特發脱疽の研究

(第1編) 交感神經節切除後の末梢交感神經機能について

抄録

Of 18 cases of Buerger's disease admitted to the hospital sympathetic ganglionectomy was performed in 13 during the past four years.
The peripheral sympathetic functions were examined by skin resistance test, galvanic skin reflex test, skin tempersture test, thermic perspiration test of Minor, subcutaneous pilocarpin injection test, intracutaneous pilocarpin injection test of Wada-Takagaki method, and sweat gland test. In addition, the reciprocal relation of each test was scrutinized.
1) According to the location and extent of the resected sympathetic ganglion, the thermic perspiration and the galvanic skin reflex in the area of the operated side became absent immediately after the operation.
This location which corresponds to the area of high resistance as described by Richter and others is clearly demarkated in its borders. Since these three phenomena are to in-dicate the sympathetic impulse from the center through sweat gland it can be easily understood that the interruption of the sympathetic ganglion route would result in the block-ing of the area covered by the nerve. However, the borderline of the elevation of skin temperature is indefinite.
2) Although the thermic perspiration test requires time, it renders the blocked area easily identified, its border easily defined, and the extent of the damage measured. The electric skin resistance test is simple both in its apparatus and its procedure while the galvanic skin reflex test is not suitable to determine the affected area. However, the retlex impulse can be shown by this simple technic. The electric skin resistance and the galvanic skin reflex can be recorded by same apparatus simultaneously.
3) It is considered that the function of sweat gland does not disappear rapidly even the area has no longer been under control of the sympathetic nerve. This is shown by the appearance of perspiration when pirocarpin is injected subcutaneously and intracutan-eously in the blocked area, My study shows that the perspiration in the affected area was abscent one year after the operation. This fact is consistent with many former reports.
4) hollwoing the operation the temperature of the leg of the operated side showed less fluctuation when it was placed in cold water or exposed to the cold air as compared to the non-operated side.
The decurease of the electric skin resistance of operated side is not marked as that of non-operated side when both legs were placed in warm water and the temperature of skin was elevated. The sympathetic nerve which controls the contraction of blood vessels loses its function as a result of sympathetic ganglionectomy in the diseased leg in thromboangitis obliterans.
Thus the blood supply to the diseased leg is increased. This is noted not only in normal condition but when exposed to cold weather or at the state of mental excitement as the contraction of blood vessel does not occur. In addition, the deminished radiation of tempe-rature due to loss of thermic perspiration may also influence favorably in the healing me chanism.