胃潰瘍における局所動脈の病変とその意義 : 心身医学的考察を併せて

スポンサーリンク

概要

論文の詳細を見る
We reported formally on experimental stress-ulcer of the stomach and on human ulcerative colitis and pointed out special changes of the regional arteries, i. e. perinuclear vacuole and its accompanying changes. At that time we emphasized that these changes must be the histological grounds of arterial spasm and important factors in ulcer formation, This time we investigated 100 cases of human gastric ulcers histopathologically and found the following three types of typical changes in the arteries of the region. 1. Perinuclear vacuoles (PnV), named by Prof. Takeuchi, were confirmed present in the exactly transected arteries, 250 to 1700,μm in diameter; there were many media-muscular cells with round vacuoles compressing the nucleus to the periphery. Electron microscopic examination revealed that the cell plasm of a muscular cell encroached upon the neighboring cell plasm, resulting in mal-distribution of the nucleus. This change has been proven experimentally to be an acute spasm of the artery, and to reverse to the normal structure when the spasm disappeared. 2. A marked winding of the elastica interna appeared in relative larger regional arteries some 4OOμm in diameter. This change is also clear evidence of arterial contraction. 3. We frequently found a fibrous (not arteriosclerotic) intimal thickening (InT). This change must have been produced by repeated or coninuous spawn, as a result of adhesion of the wrinkled intima. Among 100 cases of gastric ulcers there were 46 cases of progressive (acute) type, including 42 with PnV (91.3%) and 9 with InT (19.6%). And 37 cases were callous (chronic) type of ulcers, including 7 with PnV (19.6%) and 31 with InT (83.2%). Among 17 caces of the scarring type of ulcer, 6 cases had InT (35.1%) but no case indicated PnV (Tab. 1). There have been numerous theories on etilogy of gastric ulcers from the past, however, since Virchow, many investigators believe that some regional circulatory disturbance is an essential factor. The 3 special changes of the regional arteries, as mentioned above, must be clear evidence of repeated or continued spasm and must cause regional ischemia resulting in ulcer formation. Then, what will cause arterial spasms in the stomach? From a psychosomatic standpoint we indicated some "emotional inclinations" at the time of eating (functioning stage of the stomach) as follows : a) Fastidiousness about food. The ulcer-patient has a heavy habitual disgust for some foods prior to the disease-attack, but he or she is almost unconscious of it. This inclination can surely cause spasm of the gastric arteries. b) Extended period of abstinence from food. In the stress-ulcer-experiment, when the stomach was empty during the stress (immobilization), the spasm of the regional arteries and the ulcers always appeared, but if the stomach was fielld up with food, no spasm or no ulcer presented. Buchner emphasized strongly the necessity of "Leersekretion" for ulcer-formation. In fact many ulcer-patients had often unwittingly endured hunger for a long period of time before the onset of the disease. A coexistence of a) and b) would be the strongest emotional cause for the arterial spasm i. e. ulcer-formation.
日本心身医学会の論文
1986-06-01

著者

松岡茂
Pl病院病理部

関連論文

もっと見る

スポンサーリンク