[Pulmonary thromboembolism that developed during an airplane flight "economy-class syndrome"].

The occurrence of thromboembolic phenomena during long-duration airplane flights is called "economy-class syndrome". Recently it has become more popular for Japanese to go abroad by airplane, and an increase in the prevalence of pulmonary thromboembolism should be expected. However, there are few reports of the economy-class syndrome in Japan. A 52-year-old woman was admitted to our hospital because of chest discomfort and dyspnea that developed during an airplane flight. We suspected pulmonary thromboembolism, on the basis of a chest X-ray film and on electrocardiogram. A ventilation-perfusion lung scan disclosed mismatching between ventilation and perfusion in the right upper lung field. Pulmonary thromboembolism was confirmed by pulmonary arteriography. The patient was treated with heparin and urokinase. A phlebogram of the legs showed no significant findings. There was no history of thromboembolic disease or of consumption of oral contraceptives. We conclude that the pulmonary thromboembolism might have been caused by stasis of blood in the lower limb veins during the airplane flight. We emphasize the importance of including pulmonary thromboembolism in the differential diagnosis of patients with chest discomfort and dyspnea that develop during airplane flights. No noninvasive test can lead to a definitive diagnosis of pulmonary thromboembolism. Early pulmonary angiography should be recommended when pulmonary thromboembolism is suspected.

[Recent advances in immunological diagnosis for tuberculosis].

Recent advances in immunological diagnosis for tuberculosis including tuberculin Mantoux test and serodiagnosis were reviewed. New tuberculins (T1327, T1456) were reported to be more specific than the conventional one (RT23). Tuberculins from atypical mycobacteria (PPD-B, PPD-Y, PPD-F) were reported as a useful tool for the diagnosis of atypical mycobacteriosis. Optical density index method is a most appropriate method for a clinical use among several methods for the expression of antigen titer in serodiagnosis using ELISA. The duration of disease is important for understanding the results. IgM antibody rises in the early stage of the disease and comes down in 10 weeks after onset, while IgG antibody rises lately. Anti-cord factor antibody is a highly specific antibody for tuberculosis and may be a potent candidate for a clinical diagnostic tool. Anti-PPD-B antibody was elevated in atypical mycobacteriosis and pulmonary tuberculosis also. The ratio of anti-PPD-B antibody to anti-PPDs antibody was elevated in atypical mycobacteriosis while it was lowered in pulmonary tuberculosis. It may be helpful for suggesting the causative organism when the sputum smear is positive. The opposite results have been reported on the serodiagnosis in HIV infection. The usefulness of serodiagnosis for tuberculosis in HIV infected patients remained controversial.

[Usefulness anti-PPD antibody in the medical practice of tuberculosis].

The decline rate of tuberculosis has decreased recently in Japan. One of the problems is the tendency of increasing doctor's delay in the diagnosis of tuberculosis. One of measures against this problem is to develop a new laboratory diagnostic method. We studied anti-PPD (Purified Protein Derivative of tuberculin) antibody in serum, pleural effusion, and bronchoalveolar lavage fluid (BAL), and found its clinical usefulness in the medical practice of tuberculosis. Firstly the methods of enzyme linked immunosorbent assay (ELISA) for the antibody to PPD were examined. The expression of antibody titer in optical density was found to be the most accurate and most simple method, and was applied in this study. IgG, IgM and IgA antibody to PPD were measured in serum, BAL and pleural effusion obtained from 122 patients with pulmonary tuberculosis, 54 patients with tuberculous pleurisy, 39 patients with lung cancer, 39 patients with malignant pleurisy, 37 patients with pneumonia, 26 patients with chronic bronchitis, 51 patients with sarcoidosis, or 49 control subjects. Serum level of IgG, IgM, and IgA antibody to PPD was elevated in tuberculosis compared with those in other diseases or control subjects. The difference was most distinctive in IgG antibody. Serum IgG antibody was higher in chronic case than in acute case and IgM antibody was higher in acute case than in chronic case. IgG, IgM and IgA antibody in pleural effusion was elevated in tuberculous pleurisy compared with those in malignant pleurisy. IgG antibody was higher in chronic tuberculous pleurisy than in acute tuberculous pleurisy and IgM antibody was higher in acute pleurisy than in chronic one.(ABSTRACT TRUNCATED AT 250 WORDS)