PATHOLOGICAL, BACTERIOLOGICAL AND CLINICAL STUDY ON THE EFFECT OF CHEMOTHERAPY ON TUBERCULOUS CAVITY Report 2

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3. Tubercle bacilli stained on the cavity wall and results of culture: Even when the amount of intracavitary caseous mass was small, tubercle bacilli were observed on the wall of sclerotic walled cavity in 45% of the cases, although their number was very small, and in such cases, culture of caseous mass showed negative results, except one. In some of Kd-type cavity, however, the result of culture of caseous mass showed even when only a few bacilli were found on the stained section. In the group of cases, cavities of which disappeared during chemotherapy, the result of culture was usually negative, while many bacilli which had a marked tendency to show granular structure were found on stained sections of caseous mass. Most of the cultivated bacilli showed resistance to INN, and nearly half of them showed resistance to SM and/or PAS.<BR>4. Relation between the amount of tubercle bacilli and histological findings of cavity wall: In the cases which had numerous bacilli in the cavity, such as, drug-resistant cases, the granulation tissue of the cavity wall showed a marked hyperemia, a new formation of capillary blood vessels, sometimes, edema, and contained abundant leucocytes in caseous mass. These phenomena subside with the decrease of the bacilli and caseous mass on the cavity wall, and disappear in the clean walled cavity. Relationship between the amount of bacilli on the cavity wall and the degree of reaction of the cavity wall could be drawn from the above mentioned facts. In the cases which showed thick caseous mass on the cavity wall, the reactions of the wall were less, even when many bacilli were seen on the surface of thick caseous mass. Arginophilic fibres in the caseous mass were seen to be quelled and finally disappeared when many leucocytes had migrated into caseous mass.<BR>Comment: During chemotherapy, the number of tubercle bacilli decreases gradually, and caseous mass on cavity wall is excreted. The granulation tissue of the cavity wall become more hyperemic, new formation of capillary blood vessels occurs vigorously, epitheloid cells changes to atrophic, and specific granulation tissues have been mostly displaced by the small round cell infiltration with capillary vessels, namely, unspecific granulation tissue. On such hyperemic cavity w alls, the imigration of leucocyte into caseous mass is accelerated, resulting softening and liquefaction of caseous mass.<BR>When a cavity decreases its size markedly and rapidly, hyperemia and new formation of blood capillary vessels of granulation tissue is rather few, and epitheloid cells are rather proliferative. Furthermore, the amount of tubercle bacilli on the cavity wall showed some rela tionship to the degree of unspecific reaction of cavity wall.<BR>From these facts, it is thought that unspecific granulation tissue does not mean a good result of chemotherapy, but rather mean a result of unhealed open state of cavity for a certain period under chemotherapy. With the decrease of tubercle bacilli and caseous mass on cavity wall by effect of chemotherapy, the hyperemia of granulation tissue and leucocyte imigration into caseous mass subside, and the tendency of softening and discharge of caseous mass on cavity wall also decreases. In such a way, open negative syndrome may appear.<BR>In the cases which show resistance to drugs, numerous bacilli in a cavity provoke hyperemia, sometimes edema of granulation tissue, and cause now necrosis of granulation tissue on the other hand.
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