痔瘻ノ結核性ニ就テ : 附、療法私見
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The relationship of tuberculosis to fistula in ano has long been the subject of considerable acrimonious discussion. I have drawn the following conclusions after observations and experiments on various points on about 166 in-patients suffering from anal fistula. 1) Nowadays we have many methods of diagnosing whether an anal-fistula is tuberculous or non-tuberculous, but there are many exceptions in each method. Therefore, we must take a cautious attitude in diagnosing it. 2) I am not justified in making the diagnosis of tuberculous of tuberculous fistula except by definite microscopic picture or guinea-pig inoculation or in cases in which the lesion has the typical appearance described elsewhere in this paper. 3) There are comparatively many cases of tuberculous fistula in ano, and I have estimated that 27-29 per cent. of all petients suffering from anal fistulas are tuberculous. 4) Most of the persons with tuberculous anal fistula also have tuberculosis elsewhere in the body, but there are not a few cases in which the primary lesion of tuberculosis is in an anal fistula. 5) As a rule tuberculous anal fistula is seen in tuberculous patients and non-tuberculous fistula in non-tuberculous bodies. on the other hand we must note that non-tuberculous fistula is often seen in tuberculous patients and tuberculous fistula in non-tuberculous bodies. 6) And as a rule anal fistula is seen in tuberculous patients or tuberculous constitutions. But statistically, there are very few tuberculosis cases having anal fistulas and especially tuberculous anal fistulas. 7) It is probable that tuberculosis as such has a tendency toward the formation of anal fistula, but that this tendency is not so great as is generally supposed. The general condition of the patient is also a decided factor. 8) It would seem that the formation of anal fistulas in persons who are underweight is undoubtedly a definite warning of the presence of pulmonary tuberculosis or of a tendency toward its development. These persons are entitled to a most scrutinizing general examination, which, even if negative, should be repeated periodically. 9) It may be necessary to perform an operation even if the fistula is tuberculous, unless the patient has a serious and progressing pulmonary tuberculosis at the same time. And on operation, exhausting the patient or obstructing his nutrition is to be reprehended.
- 京都府立医科大学の論文
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