A Study on the Vascular Changes in Pulmonary Tuberculosis: Especially on the Effects of Chemotherapy Upon the Changes

Abstract

Investigation was conducted on vascular changes in the lesion characteristic of autopsied lung of cases not treated chemotherapeutically, and histological test was made on vascular changes in resected lung after chemotherapy, while research was carried on effects of this therapy administered to various types of tuberculosis pulmonary variations as well as residual lesions by checking variations in the blood vessel of the lung. 1) The newest exsudative lesion in cases not treated chemotherapeutically, where no necrosis is found, is accompanied by a few variations in the pulmonary artery and vein without much relation to the lesional size, but only by inflammatory edema or slight cellular infiltration. There remains almost no vascular change in the region, where exsudates have disappeared to the full extent by effective chemotherapy administered to such lesion. 2) When even a new exsudative lesion is followed by incidence of central necrosis, small blood vessels with cellulary thickened inner coat can be frequently encountered in infiltrated cells around its border. Interlobular wall is often affected with cellular infiltration and serous exsudation. As the lesion gets remedied with its encapsulation, the thickened fibrous inner coat and organized thrombus are encountered in the cellular or connective tissue tunica as well as in the neighboring tiny artery and vein. There is almost no variation in blood vessels among normal circumferential pulmouary tissues separated by tunica, while the connective tissue of interlobular wall connected to the periphery is not only thickened in the caseous lesion in the natural course of encapsulation, but also thickened inner coat or organized thrombus are found in the vein running through the connective tissue. Caseous lesion capsulated after chemothrapy has generally thinned tunica, and in blood vessels　therefore there is so less variation. Moreover, in cases treated non-chemotherapeutically the atelectatic sclerotic lesion takes place frequently around the caseous one, and reveals vascular changes, as explained in the preceding. However, in cases treated chemotherapeutically the circumferential pulmonary tissue generally indicates a few non-peculiar changes, and consequently a few vascular changes above mentioned. 3) There are high incidences of symptoms such as fattened inner coat of the artery and vein, proliferated elastic fibers in the inner and outer coat, and obturated hollow due to the organized thrombus. Cases treated chemotherapeutically suffer from same vascular changes in the tissue originally affected with atelectatic sclerosis or having tended toward atelectatic sclerosis owing to some reason in the course of chemotherapy as found in the same region of cases treated non-chemotherapeutically. Such condition of tissue is frequently encountered around the wall of cavity. 4) There is almost no vascular change in the circumferential normal lung, where only lobular nodules develop, but variation above mentioned appear in tiny blood vessels adherent to those nodules. These changes become less evident in nodules, which have contracted rapidly owing to chemotherapy. 5) There are few differences between variations in the artery and vein, which mean mainly fattening of the inner coat and formation of thrombus. More of the latter is involved in the vein. And variation in the lobular wall takes a dominant part in the venous one. 6) From the preceding paragraph it can be summarized that total amount of vascular changes after chemotherapy is measured by quantitative presence of residual lesions including peculiar or non-peculiar ones. 7) Mortality due to tuberculosis itself is reduced, and patients of pulmonary tuberculosis are improved in period of survival by chemotherapy, while variation in pulmonary blood vessels continues to constitute a disturbance to the pulmonary circulation over long period.