心不全の特殊形式Hegglin症候群とWuhrmann心筋症の診断限界について

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1. In order to investigate Hegglin's syndrome in due consideration of Jaeger's work, we took it for granted as pathological positive that QT-QII is longer than 40a. On this occasion, it may be always necessary to examine whether QII interval is diminished absolutely or relatively. To clarify this question we have referred to the results gained by Herkel-Blumberger, Holldack, Reindell, Jaeger and Takahashi in our clinic, as shown in Fig. 17, the approximate formulae y=a√<x> and y=b√^3<x> were assumed from the distribution of QII corresponding to RR intervals of 150 normal subjects. By means of the least square method the coefficients were calculated, and then the normal range of QII time was determined by recurrent analysis. From these results the formula y=39.7√^3<x>±40σ was obtained. The QT formula was calculated by the same method on the same subjects and the formula QT=12.4√<RR>±38σ was gained as shown in Fig. 17. In fact it was found entirely equal to Hegglin-Holzmann's QT formula. The normal variations of QT calculated by Hegglin-Holzmann's and our formulae were±40σ and ±38σ respectively. The difference between these two formulae was negligible. Therefore we thought of our QII formula as credible, and the determination of QII more than one half of 40σ (the standard deviation of QII formula which had 68% of reliability) was looked upon as absolute shortening. When the absolute shortening of QII and the absolute prolongation of QT were judged by our formulae and clinical findings were taken into account, 18 of 343 subjects who satisfied our criteria only occupied 5% of the total observation. We regarded these cases as Hegglin's syndrome in the strict sense or the literally energeticdynamic heart insufficiency (E. D. H. I.). It may be also necessary to distinguish these cases from Hegglin's syndrome in the broad sense, because the criteria of the difference QT-QII longer than +40σ alone can be include a transitory Hegglin's syndrome. 2. By means of our criteria 343 patients were classified into the following groups. Group A; eight subjects among whom Wuhrmann's myocardosis was diagnosed from clinical, serum-protein electrophoretic and metabolic electrocardiographical findings, on the other side, they were all complicated by Hegglin's syndrome or by E. D. H. I. and they were all examined by autopsy. Group B; the autopsy of one patient showed not any sign of Wuhrmann's myocardosis, but the finding of Hegglin's syndrome or E. D. H. I.. Group C; positive Wuhrmann's myocardosis free from Hegglin's syndrome was confirmed in five cases intra vitum et post mortem. Group D; 48 patients with transitory Hegglin's syndrome or its tendency; among them seven subjects were examined by autopsy. The patients belonging to this group were divided into subgroups of hypertension, myocardial infarction, other sorts of heart diseases, renal disease, hyperthyroidism, anemia and orthostatic transitory Hegglin's syndrome. The clinical and pathological finding of the typical examples choosen from each group were described in detail, with special reference to the diagnostic methodology of Hegglin's syndrome including E. D. H. I. and Wuhrmann's myocardosis. 3. Some supplements to the clinical and pathological findings of Wuhrmann's myocardosis. Our collaborators, Shigemura, Ohmi, Kashiwazaki, Tokumoto and Inagaki already published their works upon Wuhrmann's myocardosis and Hegglin's syndrome including E. D. H. I. from various sides of investigation on this Journal. Fig. 16 shows the relationship between the diminution of the ratio TH/B according to Wuhrmann and Niggli's metabolic-electrocardiography and the appearance of the mucoid degeneration in various sites of ventricle. As the reduction of TH/B is advanced, there occurs a tendency to increase in number of the sites of the above-average appearance of mucoid degeneration. However no definite relationship can not be seen between the appearance of pigment granulae and the change in TH/B without distinction of age.
千葉大学の論文
1964-07-28

心不全の特殊形式Hegglin症候群とWuhrmann心筋症の診断限界について

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