急性心・脈管性肺水腫の臨床的観察
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概要
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1. Among 162 cases of acute pulmonary edema (a.p.e.) in the sense of Drinker, Altschule, we found 283 cases of cardiovascular disorders. According to Altschule's classification, patients suffering from a.p.e. can be divided as follows; the 1st stadium in 14 observations, the 2nd in 100, the 3rd in 53, the 4th in 50. In comparison with the definition of "cardiac asthma" heretofore in use, the moderate cardiac asthma may be described as corresponding to the 2nd stadium, and the severe c.a. is equivalent to the 3rd or 4th stadium. The patients who are made the objects of the therapeutic studies are found mostly at the 2nd or 3rd stadium. 2. The basic disease of each patient is classified as follows: a. In the group being characteristic of arterial hypertension, a.p.e. can be observed in 28 cases among 52; the 1st stadium is found in 2 patients, the 2nd in 23, the 3rd in 5, and the 4th in 8 respectively. In addition the correlation between the occurrence of a.p.e. and Keith-Wagener's classification of high blood pressure is discussed. As to the benign hypertension, this syndrome can be found in 20 patients among 42, as to the malignant hypertension in 5 among 5. b. In the group being distinguished with coronary insufficiency, a.p.e. can be observed in 20 patients among 32 suffering from marked coronary sclerosis; the 1st stadium is found in 3 cases, the 2nd in 11, the 3rd in 4 and the 4th in 3, whereas a.p.e. can be found in 11 patients among 14 suffering from less marked coronary sclerosis; the 2nd stadium is observed in 7, the 3rd in 6, and the 4th in 4. Further the investigation is made also upon a.p.e. found in coronary insufficiency complicated with congestive heart failure. c. In the group being characteristic of myocardial infarction, a.p.e. was found in 18 patients among 23; the 1st stadium is observed in 4 cases, the 2nd in 8, the 3rd in 7, the 4th in 9. At this occasion the duration, the mode of occurrence of attacks and the localisation of lesion in patients suffering from a.p.e. are also investigated. Among so-called "myopathy" in the sense of Scherf a.p.e. can be seen in 11 cases of 23; the 1st stadium is found in 1 case, the 2nd in 10, the 3rd in 2, the 4th in 3 cases. d. In the group being distinguished with aortic valvular diseases, a.p.e. can be observed in 2 cases among 4 patients suffering from aortic stenosis, and in 18 cases among 27 patients suffering from aortic insufficiency, the 2nd stadium is found in 12 cases, the 3rd in 8, the 4th in 6. As to aortic stenoinsufficiency, a.p.e. can be seen in 9 cases among 13, the 1st stadium is observed in 1 case, the 2nd in 7, the 3rd in 1, and the 4th in 2 cases. e. In the group being characteristic of mitral valvular disorders, a.p.e. can be seen in 5 cases among 5 patients with mitral stenosis, and in 33 cases 5 patients with mitral steno-insufficiency, namely the 1st stadium is found in 2 cases, the 2nd in 12, the 3rd in. 13 and the 4th in 9. As to mitral insufficiency, a.p.e. can be observed in 1 case among 3 patients. f. A.p.e. in 1 case with chronic cor pulmonale which is assured at autopsy is described and discussed. Concerning above mentioned cases the digitalis therapy is evaluated and elucidated to be effective on the prevention of attacks, wheras atropine-morphine & aminophylline can be preferred for the remedy of the attack. In addition the heroic application of large dose of digitalis is discussed for the treatment of a.p.e.
- 千葉大学の論文
- 1957-03-28