下腿の炎症性硬結に関する概論

INTRODUCTION TO NODULAR INFLAMMATORY LESIONS OF THE LEGS

I．はじめに

　いわゆる炎症性下腿結節症のentityの理解および診断には，（1）臨床および病理像，（2）成立機序，（3）原因，（4）経過および治療に分けて考えてゆくのが便利である。ここで注意すべきことは，同じ臨床あるいは病理像をとるものでも，その原因がちがうことがあることである。たとえば結節性紅斑の滲出性炎は連菌の感染でもおこり，あるいは結核感染，そのほかいろいろの原因でおこりうることである（第1図）。

Nodular lesions of the legs were discussed under three parts:

(1) clinicopathological findings, (2) pathomechanisms, and (3) clinical course and treatment.

1) Their pathological nature could be divided into two main changes -itis and osis of the cutis, subcutis or vascular system. The former was composed of exudative and granulomatous reaction of stroma, while the latter was composed of degeneration and regeneration of parenchyme.

There were some relationships between clinical pictures and histopathologic chararcteristics.

2) Three kinds of pathomechanisms, circulatory disturbances, changes in blood constituents and immune reactions played some role respectively in establishment of clinical pictures of these dermatoses. Different etiological agents could make the same clinicopathological pictures, while the one or a single etiological agent could produce various kinds of clinicopathological featuras.

3) In cases of morbus Bazin extremely strong reaction of tuberculin test was noted, while more than half of them were proved to have 0 titer of Middlebrook-Dubos' test.

Not a few cases of Bazin's disease showed abnormally high titer of ASL. It suggested the possibility of mixed infection by streptococcus and mycobacteruim as causative agents of this disease.

4) The results of treatment with antituberculous or anticoccal drugs enabled us to imagine the causative organisms.