"Study of pathological and bacterioogical investigation for the specimens of pulmonary
tuverculous lesions of the 100 cases of resectod lung was performed at the thoracic
surgery section in the 36th Army Hospital Masan, Korea, in order to reach some
conclusions concerning the relationship of the histological change of tuberculous lesions
and distribution of the T B bacilli in histological specimens to chemotherapy. The
following conclusions were drawn.
(1) By the chemotherapy the followings resulted.
a) cleansing in cavitary lesions.
b) incleasing of collagenous encapsulation in caseous lesions.
c) decreasing of caseation, tubercle formation and central necrosis of tubercles in
exsudative lesions.
d) increasing of fibrosis of tubercles and catarrhal pneumonic changes in perifocal
area.
(2) By chemotherapy. 27% of cavity revealed the cleansing of cavity (disappearance of
specific reaction for TB), especially in one case a epithelization of cavity wall was
observed.
(3) best results were shown at 6 months chemotherapy for all tuberculous lesions,
with atrophy in epithelieid cells and disappearnce in giant cells, however, the fact that
specific tissue reaction appeared again after 13 months chemotherapy might be due to
the close relation with the occurance of bacilli tolerance for anti-tuberculous drugs.
(4) The synchysis of caseous lesions was soon in 55%, especially with a high
percentage in those caseous lesions combined with cavitary lesions. A re-destruction of
encapsulated caaeous losions was shown in many cases of tuborculoma and in this case,
it seemed that a opining of drnining bronchi to lesions and the infiltration of
polymerphnucleaous leucocytes at the conjunction of draining bronchi would be played
the important role.
(5) In the reaction of chemotherpy.
a) poor-effectiveness for tuberculoma.
b) good-effectiveness for non-cave-tary. caseous lesions at 3 months chemotherapy.
(6) In exsudative lesions,
a) In cases of none-treatment. a contral necrosis of tuvercles. caseation and new
tubercle formation were rovealed in high rato.
b) In cases of 3 months treatment, in spite of decreasing of above tissue reactions,
the fibrotic changed tubercles and the catarrhal pneumenic reactions were extremely
increased.
(7) The longer was chemotherapy term, the more increased the destructive figure of
nucleus arround the caseation and the infiltration of polynuclear leucocytes and the more
reproduced non specific granulation, Especially with the increasing of small round cell
infiltration and new capillaty formation.
These tissue reactions, however, was not corelated to the number of bacilli in tissue.
(8) It was 88% to reveal the tbc. bacilli in the histological praeparats of cavity walls.
Vital bacilli were found in relative high percentage of 60% in the cabities which showed
no healing tendency, 29% in softening specific encapsulated caseous lesions and in the
early exsudative lesions, on the contrary few bacilli were found in the cleansing cavity,
no-softening caseous lesions, and calcified tubercles.
(9) The morpgological distribution of TB. bacilli in tissue were classified as follows :
a) coloney-like
b) scattered
c) phagocytosed
d) intracellulary multiplicated
The coloney-like distrubution of tbc. bacilli was found in 19% of cavitary lesions, and
these were appeared in the cases of less than 3 months treated and in those cases
which were revealed the bacilli tolerance after treated more than 13 month.
(10) Most of the tbc. bacilli were located on the surface of caseous residual or torn
part of caseation where the bacilli were able to contact with air, less of them in the
deeper layer, and rarely in the layer of epitholiod cells.
This show remarkable difference from the findings of the premedicational lesions and
it may be due to the permeation of antibiotics into lesions.
(11) Other organismus were found in 27% of cavitary lesions, and mainly were
located at the broncho-cavitary conjunction, with the wandering of poly morphnuclear
leucocyte and existence of nuclear destruction-(caryoh- exis, caryolysis).
This suggests that the chemotherapy prevents tbc. bacilli from mixinfection with other
organismus.
(12) That in most cases, the polynuelear leucocytes and destroyed nucleas were
coexisted with the tbc. bacilli in tissues, and ispecially that the bacilli in tissues, and
ispecially that the bacill were intracelluary multiplicated in the necrotic leucocytes,
suggestod that TB. bacilli and leucocytes would be in some relations of parasitism and
coexistance.
(13) In catarrhalic pneumonic lesions and fibronodose residuals, none of TB. bacilli
were found.
(14) Tuberculous changes of draining bronchi were seen in 80% of total cases, and
even the main lesions reached to the healing stage the bronchial tubreculous changes
were markedly remained, continuing the bacterial outputs.
(15) The obstruction of draining bronchus does not mean the foregoing of cavity
healing.
In fact, the closed healing of cavity looks almost difficult.
(16) Study of the elastic fibre in caseous lesions might reveal the mechanism of
caseous formation, and finding of the elastic fibre in sputum would be helpful to
diagnose the destruction of caseous losions.
(17) The blood vessels aruond the focus came to have the lumen narrow and collular
thrombosis.
(18) Blood vessels were most resistable to caseation, defend in themselves by
production and infiltration of the collagenous fibre, and the elastie fibro remained to the
end of caseation.
(19) From view point of clinical relation.
a) The limit of the effect of chemotherapy for tuborculous lesions is 6 months at ost.
and it is recommended that the the cavity which was not shown healing tendency after
6 months treatment should be treated by surgical resection.
b) Long-term chemotherapy for tuberculoma is meaning-less, and resectional
treatment is recomended after 3-4 months fo chemotherapy.
|