The advent of chemotherapy in the treatment of tuberculosis manifested brilliant therapeutic effects. But it is well known that cavernous lesion or large caseous foci resist strongly against chemotherapy. The factors which rule the effects of the treatment of tuberculosis are considered partly from the relationship between drugs and bacilli and partly from the immunity or resistance of the tissues of organisms. Hence the chemotherapy are not equally effective on large cavernous lesion and on small solitary tubercles. In this regard, the chemotherapy of renal tuberculosis is not differ from that of pulmonary lesion. In the treatment of renal tuberculosis, it is considered as a general rule that surgical treatment and chemotherapy are applied separately or in combination.
In our urological clinic the authors have experienced thirty cases of renal excision after chemotherapy in these five years. We studied histo-pathologically about the effects of chemotherapy in tuberculous lesions of excised kidneys and also investigated suitable doses of drugs for preoperative treatment. The results obtained are summerised as follows.
1) The miliary tubercles showed remarkable healing tendency with those histological pictures such as (1) disappearance of exudation; (2) disappearance or decrease of necrotic substance in tubercles; (3) atrophy, disappearance or histiocytic metamorphosis of epithelioid cells; (4) tendency of atrophy or metamorphosis of giant cells; (5) no indication of proliferation of collagen and reticulin fibers.
2) Large Gaseous foci retained without evident histological changes for chemotherapy, but small ones were resorbed by histiocytic cells or became fibrous scar by extension of reticulin fibers from the surrounding tuberculous granulation tissues.
3) Tuberculous cavity resisted against chemotherapy intensely, but in some parts of cavity wall the separation of Gaseous mass from the cavity wall occured as the partial healing.
4) The tuberculous lesions of the mucosa of pelvis and ureter indicated a remarkable tendency of healing, but if the lesion penetrated deeper in their wall sufficient healing was difficult.
5) The healing effects wcre generally shown intensely in the cases administrated with more than 40g of SM and corresponded doses of PAS and INH.
From these results it was concluded as follows:
1. Combination of chemo-and surgical therapy is generally necessary for the treatment of renal tuberculosis with cavity.
2. Desirable doses of medicaments in preoperatived chemotherapy are 40-50g of SM and corresponded doses of PAS and corresponded doses of PAS and INH.
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