急性尿道淋に於ける組織内淋菌の形態學的研究
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Observations on the gonococci found in the tissues are few and for many years the problem has been considered to be a difficult one. The author has executed studies on this problem as pertaius to cases of acute gonorrhea, as one phase of the general research on gonorrhea outlined by Prof. Tabayashi. The study. is based on 40 specimens of the urethral tissue taken from 28 patients suffering from acute urethritis. All these patients gave positive results for gonococci in their purulent discharges. The tissues used for observations were removed from some convenient location, chiefly near Guerin's sinus, during the first 10 days following the drainage. All specimens- were cut in serial section, thus the total mumber of such sections is almost in-numerable. The details of pathological changes in these specimens are here omitted, since they have already been reported by H. Heima. These 5 cases represent the early stage or the beginning of the inflammatory process, 26 of which showed localized diffuse lesions and the anterior portion of the urethra presented mature inflammatory. changes. The excised tissues were characterized by a uniformly marked inflammatory picture over an area from the urethra proper to paraurethral tissue down to the cut end. Again 9 cases presented a histological picture of acute gonorrhea in relapse. These patients, with previous attacks of gonorrhea, showed purulent discharge without any new occasions, after a period of treatment. Histologically a high grade inflammatory involvement can be demonstrated in one paraurethral duct, which was spreading to the surrounding areas. For the demonstration of the gonococci in the tissue, the following 10 staining methods have been empolyed : (1) Polychrome methylene blue staining ; (2) Unna-Pappenheim's methyl green-pyronin method ; (3) Gram's method ; (4) Herxheimer's staining ; (5) Zieler's method ; (6) Pappenheim's panchrome staining ; (7) Thionine staining ; (8) Nicolle's tannin method ; (9) Pick-Jacobsohn's double staining ; (10) Schmorl's method ; All of these staining methods are capable of staining the gonococci in the tissues, although each possesses an advantage as well as a disadvantage. For the differential staining of the microorganisms, permitting a clear distinction from other cocci as well as from granular cells, 3-4 methods of staining are required. It would be convenient if the above stated condition can be satisfied by a single method of staining, but, in spite of some effort in this direction, no success has been achieved for the present study. The results of observation made on specimens stained by the various methods may be summarizsd as follows :- Polychrome methylene blue staining : The gonococci are well stained either deep blue or dark blue and stand in sharp contrast from the light blue stained tissue. The granules of mast cells take light or dark purplish red. The specimens stained by this method can be preserved for a long period of time. Unna-Pappenheim's staining : In contrast with the lightly blue stained cell nuclei and the light reddish tint of the remaining tissue, the gonococci are brilliantly stained scarlet red. However, since the cell granules also take on a scarlet red color, a possibility of error in observation exists when this method is used singly. Gram's stain : As is well known, the differentiation between the gonococci and other cocci is extremely satisfactory by this method, but the granular cells are stained just like the gonococci, making the single use of this method dangerous. Pappenheim's panchrome staining : This method is highly suitable, since the gonococci are well stained in deep blue, and the granules of the mast cells and of the eosinophils take on different colors. Herxheimer's staining method : This method is also satisfactory, since the gonococci are stained deep blue, while the granules of the mast cells and of the eosinophils take on dark red. Zieler's staining : This is a special method which enables a differential staining of the gonococci and of the granular cells in addition to good staining ability far the elastic fibers. The simplicity of staining technic is also an advantage. Comments on other methods, each possessing its own advantage, may bo omitted. In the present study 6-7 methods have been employed for the observation of the gonococci. The mode of distribution of the microorganisms presented such varieties as dense aggregation sparse dispersion, or irregular distribution. Thus, varied pictures were encountered in demonstrating the microorganisms in specimens differing in their distribution, namely, from those with abundant gonococci to those in which a few typical ones could be found after a prolonged search. The mucosal surface was the tissue where the greatest number of the microorganisms could be found, but they are also present between, the inflammatory connective tissues in the submucosa. The blood and lymph vessels also contain many gonococci. The histological picture is that of localized diffuse type, but the greatest number is found at a stage corresponding to the stadium floritationis, followed by that of initial stage, while the early stage of relapse shows only a few organisms. In the present investigation, the gonococci in the tissues were demonstrated in all 4.0 .cases or 100% of the specimens examined. This means that the gonococci were present in the tissues of in all cases clinically diagnosed as acute gonococcal urethritis.
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