腎結核に対する化学療法知見 : 第1報 3者併用療法期間と腎組織所見

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A fundamental and clinical study of urinary-tuberculosis has been got on with, and SM, PAS, INH, TB-I and other antituberculous agents has been proved to be effective in the treatment for tuberculosis. A opinion obtained from these achievements is as follows: First, to renal tuberculosis, as well as other tuberculosis, in its early conditions, these agents were expected to be effective. Second, it is admitted that, when tuberculosis is limited only to renal pelvis, urine can be made negative for tubercule bacilli in 40-50% of the cases by applying SM alone. Regarding the quantity and duration of SM administration, two methods are employed in the early period of the disease; one method of applying 1 g. per 12 hours and the other of applying 0.5 g. per 12 hours. But in the treatment by SM alone, a reaction to the bacilli is too strong, and when 40-60 g. of SM is applied, it was discovered that their rigidity appeared. To prevent this phenomenon, PAS is applied to patients in combination with SM. Now, in the cases of renal tuberculosis to which a combination of SM, PAS, INH was applied (triple-drug therapy), following results were gotten by investigating the duration of the application of these agents, observing renal tissue, and searching for tubercle bacilli within renal tissue. Tuberculous kidneys which had preoperative treatment by applying SM, PAS, INH were divided into 4 groups, according to the duration of chemotherapy, and compared the cases to which chemotherapy had not been applied with above-mentioned 4 groups. As a result, I came to the following conclusion. 1) Purification of renal papillae and cavity walls, and regeneration of epithelium were, to some degree, in parallel to the duration of chemotherapy. These phenomena were remarkable in the cases to which chemotherapy was applied for more than seven months. But in the cases where connective tissue wrapping cavity walls was formed thickly, the regeneration of capillary vessels of cavity walls was impeded, and the regeneration of the epithelium was hardly recognized. 2) Between the cases to which chemotherapy was not applied and those to which chemotherapy was applied, no quantitative difference was disclosed in number of tubercles; that is, in the cases to which chemotherapy was applied long, the number of tubercles was not always decreased, and on the contrary, in some of the cases to which chemotherapy was not applied, the number of tubercles was decreased. 3) Moreover, transformation, atrophy and cavity formation of epitheloid cells and Langhans's giant cells in tubercle, were recognized in the cases to which chemotherapy was not applied. Accordingly, I don't think that these changes can be the conspicuous effect of chemotherapy. 4) In the cases to which chemotherapy was applied long, infiltration of small round cells and augumentation of connective tissue in interstitium were greatly recognized. 5) Tubercle bacilli in the renal tissue were found in 20% of cases with chemotherapy of more than one year duration; 33% of the cases with chemotherapy of more than seven months duration, 52.4% in more than three months of chemotherapy, and 85.9% of the cases without chemotherapy. Accordingly the number of tubercle bacilli was in parallel to the duration of chemotherapy.
社団法人日本泌尿器科学会の論文

腎結核に対する化学療法知見 : 第1報 3者併用療法期間と腎組織所見

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