慢性淋菌性尿道炎(化学療法後)に於ける組織内淋菌の研究
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Gonorrhea appears to have been exterminated because of the advances in so-called chemotherapy, or has been removed from the category of disease classed as non-amenable to ready treatment. However, this disease is actually by no means a condition easy to treat, since unexpected cases of chronicity and remission are fairly numerous, often presenting much difficulty from the investigative standpoint. Furthermore, the unscupulous application of therapy without reorganizing its true nature makes the demonstration of the causative microorganism difficult and confuses its differentiation from other types of urethritis. It is to be added that in our clinic the cases of gonorrhea still occupies the first place among all outpatients. For many years past we have been engaged In clinical and pathological studies of gonorrhea, and the results of pathologic findings in acute, chronic and atypical cases of the disease in both men and women have accumulated to a considerable dimension. Nevertheless, the work on the investigation of gonococci in the tissue lags still behind because of the difficulty attending their demonstration, and we have succeeded in obtaining real results only during the past 7-8 years. This situation, which is common to all investigators both here and abroad, is explainable chiefly by the difficulty in obtaining satisfactory staining of gonococci in the tissue. However. Hayashi (1954) has sudceeded in obtaining satisfactory statning of the causative microorganism in the tissue of acute gonococcic urethritis of men, while Tabayshi (1959) in the tissue of cervical gland gonorrhea in women, both to the extent of discuss gonorrhea on the basis of directly demonstrable gonococci, which we have in the past studied only on the basis of histopathology. Despite these results, it is still exceedingly difficult to demonstrate the gonococci in the tissues of chronic and recurring types of the disease, which represent the most important cases of infection by this microorganism. Some 30-40 years ago, Kawazoe (1916) and Tabayashi (1928) demonstrated the organism in only a small percentages of many instances. Likewise, Arai and Watanabe (1930), Kusaka (1937) and others have reinvestigated this problem but were successful only in a few cases. One of the most confusing aspect of the problem related to the demonstration of gonococci in tissues is the presence of various non-bacterial granules, which is at present being gradually clarified. These granules can be differentiated by staining, thus affording little chance for diagnostic errors. The author has undertaken investigations on the gonococci in the tissues of most difficult cases of chronic and recurrent gonorrhea. The materials used for investigation consisted of 124 instances. Of these tissues those judged to present inflammatory findings of "+" upon hlstopathologic grounds were excepted leaving only 80 cases with "++" findings. Portions of the urethra and of paraurethral duct were excised under the guidance of Sato's urethroscope, after having confirmed that the patients had been treated previously with either penicillin or some other chemotherapeutic agents. With reference to the methods of staining used, only the following six may be mentioned, since the results of staining by 12 varieties of stain had already been reported from this laboratory. The six staining methods here used are: Schmorl stain, Polychrome methylene blue, Gram Stain, Thionine stain, Unna-Pappenheim stain and Pappenheim's panchrome stain. Since the tissues present the pictures as influenced by stated amounts of chemotherapeutics previously applied to the patients, the number of gonococci demonstrable in the tissues is naturally reduced . The designation of the findings as to the number of gonococci descernible in the tissue has been made as " + " for a few, ++ for 6-10 bacteria, and +Hr for 10 or more. In regard to the location where the organisms are found the terms such as "numerous " when several sites are involved, or " sparse " when only one site shows the presence of gonococci. By employing these means of evaluation. There were 31 instances in which the presence of gonococci in the tissues was demonstrated, corresponding to 38.75 percent, consisting of 1 instance of "'+++ " 17 of "++" and 13 of "+ ". These values are much lower than the incidence of 62.3 percent obtained by Tabayashi in cases of acute cervical gonorrhea after the application of chemotherapy. This fact, however, is only natural when dealing with chronic and recurrent cases. The locations harboring the microorgani ms in great numbers are between the epithelial layers of the urethra and paraurethral duct, in the subepithelial connective tissue, the intestitial spaces, and the lumina of lymphatics. The paraurethral duct was found to be the most favored tissue. As to the problem of differentiation of gonococci from tissue granules, very little need be ,discussed, since it is now commonly well-known. The greatest confusion may result when the microorganisms are few and scattered if they can not distinguished on the staining peculiarities as these resemble each other quite closely. Finally, it may be briefly stated that in examining the tissues of 124 cases of gonococcic urethritis receiving treatment, 80 instances with pathological findings of ++ or more have been selected for the demonstration of bacteria by staining technic. This gave the positive results in 38.75 percent immediately following the application of chemotherapy. It is thus cenceivable that the figures will be much higher if examined at later periods.