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Biomedical subjects

Masako Wada

Publications and source records attributed to Masako Wada.

17 recordsLinked to original sources
PubMed2006

[Tuberculosis control in health care facilities for the elderly, from the viewpoint of risk management].

OBJECTIVES: To discuss the optimal TB control system in health care facilities for the elderly where the periodic TB screening is currently not obligatory. METHODS: A study was conducted in three health care facilities for the elderly in Tokyo during the period from 2002 to 2004, and 212 admitted elderly persons were enrolled in this study. Medical charts were analyzed to identify informations about mental and physical conditions and TB risk factors. Questionnaire-based interviews were conducted in 58 residents who had no dementia or no serious conditions. TB mass screening was carried out with a mobile vehicle equipped with computed radiography, financially supported by the Tokyo Metropolitan Government. Since this mobile vehicle is equipped with a special wheelchair for chest X-ray examination, most elderly persons were able to receive chest X-ray examination. Medical chart review and interview were conducted at around the time of TB mass screening. The screening results of 183 elderly residents who received X-ray examination were reviewed. RESULTS: Of the 212 persons admitted to the facilities, 73.1% were women. The mean ages of men and women were 80.7 and 84.2 years, respectively. Mental disorders were observed in 42.9% and dysfunction of extremities in 54.7%. At the time of admission, chest X-ray records were submitted by the attending doctors in 73.1% of the residents, but this proportion differed among facilities. From these records, old TB was found in 12.3%; however this proportion was 20.8% according to the TB mass screening results. A history of TB was more prevalent in the group interviewed than in the non-interview group (24.1% vs. 6.5%; p < 0.001). Two facilities had conducted TB screening for three consecutive years and comparative reading of chest X-ray films could be done in 35.8%. The remaining facility conducted TB screening for the first time, and comparative reading was not possible. The proportion of cases requiring further investigations was higher in the facility where TB screening was conducted for the first time (2.8% vs. 13.0%; p = 0.008). No active TB patient was detected in this study. CONCLUSION: From the viewpoint of risk management for tuberculosis, it is important to establish a system of early case finding for the aged persons admitted to health care facilities for the elderly. Therefore, the information on risk factors should be collected properly at the time of admission, and careful attention should be paid to the residents with risk factors, for the possible development to active disease. X-ray records submitted by the attending doctors or by screening would provide useful informations for early diagnosis, when abnormal shadows are found on chest X-ray films.

Aged, 80 and over↗
PubMed2006

[Twice-weekly intermittent chemotherapy during the maintenance phase of the short-course treatment for new patients with pulmonary tuberculosis].

BACKGROUND AND OBJECTIVE: Various types of intermittent chemotherapy regimens have been applied for the treatment of tuberculosis worldwide, but, in Japan, any type of intermittent treatment has not been adopted currently as the standard regimens for the treatment of tuberculosis. Intermittent regimens have a great advantage to facilitate directly observed therapy (DOT). To introduce DOT more extensively in Japan, we conducted the present clinical trial to assess the effectiveness and safety of intermittent chemotherapy. PATIENTS AND METHODS: This is a non-randomized trial to compare twice-weekly intermittent therapy under DOT with daily therapy by self-administration. Newly diagnosed patients with pulmonary tuberculosis who completed the initial intensified phase of 2 months with 4 drugs were enrolled. Supervision of drug administration was carried out by the pharmacists who cooperated to the study (Pharmacy DOT). RESULTS: Total 385 patients were enrolled in this trial, of which 135 patients were treated by twice-weekly intermittent maintenance chemotherapy under the supervision by pharmacists and remaining 250 patients were treated by daily maintenance chemotherapy without supervision (self-administration). Treatment success-rates were 97.6% for intermittent treatment group and 95.6% for daily treatment group. Relapse rates after the completion of the treatment course were 3.73/ 100 person-year and 1.76/100 person-year, respectively. The difference between the two groups was not statistically significant. Adverse events required the modification of treatment schedule occurred only in 0.2% of the intermittently treated patients. CONCLUSIONS: After the successful completion of the initial intensified phase of tuberculosis chemotherapy, twice-weekly intermittent chemotherapy during the maintenance phase under the supervision by pharmacist is as effective and safe as the daily therapy, and is conveniently accepted by the patients. The pharmacy DOT with the intermittent therapy during maintenance phase adopted in this trial, should be widely introduced in Japan.

Adolescent↗
PubMed2005

[Risk of acquisition of RFP resistance out of INH resistant RFP susceptible tuberculosis].

OBJECTIVE: To investigate the prognosis of isoniazid (H) resistant rifampicin (R) susceptible tuberculosis cases with emphasis on the risk factors of developing MDR. METHOD: Retrospective review of H resistant R susceptible tuberculosis cases that were treated at Fukujuji Hospital in Japan between 1990 and 2000. RESULTS: Four cases developed drug resistance and became MDR. Seventy seven cases completed treatment with bacteriological confirmation of negativity during treatment and 2 years after treatment (cure). Other 38 cases completed treatment with confirmation of culture negativity at the end of treatment but one of them relapsed within 2 years and the remaining 37 cases were not followed up for 2 years. Fourteen cases died, 13 cases defaulted and 17 cases were transferred out. The comparison of the regimen of chemotherapy between cured cases and cases who became MDR showed that more cured cases were found among those who started treatment with 4 drugs or more than cases who started treatment with 3 drugs or less. Other factors that were related (but not significant) to cure rate were non-diabetics in comparison with diabetics and 4 drug standard regimen (HRZS, HRZE) in comparison with 3 drug standard regimen (HRS, HRE). DISCUSSION: Prevention of MDR could be achieved by wider use of 4-drug standard regimen and changes of chemotherapy regimen promptly responding to the results of drug susceptibility tests.

Adult↗
PubMed2005

[Anti-tuberculosis drug-induced hepatitis].

In 1996 a six-month short-course chemotherapy was adopted as a standard chemotherapy for pulmonary tuberculosis in Japan. The frequency of implementation of short course chemotherapy for smear positive new case was only sixty percent in 2003, although a short course chemotherapy was recommended all over the world for avoidance of acquiring a new resistance among new drug resistant tuberculosis. The reasons for the low adaptation of short course chemotherapy were speculated that high rate of elderly patients, and high frequency of drug-induced hepatitis. From our 14-year experience, the frequency of drug-induced hepatitis was 7.8% for all patients with standard 6-month or 9-month regimen, 7.2% in the patients with normal liver function tests at the start of chemotherapy, and 11.8% in the patients with any kinds of abnormality. The death rate was 0.04% among treated patients, and fatality was 0.49% among the patients with drug-induced hepatitis. Positive HCV antibody and less than 1,000 cells/microL of peripheral lymphocyte count at the beginning of treatment were independent risk factors for drug-induced hepatitis. The management of hepatitis during antituberculosis treatment was also referred.

Antitubercular Agents↗
PubMed2005

[Treatment results of multi drug resistant tuberculosis, a hospital based study].

SETTINGS: Fukujuji Hospital, Japan. PURPOSE: To evaluate treatment results of multi drug resistant tuberculosis cases. METHOD: Retrospective review of 100 multi drug resistant tuberculosis cases who started treatment in 1990-1999 at Fukujuji Hospital. Life table analysis and analysis of longterm treatment results were done. RESULT: Observation for more than 3 years after starting treatment revealed cure in 62, chronic excreters in 2, and died cases with positive culture in 10, and treatment completed with shorter observation period in 8. The remaining 18 cases were either transfer-out, defaulted or died with other causes. The older age, cavitary lesions (bilateral>unilateral>no), resistance to more drugs, interruption of treatment due to side effects to second line drugs and the complication of diabetes mellitus were independent risk factors for unfavorable results. The treatment results improved with the increase of the number of effective drugs used for 6 months or more. The surgical intervention improved the proportion of favorable treatment results for those that were culture positive after 5 months of treatment. DISCUSSION: Treatment results of MDR TB was not satisfactory. Diabetics was the risk factor of unfavorable results. The conditions for the indication of surgical intervention among culture negative cases after 5 months of medical treatment needs to be further investigated.

Adult↗
PubMed2005

[Should chemotherapy for pulmonary tuberculosis be started after the completion of pretreatment sputum examination?].

PURPOSE: Investigation on the influence of early start of chemotherapy on the results of sputum smear and culture (Ogawa medium and BACTEC MGIT960). OBJECT AND METHOD: Retrospective study for tubercle bacilli positive pulmonary tuberculosis cases in our hospital. RESULT: Starting chemotherapy before the completion of pretreatment sputum examination was found to have no adverse effect on smear positive rate and smear positive grade (246 cases), culture contamination rate on Ogawa medium and BACTEC MGIT960 (1128 sputums), culture positive rate and culture positive grade/time to confirm positive on Ogawa medium (245 cases), and culture positive rate on BACTEC MGIT960 (239 cases). Time to confirm positive on BACTEC MGIT960 was slightly, but significantly prolonged (1.16 days delay in cases with 1-3 days chemotherapy [228 cases], and 4.01 days delay in cases with 4-6 days chemotherapy [59 cases]). CONCLUSION: Unfluence of early start of chemotherapy on the results of sputum smear and culture is minor. In most of bacilli positive pulmonary tuberculosis cases chemotherapy can be started before the completion of pretreatment sputum examination.

Adolescent↗
PubMed2004

[C-reactive protein in patients with bacteriological positive lung tuberculosis].

PURPOSE: To investigate the usefulness of measuring C-reactive protein in the diagnosis of lung tuberculosis. OBJECT: Tuberculosis patients treated by chemotherapy at Fukujuji Hospital from Jan./1/2000 to Dec./31/2001. METHOD: Chart review. RESULTS: CRP are negative in 13.3% (95%CI: 8.9-17.7%) in sputum smear positive lung tuberculosis patients (N = 226), and in 73.0% (95%CI: 62.0-84.0%) of sputum smear negative culture positive lung tuberculosis patients (N = 63). CONCLUSION: Usefulness of measuring C-reactive protein in the diagnosis of bacteriological positive lung tuberculosis is limited.

Bacteriological Techniques↗
PubMed2004

[Multi-drug resistant lung tuberculosis due to double infection of MDR strain].

The case is 47-year-old, homeless man. He was diagnosed as cavitary, sputum smear positive pan-sensitive lung tuberculosis, and admitted to TB ward of our hospital. At the age of 4-year-old he had tuberculous hilar lymphadenopathy and took medicine. He had no other associated disease, and HIV test was negative. He started standard chemotherapy and 2 months later his sputum culture was converted to negative. His adherence to medicine was thought to be good. But about 2 weeks after the sputum conversion, his sputum culture was re-converted to positive for Mycobacterium tuberculosis. Thereafter, during and after the completion of standard chemotherapy, his sputum culture had been intermittently positive. The drug sensitivity tests of the strain after re-conversion showed multi-drug resistance. RFLP analysis revealed that the strain before conversion was totally different strain from the strain after re-conversion to positive. The case was considered to be caused by the double infection of MDR strain of Mycobacterium tuberculosis during the course of treatment for tuberculosis due to a sensitive strain of Mycobacterium tuberculosis.

Antitubercular Agents↗
PubMed2004

[Drug resistance in recurrent cases of tuberculosis].

PURPOSE: Investigate drug resistant rate in recurrent cases after cure, or after drop-out from treatment, and the analysis of the risk factors for acquired drug resistance in these cases. OBJECT: Patients who were previously treated for tuberculosis that was drug sensitive or unknown about previous drug sensitivity, and were hospitalized to Fukujuji Hospital to start treatment for recurrent tuberculosis from Jan. 1, 1993 to Dec. 31, 2003. Primary drug resistant cases were excluded and cases were further divided into full sensitive cases and cases with drug sensitivity test results were unknown. METHOD: Chart review. RESULT: Drug resistant rate (any resistance to INH, RFP, SM, EB) in all recurrent cases (N=200) was 16.5%. Availability of previous drug sensitivity results affected on the drug resistant rate in recurrent cases. In previously pan-sensitive cases, drug resistant rate was 4.3% and it was lower than the rate in primary treated cases. No significant risk factor for acquired drug resistance was not found, including poor adherence to medication. CONCLUSION: Every effort should be made to know the previous drug sensitivity results because these results have a major impact on drug resistance rate at recurrence. Doctor's mismanagements of tuberculosis patients might be the major factor for acquired drug resistance in recurrent cases, and it is needed for the improvement of tuberculosis control program to implement the measures to control these mismanagements.

Adult↗
PubMed2004

[Miss-management in treatment failure of pulmonary tuberculosis].

PURPOSE: To investigate the risk factor of treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from the standpoint of both clinical management and tuberculosis control. OBJECT AND METHOD: Retrospective chart review of patients who admitted to Fukujuji Hospital for treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from Jan. 1993 to Dec. 2003. RESULTS: Out of 24 treatment failure cases available for analysis, 4 cases were associated with chronic tuberculous empyema with broncho-pleural fistula, and among them, chronic empyema was considered to be the main cause of treatment failure in one case. In 6 cases, poor adherence to medication was confirmed or suspected, and 2 of these 6 cases was also associated with miss-management. In 9 cases miss-management was found without poor adherence or chronic empyema, and in 8 out of these 9 cases, miss-management was considered to be the main cause of treatment failure. In 5 cases no apparent risk factor was found, but in 2 out of these 5 cases the ignorance of the results of drug sensitivity tests (and, therefore, miss-management) was strongly suspected. Summing up, in 10 out of 24 cases (41.7%), the miss-management was considered to be the main cause of treatment failure, and it was more frequently seen than poor adherence to medication. CONCLUSION: Clinicians should be aware of these risk factors of treatment failure such as chronic empyema, weak regimen in bacteriological negative cases, rifampicin+ethambutol regimen, and miss-management of drug adverse effect. From the standpoint of tuberculosis control in Japan we considered that, in addition to DOT, strategy to secure the quality of tuberculosis treatment is by all means needed.

Adult↗
PubMed2004

[Are tuberculosis advisory committees well-functioning?].

PURPOSE: To evaluate the function status of TB advisory committee to assess treatments of tuberculosis. OBJECT AND METHOD: Estimate by questionnaire sheets to public health nurses attending to seminars on tuberculosis at Research Institute of Tuberculosis. RESULT: 137 answers are available for analysis. Of these, 57 (41.6%) TB advisory committees are estimated not to assess treatments of tuberculosis at all and/or to assess treatments without necessary informations on drug sensitivity in more than around half of the cases. In 13 (16.3%) committees of the other 80, many cases are in fact self-assessed. Number of committees that are estimated to functioning well is only 44 (32.1%). CONCLUSION: Many TB advisory committees are estimated to be malfunctioning from the stand point of assessments of treatment. As TB advisory committee is one of key agency to control drug-resistant tuberculosis, its reform and revitalization are urgently needed.

Advisory Committees↗
PubMed2004

[Process of acquiring drug resistance: retrospective review of records of MDR TB].

PURPOSE: To investigate the reasons of acquiring drug resistance among MDR TB cases and to learn lessons for the prevention of acquiring of drug resistance. METHOD: Retrospective review of 159 MDR TB cases who were treated at Fukujuji Hospital from 1990 January to 2003 August. RESULT: We found that among 159 cases, 48 cases were infected with multidrug resistant M. tuberculosis bacilli, 35 cases acquired drug resistance, 7 cases were with the history of tuberculosis treatment before 1970 only, and that remaining 69 cases were difficult to evaluate because of the lack of informations on previous drug susceptibility tests. Among 35 cases that acquired drug resistance, the drug susceptibility test patterns before becoming MDR TB were categorized as follows: 12 HR susceptible, 18 H resistant R susceptible, 3 R susceptible (H unknown), and 2 H susceptible R resistant. The factors that may have influenced to acquire MDR were lack of modification of the regimen after knowing drug resistance among H resistant R susceptible cases, and defaulting among cases that were not evaluated (15/69) and H resistant R susceptible cases (3/18). DISCUSSION: Control of MDR TB needs to be strengthened. Proper drug susceptibility test, proper choice of drugs at the beginning of treatment and modification of treatment after knowing drug susceptibility test results are important for the prevention of MDR TB. Ensuring patient adherence to treatment is important in the medical institutions where drug susceptibility test is not properly done, in particular, for H resistant R susceptible cases, and guidance to these institutions by the public health centers should be intensified.

Adult↗
PubMed2003

[A comparative study on severity of tuberculosis cases between those found by periodical chest X-ray examination and those found by symptomatic visit to OPD in Japan].

BACKGROUND: Japanese national tuberculosis control program (NTP) has included indiscriminate chest X-ray examination for adult population. METHODS: A comparative study on the severity of pulmonary tuberculosis cases in a hospital in Tokyo by the mode of detection (between cases found by periodical check and cases found by symptomatic visit) and previous history of X-ray examination (among cases detected by periodical check, cases detected by symptomatic visit but with previous history of periodical check and cases without history of chest X-ray examination during the past 3 years). RESULTS: The comparison between patients found by symptomatic visit with and without previous history of periodical check showed that there was no difference in the grade of sputum smear positivity at the time of diagnosis but that those without previous history of periodical check were more serious as to chest X-ray findings. The comparison between patients found by symptomatic visit with previous history of periodical check and those detected by the periodical check showed that the grade of smear positivity was less among those found by the periodical check but no difference as to chest X-ray findings, however, comparing cases of these two categories in the age group of 40-59, those detected by the periodical check were less serious as to both X-ray findings and smear result. There were 21 persons who were indicated requiring further investigation but actually were not examined. The severity of tuberculosis among these 21 persons were more serious as to the grade of smear positivity than those detected by periodical X-ray examination.

Adult↗
PubMed2003

[Factors related to early case detection of tuberculosis in health service facilities for the elderly].

The proportion of newly notified tuberculosis cases aged over 65 years has been rising and reached 49.2% in 2001. For this reason, the Ministry of Health, Labor and Welfare recommended in 1999 to give preventive therapy for tuberculosis to elderly persons with fibrous lesions on chest X-ray. However, our research pointed out many problems in the matter and low public health benefits of preventive therapy. At present, early case detection and treatment are considered to be the most effective tuberculosis control measures for the elderly in Japan. For the purpose of developing the most effective case finding method for the elderly, we investigated various aspects of tuberculosis in health service facilities for the elderly. Health service facilities for the elderly were established since 1988 to provide nursing care and rehabilitation services to enable elderly persons who no longer need hospitalized care to return home. Questionnaires were mailed to 358 health service facilities for the elderly in a metropolitan city and 4 prefectures. One hundred and sixty-nine facilities (47.2%) responded. Among them, 61 (36.1%) are attached to hospitals, 21 (12.4%) are attached to clinics, and 87 (51.5%) are not attached to any medical facilities. The median duration from the opening of the facility was 3.5 years, and 113 (66.9%) facilities were founded within 5 years. The mean age was 83.2 years for facility-care users and 79.6 years for day-care users. The mean duration of care was 7 months for facility-care users and 13 months for day-care users. Pre-admission chest X-ray was conducted for facility-care users in 72 (42.6%) facilities, and for day-care users in 40 (23.7%) facilities. Comparing with 84.3% (Shishido, 2002) in special nursing homes for the elderly, the rate was significantly lower in health service facilities for the elderly. Periodic TB screening during care utilization was also less frequently carried out in health service facilities for the elderly (45.6% for facility-care users and 15.4% day-care users). A possible reason is that special nursing homes for the elderly are mandated to conduct periodic TB screening as provided by the TB Control Law, while health service facilities for the elderly are not under such provision. Periodic TB screening for employees was carried out in 160 (94.7%) facilities. Respiratory symptoms were less frequently checked compared with anorexia or lassitude. Thirty-two facilities (18.9%) checked the facility-care user everyday for respiratory symptoms using a check-list, while 114 facilities (67.5%) checked only for anorexia or lassitude (p < 0.01). When persistent respiratory symptoms were observed in facility-care users, 157 (93.5%) facilities referred them to hospitals with letters explaining their symptoms and 108 (63.9%) facilities requested chest X-ray and sputum tests. However, for day-care users, most facilities only advised them to visit medical institution without any letter of referral. Within 5 years, 52 (30.8%) facilities reported 65 TB cases among facility users and 5 (3.0%) facilities reported 5 TB cases among employees. Based on person-year, case rate was calculated to be 104.6 per 100,000 among elderly facility users. This rate was compared with that of people aged 75 years over in the community. Rate ratio was 1.04 (95% CI: 0.82-1.34). The risk of developing tuberculosis was slightly higher in the elderly facility users, but the risk was not statistically significant. This result may be influenced by the low response rate from facilities with tuberculosis cases. We conclude that it is very important to detect TB cases at the early stage of disease not only to protect the elderly from tuberculosis death but also to prevent outbreak of tuberculosis infection in health service facilities for the elderly. Effective and feasible tuberculosis control for the elderly should be provided under the TB control Law and be implemented with the cooperation from related medical institutions and public health centers.

Age of Onset↗
PubMed2002

[Discussing the current situation of tuberculosis case-finding by mass miniature radiography in Japan].

The system of tuberculosis (TB) case-finding by mass miniature radiography (MMR) was established and expanded for almost all Japanese citizens in the 1950s. And, as stipulated by the TB Prevention Law, periodic mass screenings for schools, inhabitants, employees and institutions have been carried out. Among those aged over 25 years, the proportion of people screened by MMR was estimated to be 60.3%. This means that about 54 million people aged over 25 years are receiving medical service with MMR every year. However, the detection rates of TB cases by MMR have declined markedly compared with those in 1950s. As of 1998, the detection rate was 0.03 per 1,000 for school children and students, 0.06 per 1,000 for employees, and 0.16 per 1,000 for inhabitants. The proportion of cases detected by MMR among newly notified TB cases was 12.8% in 1998, and this ratio has been almost constant for the last 10 years. This ratio was greater among young adult TB cases. Approximately 20% of notified TB cases aged 20-39 years were detected by MMR for employees. Although the purpose of MMR is to find the cases before discharging TB bacilli, 35.1% of the cases were bacteriologically confirmed, and this proportion was greater among elderly TB cases. The Japan Anti-Tuberculosis Association (JATA) has been carrying out MMR for a long time. Eight selected branches of JATA that has been doing high quality case-finding reported 228 TB cases out of 965,440 inhabitants aged over 40 years examined by MMR in 1996. Based on these results, the cost per TB case detected by MMR was calculated. The cost was 4.4 millions yen (yen) per case for all forms of TB, yen 2.3 millions for male, yen 8.4 millions for female, yen 7.3 millions for those aged 40-49 years and yen 1.8 millions for those aged over 80 years. TB detection rate by MMR for inhabitants was correlated with TB incidence rate in various areas, and based on this correlation, the cost was calculated for various incidence rates. For all forms of TB, the cost was yen 4.0 millions per case for an incidence rate of 30 per 100,000, and yen 6.7 millions for an incidence rate of 20 per 100,000. MMR is not economically cost-effective even among elderly people and in areas with incidence rate less than 50 per 100,000, because the medical expense for a TB patient treated under hospitalization for 2 months and outpatient's clinic for 4 months is approximately yen 0.9 millions in 1996. The decision making in continuation or abolition or limitation of MMR should be discussed from a wide range of cost-effectiveness analyses as well as from the view of public health service and willingness of people. For the purpose of decision making, this study provides the detection rates; the costs stratified by sex, age and incidence; and the proportion of cases detected by MMR among newly notified TB cases by age-group and bacteriological status.

Adult↗
PubMed2002

[Preventive therapy in middle-aged and elderly persons selected from the population-based screening by mass miniature radiography--methodological aspect and adverse reactions].

The notification rate of tuberculosis in Japan was 31.0 per 100,000 in 2000. The rate was especially high among the elderly population, reaching 85.5 per 100,000 among those over 65 years of age. We conducted a study of preventive therapy in middle-aged and elderly persons selected from the population-based screening by the mass miniature radiography. The eligible criteria were 50-79 years of age, fibrous lesion which were compatible with healed tuberculosis and showed no change for at least one year, no previous treatment for tuberculosis, normal liver function tests, and no serious disease at the time of study. The eligible criteria for liver function tests in this study was less than 50 IU/L of AST and ALT value, and less than 1.5 mg/dl of T-bil level. A total of 13,219 people underwent TB screening in 4 cities in 1997 and 2 cities in 1998. Among them, 440 persons fulfilled the above criteria based on the screening records and chest X-ray films. The municipal offices sent letters to 418 people, except 22 whose addresses were unknown, to obtain permission to use their addresses and results of screening in our study. Permission was obtained from 137 persons and we sent them invitation letters for cost-free physical checkup service. Ninety-five persons visited us, and we offered them physical checkup and explained about our study. After obtaining the informed consent, we performed chest X-ray and sputum examination for 3 consecutive days. Finally 29 people were enrolled in the study. They were divided into 4 groups by sex and age, and were randomly assigned to one of two treatment groups. One group took 300 mg of INH per day for 6 months and the other group was only followed up by chest X-ray. Fourteen out of 29 persons began to take INH and received monthly liver function test. All the subjects were scheduled to follow by medical checkup every 6 months for 5 years. The proportion of taking INH tablets was estimated to range from 94% to 100%, based on the calendar for record of taking medication and the number of remaining tablets each month. Six (42.9%) of 14 persons reported adverse reactions. Two of 6 persons complained some of diarrhea, vomiting and gastrointestinal disturbance within 2 weeks, and discontinued taking INH, although none of them showed abnormal liver function tests. Two of 6 persons who reported some kinds of symptoms and 2 of 8 persons who did not complain of any symptoms showed abnormal liver function tests. The abnormal liver function tests had developed from 2 months after the beginning of INH taking in most of the persons and the abnormality improved after the completion of 6-month treatment. We have followed them for a maximum duration of 2.5 years, and 3 cases dropped out from the study. These defaulted cases had completed 6 months of INH. One person (69 y.o. male) was diagnosed as active TB by his chest X-ray film at the 6th month medical checkup, although it was not confirmed bacteriologically. One person (62 y.o. female) had the mastectomy for breast cancer 7 months before the entry to this study and relapsed at the 8th month after the entry. One person (73 y.o. female) was diagnosed as lung cancer at the medical checkup on 2.5 years. Besides them, 4 persons were suspected of worsening the abnormal shadows on chest X-ray films; one was from the INH group and three were from the follow-up group. However none of them was diagnosed clinically and bacteriologically as active tuberculosis.

Aged↗