An American text-book of genito-urinary diseases, syphilis and diseases of the skin . issue soon undergoes necrosis and cheesy changes,and then may soften or calcify. Those parts of the kidney not directly involved generally show thechanges of chronic diffuse nephritis. 560 THE SURGICAL DISEASES OF THE KIDNEY. What is of special importance for surgeons to know is that the perirenaltissue is sometimes involved, and that then very tough adhesions may formbetween the kidney and contiguous organs, and render removal of the kidneya matter of very great difficulty, or even- impossible : thus it has
An American text-book of genito-urinary diseases, syphilis and diseases of the skin . issue soon undergoes necrosis and cheesy changes,and then may soften or calcify. Those parts of the kidney not directly involved generally show thechanges of chronic diffuse nephritis. 560 THE SURGICAL DISEASES OF THE KIDNEY. What is of special importance for surgeons to know is that the perirenaltissue is sometimes involved, and that then very tough adhesions may formbetween the kidney and contiguous organs, and render removal of the kidneya matter of very great difficulty, or even- impossible : thus it has happened,even in skilful hands, that fatal laceration of the vena cava has occurred. Etiology.—Tubercular nephritis occurs oftener in men than in women,and generally occurs between the ages of twenty and forty years, more rarelybefore than after this The disease may begin in the kidney itself as the result of lodgement inthe organ of tubercle bacilli carried there by the blood, to which they havegained entrance by one or other channel; or the tubercular inflammation may. Fig. 200.—Tuberculous nephritis: 1, cheesy focus; 2 and 3, abscess-cavities (Specimen 2931, Museum N. Y. Hosp.). spread to the kidney from the testis, for instance, by way of the vas deferens,prostate, bladder, ureter, and pelvis. Of these two ways, the primary, embolic form is probably more rare thanthe forms in which the kidney is involved secondarily to tuberculosis of theureter and pelvis, but it is said to be of more frequent occurrence than hasheretofore been Symptoms.—Those cases of tuberculosis of the kidney which, in fact,are only part of acute general miliary tuberculosis give no symptoms referableto the kidney other than those of acute degeneration belonging to infectiousdiseases. Whether the tubercular nephritis is primary, and the mucous membraneslower down are secondarily infected, or the nephritis itself is secondary, after 1 Those cases of miliary tubercles of the kidne
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