Journal of Okayama Medical Association
Published by Okayama Medical Association

Full-text articles are available 3 years after publication.


Wada, Masayuki
Thumnail 49_2088.pdf 8.14 MB
This paper presents the results of diagnosis, operation and therapy of a case of carbuncle of the kidney, as follows: Miss H. I., aged nineteen was first seen by the author on January 17, 1937, complaining of high fever with light pains in the left upper abdomen since one month ago which increased by the finger pressure. On November 10, 1936, she went to the school excursion and about that time she injured her right little toe by her shoes, which suppurated and about four weeks later was completely healed by medical treatment. On December 17, 1936, suddenly the present illness appeared with high fever (41°C), rigor and shudder accompanied by pains in the left kidney region. Immediately a physisian treated her illness for about one mouth but failed to cure her. She was a well developed girl, rather pale who appeared to passed through a critical condition; puls were good; conjunctiva were pale; pupills were equal, round and reacted directly to the light; tonsillitis negative. A few inguinal nodes were palpable; and heart and lungs were normal. Her abdomen was apparently normal; right kidney regions and Mac Burney's point also palpated as normal. In her left abdomen, coincided with the left kidney region, a hard tumor palpable was found which was very painfull by the finger pressure and moved freely with her respiration. The skin over this region had slight Défense musculaire, but no reddness was observed. The results of blood examinations were as follows:- 1) Browning (-), Murata (-), M.K.R.II (-). 2) Blood group was B. 3) Bloody time was normal. 4) Time of sinking of red blood cells: for 1 hour 134, 2 hours 140, 24 hours 144. 5) Erythrocytes 3,360,000, Leucocytes 11,000. Poly 52%, mono 15%, lymph 29%, eosino 2%, baso 0.2%. 6) Haemoglobin (Sahli) 38%. A mixed phenolsulfonephthalein test showed an output of 75% in one hour. She discharged 805cc. of water in all four hours from 1,000cc. which she had drank. The specific weight of her urine before she had drank the water was 1,024 and its minimal specific weight after she had drank was 1,004. Cystoscopy was performed on January 19th, showed a completely normal bladder and ureteral orifice. There were no disturbances to the passage of the catheter to either ureter. Urine from the both kidney contained a few red blood cells and a few epithelium of the calyces occasionally, but no leucocytes. Urine itself was transparent and acidic. By the partial kidney function test of indigocarmin was almost good and both sides were almost equal. Pyelogramms of iodnatrium and airs in the both kidneys, both of them revealed the perfectly nomal shadows. Rosenstein's Pneumoradiography of the left kidney manifested a round tumor shadow corresponding to the front surface of the middle part of the kidney, which measured about 5cm. in diameter. Operation was performed on January 26th under the lumbal anesthesia. Incision was made with Israels method. At the front surface of the kidney, corresponding to the carbuncle, adhered severely to the surrounding places, so that it was fairly difficult to remove. On freeing this part of the kidney a small quantity of pus escaped. The posterior half of the kidney was normal, but a large carbuncle of hen's egg size, located nearly at the middle part of the anterior surface of the kidney, was noted. In the part of the carbuncle, here and there were many little pus parts surrounded by the violet red region appeared very much like a carbuncle of the skin. On the cutting surface, also were many little pus parts, but this time it was surrounded by the ash white edematous region as observed by the agar-agar. It's consistence was like a gum. For the bacteriological examination, a culture was mad from the pus and found to be Staphylococcus pyogenes aureus. Microscopical examination of the pus also revealedthe staphylococci. Pathological examination of the pus parts and indurated tissues removed, showed a inflammatory tissue consisted of plasma cells, cells of connective tissue, poly and mononuculare leucocytes. In the part of the carbuncle, atrophic tubuli and glomeruli were noted. The severe cramp and vomitting followed the operation. Many ampulles of Vitacampher and Coramin etc. were given. The drain was removed on the second day after the operation and iodform wicks placed in the wound. After the operation the patient's temperature did not subside because the wound was suppurated, from a small quantity of pus escaped from the carbuncle on this peration, and truely, staphylococci were recognized from the pus of the wound. The patient was perfectly cured and discharged from our hospital on May 18, 1937.