移動盲腸症の薬理X線的診断と回盲部切除適応の検討
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概要
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Using pilocarpine which stimulates the parasympathetic nervous system, pharmaco-roentgenologic examination (mainly by means of X-ray cinematography) was carried out in 88 patients with cecum mobile with clinical manifestations. The following observations were made: 1. Administration of piloearpine caused a change in the degree of hypertonia and an abnormal mobility to occur in the intestine. The patients under study were divided into the following 5 groups according to a difference in the site in which the most marked reaction to the drug was noticed: (1) Patients in whom increased tension and abnormal mobility were confined to the ileocecal region and the ascending colon. (Type I). (2) Patienes in whom diminished tension was confined to the ileocecal region and the ascending Colon. (Type II). (3) Patients in whom increased tension and mobility were noticed throughout the intestine. (Type III). (4) Patients in whom spasm occurred in one part of the colon. (Type IV). (5) Patients in whom the reaction is slight (Type V). 2. Patients classified as Types I and II, who are considered to have functional disturbances of the ileocecal region, accounted for 47% of the patients understudy. If patients classified as Type III, who are considered to have hypertonia involving the whole intestine, are added to patients of Types I and II, patients belonging to these three types make up 68% of the patients understudy. Among patients with cecum mobile without clinical manifestations, adhesions of intestine due to appendicitis, and colitis who served as controls, those of Type V, Type I and Type III, respectively, were most numerous. 3. Many patients with cecum mobile complain of right lower abdominal pain. However, 42% and 63% of patients of Type III and Type IV, respectively, had pain in other regions of the abdomen then the right lower abdomen. There was a higher incidence of constipation among patients of Type V and Type II then among patients of other types, while 20% of patients of Type I , Type III and Type IV complained of diarrhea. 4. As compared with patients with cecum mobile with no clinical manifestations, patients with cecum mobile with clinical manifestations showed marked systemic reactions of slobbering and sweating. This was especially the case with patients of Type III. 5. Of 88 patients with cecum mobile understudy, 30 patients developed pain as a result of administration of pilocarpine. The sites where pain was caused to develop included the right lower abdominal region in Type I, and the right and left lower abdominal regions and the umbilical region in Types III and IV. 6. The results of ileocecal resection for surgical treatment of cecum mobile show that excellent results were achieved in patients of Types I and II who have functional disturbances of the the ileocecal region, patients in whom pilocarpine caused pain to develop in the right lower abdominal region and patients with slight systemic reactions to pilocarpine. It seems that ileocecal resection is indicated in these patients.
- 千葉大学の論文
- 1964-07-28
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