy of cisplatin and irinotecan.

A case of isolated peripheral pulmonary artery branch stenosis associated with multiple pulmonary artery aneurysms.

Selective right pulmonary arteriography and 3-dimensional computed tomography revealed multiple severe stenoses of the peripheral pulmonary artery associated with poststenotic aneurysms in a 65-year-old woman. She was referred to the hospital for evaluation of dry cough, gradually increasing dyspnea and multiple nodular shadows on a chest radiograph. Echocardiography and cardiac catheterization showed severe pulmonary hypertension, though other structural heart diseases or well-characterized congenital syndromes were ruled out. She was diagnosed as isolated peripheral pulmonary artery branch stenosis. Recent advances in CT technology enable a less-invasive assessment of pulmonary artery, and can be useful in the management of pulmonary arterial hypertension.

Regulation of brefeldin A-inhibited guanine nucleotide-exchange protein 1 (BIG1) and BIG2 activity via PKA and protein phosphatase 1gamma.

Brefeldin A-inhibited guanine nucleotide-exchange proteins (GEPs) BIG1 and BIG2 activate ADP-ribosylation factor (ARF) GTPases, which are required for vesicular trafficking. Both molecules contain one or more sites for binding protein kinase A, i.e., A kinase-anchoring protein (AKAP) sequences. Elevation of cell cAMP caused PKA-catalyzed phosphorylation and nuclear accumulation of BIG1 but not BIG2. We then asked whether BIG1 phosphorylation altered its GEP activity. Incubation of BIG1 or BIG2 with PKA catalytic subunits and ATP resulted in retardation of their electrophoretic migration, consistent with PKA phosphorylation. Okadaic acid inhibits many protein phosphatases, including protein phosphatase 1 (PP1) and PP2A, that can reverse PKA-catalyzed phosphorylation. Incubation of HepG2 cells with okadaic acid caused concentration-dependent accumulation of presumably phosphorylated BIG1 and BIG2 with decreased mobility, which was increased by subsequent incubation in vitro with specific recombinant phosphatases, PP1gamma > PP2A >> PP1alpha. For assays of GEP activity, BIG1 and BIG2 were immunoprecipitated from cells that had been depleted, respectively, of BIG2 and BIG1 by using specific siRNA. GEP activity of each was significantly decreased after incubation with recombinant PKA plus ATP and restored by incubation with PP1gamma. In agreement with a role for PP1gamma in regulation of BIG, endogenous PP1gamma, but not PP1alpha or beta, was immunoprecipitated with BIG1 or BIG2 from microsomal fractions. All observations are consistent with the effects of BIG1 and BIG2 phosphorylation on vesicular trafficking, via alterations in ARF activation and regulatory roles for cAMP, PKA, and PP1gamma in ARF activation by BIG1 and BIG2.

Inhibitory effects of polyphenols on gastric injury by Helicobacter pylori VacA toxin.

BACKGROUND: Helicobacter pylori induces gastric damage and may be involved in the pathogenesis of gastric cancer. H. pylori-vacuolating cytotoxin, VacA, is one of the important virulence factors, and is responsible for H. pylori-induced gastritis and ulceration. The aim of this study is to assess whether several naturally occurring polyphenols inhibit VacA activities in vitro and in vivo. MATERIALS AND METHODS: Effects of polyphenols on VacA were quantified by the inhibition of: 1, vacuolation; 2, VacA binding to AZ-521 or G401 cells or its receptors; 3, VacA internalization. Effects of hop bract extract (HBT) containing high molecular weight polymerized catechin on VacA in vivo were investigated by quantifying gastric damage after oral administration of toxins to mice. RESULTS: HBT had the strongest inhibitory activity among the polyphenols investigated. HBT inhibited, in a concentration-dependent manner: 1, VacA binding to its receptors, RPTP(alpha) and RPTP(beta); 2, VacA uptake; 3, VacA-induced vacuolation in susceptible cells. In addition, oral administration of HBT with VacA to mice reduced VacA-induced gastric damage at 48 hours. In vitro, VacA formed a complex with HBT. CONCLUSIONS: HBT may suppress the development of inflammation and ulceration caused by H. pylori VacA, suggesting that HBT may be useful as a new type of therapeutic agent for the prevention of gastric ulcer and inflammation caused by VacA.

[A case of perforative peritonitis complicated with lung and intestinal severe tuberculosis].

A 27-year-old man was admitted to our hospital in September 18, 2000, complaining of fever, cough, appetite loss and body weight loss. He was diagnosed as advanced lung tuberculosis, because of chest X-ray findings and positive acid-fast bacilli in his sputum. He was administrated rifampicin (RFP), isoniazid (INH) and ethambutol (EB). Two days after starting treatment he complained of abdominal pain and the signs of perforating peritonitis. Emergency laparotomy was performed and we observed multiple ulcers and a perforation of ileum. We resected a part of distal ileum and ascending colon and made ileostomy. Histopathologic examination of resected ileum and colon showed multiple ulcers and epithelioid cell granulomas with caseous necrosis. Many acid bacilli were identified from the lesion by specially stained tissue sections. He was administrated streptomycin and INH by injection post-operatively while oral administration was impossible. Six days after the first operation, we found the signs of perforation in another part of the ileum. So we were obliged to perform second laparotomy and resect the part involved. Five days after the second operation, he was able to take RFP, INH, and levofloxacin per oral route. On February 8, 2001 we performed ileocolonal reconstruction with side to side anastomosis and closed ileostomy at the third laparotomy. He had continued chemotherapy and went back to Korea in April 7, 2001. Although intestinal tuberculosis has sharply declined in Japan thanks to development of effective antituberculous drugs, we should keep in mind that it could be a possible cause of the acute abdomen.

[A study on far-advanced cavitary pulmonary tuberculosis cases].

In cases with far-advanced cavitary pulmonary tuberculosis, the most serious lesions according to the chest X-ray classification by the Japanese Society of Tuberculosis (b I 3), their prognosis is believed to be poor due to their emaciated general conditions, and a retrospective clinical study was made on these cases admitted to our hospital. The subjects consisted of 95 cases, and among them 87 were male and 8 were female, and their mean age was 49.5 +/- 13.0 years. Eighty four cases were detected by symptomatic visits to clinics, 10 cases during their treatment for other diseases, and 1 case was discovered accidentally. Sputum examination for acid fast bacilli was all smear positive. As to their social background, the majority were occupied by socially vulnerable groups; 31 cases (32.6%) were jobless on admission, 24 cases (25.3%) were day laborers, and 25 cases (26.3%) were receiving poor relief. Regarding their general condition on admission, 40 cases were very serious and they could not stand by themselves, and their nutritional conditions were poor, and 19 cases (20%) died during hospitalization. All of them were male, and they were found by symptomatic visit to clinics. The period from hospital admission to death was short, the average was 35.0 +/- 39.8 days, and the median was 11.0 days. Among 84 patients detected by symptomatic visit, the patient's delay was 5.5 +/- 5.0 months, while the doctor's delay was 0.3 +/- 0.9 months. Major cause of late detection at advanced stage of these cases was patient's delay which caused poor prognosis of these cases, and various measures to shorten the delay in case-detection must be taken.

[Clinical review of pneumothorax cases complicated with active pulmonary tuberculosis].

Pneumothorax is an important and dangerous complication of pulmonary tuberculosis. Forty-six pneumothorax cases complicated with active pulmonary tuberculosis at National Chiba-Higashi Hospital were studied retrospectively. From Jan. 1987 to Dec. 1997, we experienced 3611 patients with pulmonary tuberculosis, and among them 46 patients (18-90 years old, 38 males and 8 females) had pneumothorax. On admission, 33 out of 46 cases (71.7%) were smear positive by sputum examination of mycobacteria and 41 out of 46 cases (89.1%) had cavitary lesions on chest X-ray. Eleven cases had mild pneumothorax, thirty-two had moderate, and three had severe. Pneumothorax was present on admission in 23 patients and developed during treatment for tuberculosis in the other 23 patients. Eleven patients were treated with bed rest alone, four were thoracentesis and aspiration, twenty-four were intrathoracic tube drainage and seven were operated. Thirty-one patients were recovered, but fifteen passed away, among them 13 due to respiratory failure. The Prognostic nutritional index (PNI; 10 x serum albumin concentration +0.005 x peripheral lymphocyte count) which was proposed by Onodera, serum albumin level and Body mass index were lower in the fatal group than in the survival group. We consider these indices are useful to evaluate the prognosis of active tuberculosis patients complicated with pneumothorax.

[A study on low performance status cases of pulmonary tuberculosis in the elderly].

The subjects consisted of 42 patients aged over 60 years, whose performance status (PS) was grade 3 or 4, and who had been admitted for pulmonary tuberculosis at National Chiba-Higashi Hospital between 1997 and 1998. The average age (+/- SD) of the 34 men and 8 women was 77.6 (+/- 8.5) years (range, 60-91 years). The mean stay in the hospital of the improved patients was 166.6 days (range, 57-303 days), and the mean survival period from admission to death was 43.4 days (range, 2-179 days in died patients). On admission to our hospital, 26 cases were sputum smear positive, 8 cases were smear negative and culture positive, and 8 were negative both on smear and culture. The cavity was observed in 30 cases (71.4%) on the chest X-ray. The laboratory data on admission revealed low nutritional condition. The mean serum total protein, albumin, and cholesterol level on admission were 6.2 (+/- 0.82) g/dl, 2.7 (+/- 0.62) g/dl, and 143.0 (+/- 41.9) mg/dl. Most of the patients had a difficulty in taking foods, and 20 cases (47.6%) were performed parenteral nutrition by central venous catheter. 23 cases (54.8%) received oxygen therapy by facial mask or nasal tube. The most common cause of low PS on admission was pulmonary tuberculosis in 14 cases (33.3%), followed by cerebrovascular diseases in 11 cases, and orthopedic disease in 8 cases. The proportion of patients whose cause of low PS was not due to lung tuberculosis increased with age. Observing the mortality by the route of administration of antituberculosis medications on admission, 19 (55.9%) of 34 cases who could take drugs per oral route died. One (50.0%) of 2 cases who were administered drugs through gastric tube died, and all (100.0%) of 5 cases who could not take drugs per oral route and were injected isoniazid and streptomycin died. One case who could not administer any drug died. 16 cases improved and 26 cases died, of whom the most common cause of death was pulmonary tuberculosis in 11 cases (42.3%), followed by bacterial pneumonia in 5 cases, and cerebrovascular disease in 3 cases. The mortality by the PS on admission were as follows: 10 (47.6%) of 21 cases with PS 3 died. 16 (76.2%) of 21 cases with PS 4 died. 16 (6.4%) of 249 cases aged over 60 years with PS 0, 1 or 2, and were admitted for pulmonary tuberculosis at the same hospital during the same period died. This study confirms that the prognosis of low performance status patients of pulmonary tuberculosis in the elderly was significantly poor. We have to detect tuberculosis patients in the early stage, and give them antituberculosis medications per oral route as far as possible.