糖尿病の心・脈管合併症,とくに,その心・脈管力学的数値について : 附 Tes-Tapeのたしからし
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概要
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The cardiovascular complications were investigated statistically in 132 cases with diabetes mellitus who were hospitalized in our clinic from 1935 to 1957, and the cardiovascular dynamical values were determined by means of Blumberger-Holldack's and Wezler's methods which are to some extent modified by our collaborators, with spcial reference to the arteriosclerotic findings. 1. Complication with high blood pressure: 24,6 % of the total observation showed systolic pressure beyond 151mmHg. The more the duration of diabetes is prolonged, the more frequently the complication occurs. The frequencies of the complications in overweighted patients are found higher than those in normo-weighted. 13;8 % of the total observation had diastolic pressure above 95mmHg. 2. Cardiac complication : Among 128 cases, there could be seen two patients with congestive heart failure, and 21 % of this observation showed the cardiac dilatation, while 40 % of 17 cases who were examined by x-ray kymograph had the cardiac hypsrtrophy. But the extent of these changes in general was slight, and the moderate enlargement of cardiac area was seen only in one case. 4.6% of 128 cases showed the symptoms of coronary insufficiency. Amongst 32 cases who were examined by electrocardiography with routine twelve leads, the abnormal patterns at any rate were found in 13 patients of whom 8 cases (25 %) were complicated with ST-T depression, 3 (9 %) with abnormal QRS changes, ventricular extrasystole and auricular fibrillation one by one. There was a tendency to increase in the frequency of electrocardiographs changes in the systolic hypertensive group, rather than in the normotensive or the diastolic hypertensive. 3. Renal complication: 27 % of the total observation showed albuminuria, and 10 % of it edema; These findings were most frequently seen in the systolic hypertensive group. Renal clearance was studied in 13 cases; among them, 4 (30%) patients showed the moderate or severe disturbance. Kimmelstiel-Wilson's syndrome complex was clinically diagnosed in 2 cases of 116 (1.7%). 4. Retinal complication : 28 patients of 118 (23.7 %) ophthalmoscopically observed, showed at any rate retinal changes of various degrees, and 8.4 % among them had the diabetic retinopathy, each 5 % the bleeding and the white spots, 6.7 % the vascular sclerosis. The frequencies of the complications increased roughly in proportion to the prolongation of the duration of diabetes mellitus. 5. In 18 cases the cardio-vascular dynamics was examined. Concerning cardiac dynamics, 14 estimations of 28 showed" Druckreaktion" in the sense of Blumberger, 11 "Normale Reaktion"and 3 "Volumenreaktion". Regarding peripheral vascular dynamics, 17 estimations of 29 showed "Normotone Regulation", mainly of "Anspannungstypus". 10 estimations of 29 showed "Hypertone Regulation", chiefly of "Widerstandsu. Elastizitatstypus". Nextly the relationship between peripheral vascular dynamical values and fasting glucose values were investigated. Glucose values above 121 mg/dl showed a tendency to be more frequently accompanied with "Druckreaktion" in cardio-dynamics and "normotensive Anspannungsregulation" in peripheral vascular dynamics. While "Volumenreaktion" could be found in the slight cases, such a reaction was impossible to be recognized in the moderate or severe patients who did not show "Entspannungstypus" in peripheral vascular dynamics. There could not be seen any close relationship between the duration of, diabetes mellitus and the cardio-vascular dynamical values. 6. Clinically 30 % of the total observation showed the sclerosis of radial artery. The wave velocity of hypertensive patients is faster than that of normal subjects, even if under the diual consideration of aging. While the wave velocity of diabetic patients with normotension, hardly differs from that of normal subject, however, the wave velocity of hypertensive diabetic patients tends to exceed the mean value of the hypertensive cases without diabetes. The accefelation of the wave velocity of diabetic cases appears more largely to depend upon the complication of the arterial hypertension, less than the duration of diabetes. Supplement: The reliability of Tes-Tape (Lilly) The reliability of "Tes-Tape (Lilly)" was examined with glucose solution and urine, and the influence of acetone, creatinine, bilirubin and urinary colour tone, pH, and protein upon the colouration of Tes-Tape were studied. A. Examination with the use of glucose solution. 1. Colouration from 0.01 to 0.5% glucose solution shows the same colour tone as the standard tone in comparison with colour table at 2 or 3 after the immersion of Tes-Tape into glucose solution. 2. Glucose solution above 2 % does not descriminate with the application of Tes-Tape unless the suitable dilution is performed. 3. Acetone and creatinine do not affect upon the colouration of Tes-Tape. 4. Even if glucose solution is acidified, the colouration does not essentially alter in a certain range. Alkali modifies the mode of colouration markedly and the more alkalinity or concentration of glucose solution increases, the more colouration is influenced largely. B. The examination with the use of urine. 1. The colouration with normal urine in which glucose is put at various rates reaches in the standard colour tone at 1 or 2' after the immersion of Tes-Tape into urine. 2. Urinary protein, bilirubin, and urinary colour tone do not affect upon the colouration of Tes-Tape. 3. Acidified urine does not influence upon the colouration within a certain limits; however alkaline urine affects it largely, and moreover retards to reach in the standard colour tons the colouration particularly in case of high alkalinity or high concentration of glucose.
- 千葉大学の論文
- 1958-11-28