栄養失調症に於ける腸炎の発生に関する病理組織学的研究
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概要
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The author has conducted 12 autopsy cases of malnutrition which showed enteritis as the complication in that process. They were observed pathologic-histologically and the following changes are confirmed. The areas in which the changes of enteritis appear in malnutrition, are. usually the large intestine and also the end part of small intestine. The mucous layer of intestine in these cases showed to incline to necrobiosis. And in the surrounding tissue we found the infiltration of the round cells which contain usually histiocytes and lymphocytes but few leucocytes. There are recognizable dilatation of capillaries full of erythrocytes and the erythrodiapedesis in the necrotic areas. In the more advanced cases we found the erosion of the mucous layer. And in the most severe cases the ulcers of intestine occured. But the appearance of fibrin in these infiammative areas is usually scanty. In the necrotic areas of the beginning stage of this enteritis no bacterial proliferations are microscopically observed. But in the superficial layer of ulcers in the end stage of this enteritis moderate proliferation of cocci which gave usually positive in Gramm staining. So this bacterial invasion does not mean the primary cause of enteritis. In the necrotic areas of the mucosa the diffuse fatty debris appeared with fatty degenerated leucocytes. The submucous tissue showed the remarkable edematous thickening. They are rich in severe dilated capillaries with the remarkable perivascular infiltration of lymphoid cells but few leucocytes: In the severe cases these lymphocytic infiltrations appeared also in the muscularis of the intestine with slight fatty debris but no appearance of fibrin. The miiscularis and the serosa are usually edematous thickened with the infiltration or round cells. The mesenteric lymph nodes in the neighbourhood of the ulcerated parts of intestine showed the swelling by the resorption of blood in these autopsy cases. In the aforementioned findings the acute necrobiotic enteritis in malnutrition is not inclined to the leucocytic infiltration with the appearance of fibrin in the areas but shows the remarkable dilatation of blood capillaries with erythrodiapedesis into the space of connective tissues. These changes of the intestine are different from the changes in the bacterial enteritis and are resembling the changes in uraemia, i.e. the favorite occurence in the large intestine and the end part of small intestine, the necrosis of mucous layer with the infiltration of round cells and the dilatation of capillaries with the erythrodiapedesis in the edematous submucous tissues. In the severe cases of enteritis in malnutrition we confirmed the remarkable degenerative atrophy of the endocrine apparat (so called secretory tube, "Streifensttick" Zimmermann) of salivary gland which shows to have the effect on the maintainance of mesenchymal tissues including the reticulo-endothelial system. But in the slight cases of enteritis the changes of that part of salivary glands are slight. And in the genuine cases of malnutrition which have no complication of enteritis, the salivary gland shows moderate hypertrophy especially in the endocrine part: "secretory tube, Streifenstuck" Zimmermann. So we are inclined to the opinion that the enteritis in malnutrition does not occur primarily enterogen but endogen as well as in uraemia, following the secondary enterogen bacterial infection. And in that stage the disturbance of the internal secretion of salivary gland has the remarkable meaning of the secondary appearance of ulceration of intestine by the bacterial infection.
- 千葉大学の論文