滲出性肋膜炎の臨床的研究 : 主として結核菌培養より観たるもの
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概要
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In the majority of cases under investigations, spontaneous pleurisy occurred soon after the conversion from tuberculin-negative to tuberculin-positive state, i.e. within from one to one and half years after tuberculin-negative state was confirmed for the last time. However, there were cases, though very few, in which oneset of the disease was recorded more than two years after Mantoux conversion. 1) Monthly observation of tuberculin reaction in cases of spontaneous pleurisy has disclosed that in the first month of the disease, 13 % showed negative reaction, 24.1 % pseudopositive reaction and 7.4 % stronger positive reaction; in the third month, 6.6 % showed psendopositive reaction; and in the fourth month all showed positive reaction. This phenomenon, which could be attributed to desensitization caused by antigenantibody reaction, would evidence that pleurisy might occur when individuals become allergic to tubercular bacilli. 2) Examinations of pleural effusion have revealed that the highest frequency of positive reaction for tubercular bacilli occurred in cultures of effusion made within one month after the onset of the disease, corresponding in time to the weakening of tuberculin reaction. 3) Examinations of effusion have also revealed that, within one month after the onset of the disease, cultures of small amount of effusion became negative for tubercular bacilli in almost all the cases under study. 4) 27.0 % of spontaneous pleurisy patients whose roentgenograms showed on lesions in lungs produced sputa positive for tubercular bacilli on culture. This will demonstrate that the examination of the sputum plays as important a role as roentgeno graphic examination for the prevention of the onset of pulmonary tuberculosis. The highest frequency of sputum positive for tubercular bacilli on culture occurred in the patients who manifested worsening in erythrocyte sedimentation rate during the course of 3 months' observation. 5) The prognosis of spontaneous pleurisy patients depends upon the presence or absence of tubercular bacillin in the sputum. Follow-up results of investigations revealed that the patients who had produced sputa positive for tubercular bacilli developed lesions, both large and small, in lung field about one year after the onset of the disease; that they had to go through longer convalescence; and that 3 out of 13 patients died of tuberculosis within two years. On the contrary, only 1 out of 33 patients who had produced sputa negative for tubercular bacilli died of peritoneal complications.
- 千葉大学の論文