Studies on Patho-physiology of Lung Cavity. Relationship between morphological and pathophysiological changes of lung cavities in experimental tuberculosis and pulmonary suppuration observed for long period.
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As a series of path o-physiological studies on lung cavity, which have been conducted at the author's clinic, the author induced experimental tuberculous cavity with BCG and experimental suppurative cavity with staphylococci and streptococci in dog, and followed up the rediological and pathological changes of these cavities with special reference to their patho-physiological changes. The results were the following.<BR>1. The stage of cavity formation after the introduction of secondary antigen into the lung was divided into following 4 stages: pre-cavitation stage, early stage of cavitation, completion stage and regression stage. In experimental tuberculous cavity, pre-cavitation stage was within 20 days, early stage of cavitation between 21 to 60 days, completion stage between 61 to 120 days and regression stage over 120 days after the introduction of secondary antigen. Though regression of lung cavity was observed in later stage, disappearance of cavity was hardly noted. In experimental pulmonary suppuration, cavity was formed very early (3 days) after the introduction of secondary antigen, and the course of cavitation was similar to that of tuberculous cavity, though the duration of each stage was shorter in pulmonary suppuration, and disappearance of cavity was observed finally.<BR>2. The course of tuberculous cavity was divided into 2 types rediologically. In one type, the size of cavity reached to maximum in early stage, and in the other type, the size of cavity was small in early stage and showed increase later. In the latter group, giant cavity was formed in many cases. On the other hand, in pulmonary suppuration, cavity was formed very early with relativery large size in early stage, showed rapid regression and finally disappeared. Generally speaking, tuberculous cavity was thick-walled, and both monolocular and multilocular types and the transition of both types were observed. Positive pressure cavities were found more frequently in regularly shaped cavities. Suppurative cavity was, in general, thin-walled, regular in shape and small in size. Clear difference was found in the nature of surrounding lesions between tuberculous and suppurative cavities.<BR>3. Patho-morphological changes of both cavities were non-specific pneumonia in pre-cavitation stage. In early stage of cavitation, specific granulation tissue with caseation and epithelioid cell reaction was formed in tuberculous cavity, whereas nonspecific granulation tissue consisting mainly of compact mass of neutrocytes was found in suppurative cavity. In completion stage, wall of tuberculous cavity was thicker with more necrosis mass than that of suppurative cavity, and the surrounding lesions were more marked in tuberculous cavity. In regression, stage fibrosis of cavity wall and cleansing of caseous mass were found in tuberculous cavity, while regression and disappearance were observed in suppurative cavity.<BR>4. Patho-physiol ogical changes of both cavities were as follows:<BR>a) Intracavitary pressure: In tuberculous cavity, respiratory changes of intracavitary pressure showed decrease in later stage of cavitation, while in suppurative cavity, it showed little changes with the course of cavitation.<BR>b) Intracavitary sound: Types of intracavitary sound were divided into continuous type (Type II)and intermittent type (Type I). The former was found more frequently in tuberculous cavity with small size, monolocular type, negative intracavitary pressure and exudative type surrounding lesions.
- 一般社団法人 日本結核病学会の論文
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- Studies on Patho-physiology of Lung Cavity. Relationship between morphological and pathophysiological changes of lung cavities in experimental tuberculosis and pulmonary suppuration observed for long period.