心不全患者における自律神経性諸スチグマータについて
スポンサーリンク
概要
- 論文の詳細を見る
Manoiloff-Kroll's reaction is described as one of diagnostic methods to indicate the tonic state of autonomic nervous system; author already has reported that the electrophotometry is applicable to the determination. This method can be easily performed, moreover this result well agrees with that of the other sorts of diagnostic examinations. In this paper, M.-K. reaction was studied mainly in cardiac patients. From the observation upon the day-night flucturation of M.-K. reaction in normal health, it can be concluded that the S-type is apt to be found in the night among nearly all instances. Many of patients suffered from angina pectoris and allied disorders show S-type during attack, whereas most of patients with bronchial asthma V-type during nocturnal paroxysm. The occurence of S-type, even if it may be causal or effective, may relate to the tendency of nocturnal cardiac dyspnea. After the digitalisation all of the patients with cardiac failure reveal the intermediary types or V-types; the day-night fluctuations in the digitalised cases are decreasing and the nocturnal S-type is apt to reduce in population. Digitalis effects were observed in 46 patients suffered from congestive heart failure, in addition to examinations of electrolytes in sera, plasma protein fractions, extracellular liquid quantities, renal clearance and circulatory dynamics according to Wezler's method, before and after the medication. While before digitalisation most of patients show normo-, hyperkaliaemia, after the medication in some part of them the K value which more or less decreases at first estimation, recovered to initial level or above it, whereas in another group of them K value increased from its beginning. These phenomenon were found in those cases which reacted to digitalis effectively. While many of them showed higher value of Na or Cl in the stage of marked decompensation, by means of digitalisation that value fluctuated within normal range. Especially this tendency could be observed as to serum Cl; and in the shifting phase to decompensation at first the Cl value was elevated. When once the excretion of these electrolytes increases along with digitalisation, again they go down to initial or rather lower level. Even if K value in serum increases, the excretion in urine does not grow more. There exists not so close correlation between K value in serum and QT, except for some particular cases. The amount of albumine in plasma shows the significant relationship to the effectiveness of digitalis. The tendency of refractoriness against digitalis is distinctly found in damage of the liver in which albumine is produced, or in renal disorder in which albumine is excreted abnormally. The fraction of γ-globuline changes more parallel to the extent-of secondary hepatic disturbance than that of β-globuline, and there exists the correlation between quotient of A1/G, however there may be some exception as to their absolute concentration, and the degree of cardiac insufficiency among majority of patients. Digitalisation reduces the increase in circulating blood quantity and extracellular liquid amount which is found in the stage of cardiac insufficiency; however the normalisation of the former is of slower tempo than that of the latter. In some refractory cases, the extracellular liquid decreases in its amount, whereas the circulating blood increases in its volume. On these scores, clinical course of cases, including both effective and ineffective, is fully discussed in detail. In animal experiments the effects of Diamox upon respiration, electrolytes, and pH were examined, then these results were compared with the clinical data observed in congestive cardiac failure and renal diseases. In dog the intravenous injection of Diamox induces hyperpnea after which second wind can not be found. 2〜3 % CO_2 inhalation after Diamox medication does not bring hypercapnia in blood. In other words, after the hyperpnea there can not be found second wind. By means of application of Diamox Na and K in sera decrease in amounts and their excretions in urine increase in quantities. The increase of serum Cl is due to the Cl-shifting from red blood cells. pH of blood declines to acidosis, combining capacity with CO_2 diminishes. The effect and side-effect of Diamox were discussed in cases suffered from cardiac insufficiency and renal diseases under the consideration of their clinical courses.
- 千葉大学の論文