慢性腎結核の組織細菌学的ならびに組織化学的知見補遺
とくに化学療法の影響について
1963 年 54 巻 10 号 p. 997-1017
詳細
1963 年 54 巻 10 号 p. 997-1017
The following subjects (1-3) were examined on 106 of tuberculous kidneys extirpated surgically, six of which were freshly obtained.
1) Distribution of tubercle bacilli in the lesion: The observed numbers of tubercle bacilli were in plenty in the oder of caseous substances in the renal pelvis, ulcers in the region of the pyramid and calyx and caseous lesions on the cavitary wall. Furthermore, there were 14 cases in which tubercle bacilli were found inside the bloodvessels (within the artery in 5 cases, the vein in 7 cases and both of artery and vein in 2 cases). In the cases in which the chemotherapy was performed with a large dose bacilli in the lesions were markedly reduced in the number or disappeared.
As for the formation of wedge-shaped lesion, it has not been made clear whether they were produced by lymphogenous types or hematogenously. Arteritis could be detected in the irrigating arteries to the lesion, containing tubercle bacilli inside them. This fact established that the lesion were tuberculous septicemic infarct produced by hematogenous dissemination of tubercle bacilli to the peripheral area, after the entry into blood-vessels.
2) Histological changes due to the chemotherapy: Powerful chemotherapy resulted in decrease in the number of lymphocytes, giant cells and epithelioid cells and increase in the number of plasma cells as a general trend. In the cases receiving chemotherapy of more than medium grade, there are a few cases showing the formation of extremely thick connective tissues. Earlier and powerful chemotherapy was noted to have remarkable therapeutic effect. Even in case of extirpation of the kidney, it was emphasized that powerful chemotherapy should be performed before and after the operation.
3) Histochemical findings: It was found that chemotherapy resulted in increase in the amount of neutral fat, fatty acid, phospholipid and polysaccharide. In giant cells and epithelioid cells, acid phosphase activity showed a tendency to decrease following the chemotherapy, while alkaline phosphatase and nucleic acid showed no change in the reaction.
