PATHOLOGICAL, BACTERIOLOGICAL AND CLINICAL STUDY ON THE EFFECT OF CHEMOTHERAPY ON TUBERCULOUS CAVITY

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In order to analyse the effect of chemotherapy on tuberculous cavity, histological findings ofcavities were observed in relation to the findings of tubercle bacilli and to clinical findings.From these observations, the healing process of cavity wall and the way of appearance of "opennegative syndrome" were discussed. The observed materials were 199 cavities of 191 cases, whicn showed a cavity on X-ray film before chemotherapy, and were treated without sucha combination as collapse therapy. The cavities were divided into 4 types (non-sclerotic walled, sclerotic walled, cavitation of tuberculoma (Kd), and cavities disappeared during chemotherapy), according to the preoperative X-ray findings.<BR>1. Histological findings of the cavity wall by the length of chemotherapy: In the casesshowing non-sclerotic walled or sclerotic walled cavities on preoperative X-ray films, caseousmass on cavity wall showed the tendency to be excreted during chemotherapy, but the amountof tubercle bacilli decreased till the 3rd month without decrement after that. The thickness ofgranulation tissue increased till the 3rd month but was constant after that. The degree ofhyperemia and new formation of capillary blood vessels of granulation tissue became markedlyrelated to the length of chemotherapy. The thickness of the fibrotic tissue of cavity walldid not change so markedly after the 4th month, and the infiltration or tubercles of pericavitary lung tissue were observed till the 3rd month. As for Kd-type cavities, the relationbetween the amount of tubercle bacilli and the length of chemotherapy was not distinct.In the cases, cavities of which disappeared during chemotherapy, different histologicalfindings were found according to the degree of improvement of cavities on X-ray films.<BR>2. Relation between histological findings and findings of cavity wall on X-ray films: Asfor sclerotic walled cavities, the thickness of the cavity wall on X-ray film was in proportionto the amount of caseous mass on cavity wall on histological slices, and, to some extent, tothe thickness of the fibrotic tissue of the cavity wall, but showed no correlation with the thickness of granulation tissue. Some cavities had no caseous mass on the wall when the shadows, of cavity walls were 2 mm in thickness, while no caseous mass was seen in high percentage when thier thickness was 1 mm. The amount of tubercle bacilli on the cavity wall had correlation to the duration of negative spumut before operation in sclerotic walled or non- sclerotic walled cavities, and most of the cases which showed negative sputum for a period over 7 months before operation had no or only a few bacilli on the wall of cavities. In some of Ka-type cavities, however, many bacilli were found on the surface of caseous mass, while clinical data showed a long period of negative sputum. Such cases were often found in inspis- sated cavities.
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PATHOLOGICAL, BACTERIOLOGICAL AND CLINICAL STUDY ON THE EFFECT OF CHEMOTHERAPY ON TUBERCULOUS CAVITY

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