Intestinal Behcetの臨床的および病理組織学的研究 : 7症例の分析 : 特に潰瘍の発生機序に関する考察
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Clinico-pathological investigations were done on 7 cases of intestinal Behcet's disease, of which 2 cases were complete type, 3 were incomplete type and 2 were suspicious type. Intestinal involvements were also recognised in latter two types. Affected sites were terminal ileum in 2, ileocecal region in 2, and colon in 3 cases. We recognised that tendencies of exacerbation or remission of abdominal complaints usually occur simultaneously with the overall rise and fall of main symptoms of Behcet's dsease. Acceleration of skin irritability was noted in 5 out of the cases. Abdominal symptoms were viarious. However abdominal pain, tenderness at ileocecal area and Blumberg's sign were usually noted. Because of this symptom complex they were occasionally indistinguishable from acute appendicitis. No abnormality specific to intestinal Behcet's disease was detected on laboratory data, but acute inflammatory reaction was found. According to X-ray, endoscopical and pathological examinations, site of predilection of digestive Behcet's disease was in ileocecal region. The main macroscopical lesions of the ileum were the clear, punched-out ulcerations which were round or oval shaped and found at antimesenteric border of the small intestine. Large intestinal lesions too usually were punched-out ulcerations but it is not constant. In one case diffuse colitis-like finding was observed on X-ray examination of the colon. Almost no deformity or stenosis of the colon was seen on the Xray films of the three patients who had gone into remission after medical therapy. For mild cases low residue diet or parenteral nutrition are considered valid. Remission was obtained in 3 cases by this therapy. By histopathological examination of 4 resected specimens we demonstrated that ileal lesions appeared in the Peyer's patches as well as in the solitary lymphnodes. Also it is suggested that large intestinal lesions occur in solitary lymphoid follicles of the mucosa because the lymphoid tissue reacted strongly but fibrosis was poor. Contents of the digestive canal on reaching the subepithelial layers of the mucous membrane when it is based on "Behcet's state" stimulate the lymphoid tissues resulting in pyocele formation there -by the same mechanism as needle reaction on skin or scrotum-being followed by ulceration. There are no positive data which support a vascular and ischemic etiology of intestinal Behcet's disease, and our findings rather deny this.
- 北里大学の論文
- 1978-12-31
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- Intestinal Behcetの臨床的および病理組織学的研究 : 7症例の分析 : 特に潰瘍の発生機序に関する考察