(核性乾酪巣の形態発生からみた) 腎結核の発生病理に就て
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概要
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Many investigationso n the pathogenesiso f chronic r enal tuberculosis have been reported, but still present knowledge of the interrelation between the so-called anatomical primary lesion is far from abundant. The author attempted an elucidation of this problem by the study of morphogenesis of caseation in renal tuberculosis. 90 cases of tuberculous autopsied kidney s and 80 cases of nephrectomized tuberculous kidney were examined. 1) Case a t iono f renal tuberculosis is caused by the necrosis of large mononuclearc ells or epitheloid cells in the tissue spaces of the parenchyma and in the wall of the pelvis. This fact shows that tissue space of the kidney and the pelvis may probably affort a suitable place for growth of tubercle bacilli. 2) Tubercle bacilli carried hem atogenously lodge most frequently in the glomerular tuft and consequently,s evere inflammationo f the BOWMANs'sp aces and tubules are caused. Rarely, t ubercle bacilli which lodge in other arteries causei nflammationsi n the a d jacent tubules. This indicates that hematogenoustubercle bacilli are excreted in to the tubules. 3) In the miliary tubercles caused by hematogenous infection, caseous mat e rials discharge frequently into the adjacent tubules and cause exudative inflammation in these spacse before the caseous foci are encapsulated by the epitheloid granulation. This fact shows that tubercle bacilli can be excreted d o wnwardsi nto the tubules in the course of formation of miliary tubercles. 4) Primary lesion of the p a pilla and calyces is diffuse or local infiltrated foci of large mononuclearc ells in the submucosa. Gaseousf oci occur in place where large mononuclear cells infiltrate and where e pitheloid granulations are bathed directly by urine through the desquamation and disappearance of the epithelium. 5) Tuberculous lesions of the papilla and calyces region mainly ascend through the dilated tubules caused by acculumation of urine due to obstruction of the collecting tubules.
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