慢性肺結核症に対するステロイドホルモン刺激療法に関する臨床的研究
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概要
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It is of ten seen that antituberculous agents are ineffective for cases of chronic lung tuberculosis with caseous lesions encapsulated by connective tissue. Possibility of softening and resolution of such lesions through destruction of fibrous capsule by artificial means combined with antituberculous drugs was first discussed by Hart.<BR>In order to attain such changes in the lesion, v arious kinds of stimulation therapy have been tried. The purpose of this study is to evaluate the stimulation therapy with steroid hormone.<BR>Thirty two patients were divided into three groups, each of which received prednisolone and/or ACTH in addition to isoniazid and PAS as described in Fig.1.<BR>For cases showing such reactions as perifocal exudation or cavity formation during the stimulation therapy, SM or secondary antituberculous drugs (KM, 1314 Th or CS) were immediately added.<BR>Changes in chest roentgenogram, blood chemistry, pituitary-adrenocortical function and other side effects were examined during the therapy.<BR>On six cases of group C (see Fig.1), fur t h ermore, changes of 17-ketosteroid fractions were analysed by gaschromatography.<BR>The results were summarized as follows:<BR>1) No marked changes in chest roentgeno g ram was noted in group A.<BR>2) Slight changes in chest roentgenogram was observed in group B.<BR>3) In group C, nine out of eleven cases showed improvement in r oentgenogram, and in four cases, marked clearing of lesions was noted. It could be said that the large dose steroid and ACTH-Z therapy for 9 months is the best steroid-hormone stimulation therapy among these three methods.<BR>4) Moon face, acne vulgaris, striae cutis and disturbance of menstruation were often observed, but they disappeared soon after the cessation of the stimulation therapy. Severe complications such as grave infection, glycosuria, hypertension and peptic ulcer were not found.<BR>5) Cases in all the three groups suffered from pituitary-adrenocortical hypof unction due to the therapy, although this side effect was relieved soon after the withdrawal of hormone administration.<BR>6) According to gaschromatographic analysis of urinary 17-ketosteroids, dehydroepiandrosterone fraction was significantly decreased in cases of group C compared with that of normal adults. In group C, decrease of androsterone fraction and increase of etiocholanolone fraction were also observed after ACTH loading.<BR>Interesting finding was that e tiocholanolone fraction increased at first, and decreased later by SU-4885 administration in some cases of group C.
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