重症熱傷に伴う副腎皮質変化についての電子顕微鏡的研究

抄録

1) Third degree 30% thermal burns were created experimentally on the back of rabbits according to Stenberg's method. The adrenal corteces were examined 6, 12, 24 hours and 3, 7, and 14 days following the burn insult.
2) Light microscopically there was a marked lipid depletion in the early stages. Hydropic and granular degenerations followed, but cell necroses were not observed. Those changes showed a tendency to return to normal starting around the 7 th day.
3) Electron-microscopical findings were:
i) Inside the cytoplasm there were a marked increase in the number and size of the mitochondria, gigantic dilatation and vacuolization of the smooth endoplasmic reticulum, and deformed, atrophic lipid granules encroached upon by vacuolized smooth endoplasmic reticulum. Degenerative changes of the organelle were occasionally seen. These findings tended to return to normal around the 14 th day.
ii) Inside the capillaries in the early stages there appeared numerous cytoplasmic fragments, which seemed to represent a holocrine type secretion of the steroid hormones. They reached the maximum after 24 hours. The initially observed microcircular derangements recovered spontaneously on the 3 rd day, but reappeared on the 7 th day, suggesting the necessity of adequate fluid therapy.
4) The adrenocortical changes resulting from the burn stress were mainly manifested as an increase in the cytophysiologic function, and those resulting from the burn shock as a decrease in the cytophysiologic function. In third degree 30% burns both changes were observed, the former being much more prominent.
5) Clinically it is justified that there is no necessity for steroid hormone treatment in burns around 30% third degree. But the danger of adrenocortical insufficiency increases in cases of wider surface area burns, cases with great difficulty in recovering from the burn shock, cases with antecedent chronic diseases, or in cases complicated with septicemia. In such cases appropriate maintenance treatment with steroid hormones should be considered.