リンパ系造影法による乳糜尿症の研究

Abstract

This report deals with some contributions to the elucidat i o n of the outbreaking mechanism of filarial chyluria, applying lymphography (LG) of the pedal infusion method by Kinmonth and as well as characteristic findings in the lymphatic system. The findings ascertained in the present study are as follows 1) As to the path o genicity of chylurial disease, the studies were focused to clarify the mechanism of retention of chylic lymphatic fluid and its process of pouring into the urinary tract. 2) On the former problem, Okamoto (1963) suggested the following mechanisms as the cause to lie in its cause in the order of inflammation due to space occupation of pelvic retroperitoneal lymph vessels by adult filaria worms, allergic inflammation (deep filarial fever), hypertrophy, dilatation, and valvular insufficiency of lymphatic vessels, retention of lymphatic fluid, and its extension as far near the cisterna chyli. In the present study, it was found that the chylurial disease was characterized by increase of number, dilatation and zigzagging intricacy of the pelvic and lower lumbar retroperitoneal lymph vessels and in some cases swelling and increase of the pelvic lymphatic glands. The above findings in the lymphatic vessels indicate the alterations on circulus vitiosus consisting of the retention of lymphatic fluid and aggravation of the disease. By the fact that the process extend as far as near the cisterna chyli, the above mentioned Okamoto's assumpsion was able to confirm. 3) The pouring of chylic lymphatic fluid into the urinary tract was found to occur extremely frequently in this disease. The observation of the renal lymphatic figures (backflow figure of renal lymphatic system) by LG could easily demonstrate the lesion in which chylic lymphatic fluid flows back into the renal lymphatic system. In the area of thoracic duct no impediment was observable causing lymph flow retention, so that it is reasonable to conclude that the lymphatic backflow into the renal lymphatic system is attributable to the dilatation and the valvular insufficiency of lymphatic vessels which gradually extend upward and to the retention of lymphatic fluid as near the cisterna chyli. On the other hand however, it was unable to deny the possibility of exasperation of lymphatic vessels in the renal lymphatic system as well as in the lower lymphatic system. 4) As to the process of chylic lymphatic fluid pouring into the urinary tract, it is hitherto shown for the most part, being " the backflow of chylic lymphatic fluid into the renal lymphatic system, lesions of mucous membrane in renal calices and renal pelvis , and pouring into the urinary tract." In the present study, the process was further clarified by contrasting the renal lymphatic figure of LG with the backflow figure of RP. 5) In the chylurial disease, the renal lymphatic figures a p pear bilaterally and on the affected side there is remarkable clearness. As a rule, this disease should be considered to develop on both sides. The unilateral occurrence of this disease may be considered to be due to an individual difference of the anastomotic condition in lymph truncus near the cisterna chyli and of the presence of weakened resistance in the renal calices and renal pelvis which becomes the cause of the backflow figure of RP. However it is thought that the factors concerning development the communication with the urinary tract play the dominancy on the backflow into renal lymphatic system and the fulness of lymphatic fluid in lymphatic vessels.