血中アミンの変動よりみたダンピング症候群の発生機序ならびに治療法の研究

抄録

This report is based on the analytical study of on 33 patients with pre-operation, 84 patients with post-operation of gastric diseases and also 11 patients with pre-operation, 14 patients with post-operation of another diseases admitted to our department.
First, the urine of all these patients were collected in the period of 24 hours. Excreated 5-HIAA value was determined according to the method of Udenf riend and Titus. Second, blood serotonin and histamine was also tested according to the method of Waalkes or Durner and Pernow. Namely, 27 post-operative patients were devided into three categories: beginning stage of symptom, as control, appeared stage and disappeared stage of symptom. The results obtained were as followed;
1) Excreated volume of 5-HIAA in the pre-operative patients, showed no significant value in the patients with gastric diseases.
2) During the post-operative treatment, decreased urine 5-HIAA volume was observed, following with high value was observed in 3 days after operation, and not recovered until 3 weeks. On the other hand, urine 5-HIAA was increased in 4 of these 5 cases with cancers of any sort.
3) 5-HIAA volume after operation of gastric diseases was shown in high response in order of non symptom group, indicated sign group and dumping group so on.
4) Compared between blood serotonin and histamine, the level of these amines was observed or indicated the three types as decreased type, increased type and constant type in the beginning stage of dumping syndrome. Therefore, it is postulated that the balance of patterns between blood serotonin and histamine may be significantly related to the causation or induction of dumping syndrome.
5) From the above points of view, the classification was accomplished throughout the relationship between blood serotonin and histamine which was attributed to the each symptoms with different patterns in dumping syndrome.
6) Dumper was classified or devided into several symptom goups from the type of pattern by mean of the determination of the blood serotonin and histamine levels.
7) The patients of dumping syndrome were attributed to the increased histamine rather than serotonin in the blood.
8) From the determination of blood serotonin as well as histamine and circulatory plasma volume just after the test meal, it was observed that blood histamine was increased and meantime blood serotonin was shown an downward trend in the case of decreased plasma volume. On the other hand, in the case of increased plasma volume blood serotonin was increased and histamine was decreased. However, it could not be applied to all explanation, since this case is only one. Finally, in the case of non change of plasma volume the both of serotonin and histamine were also unchanged.
9) The reason of the decreased plasma volume was explained by the test of histamine injection subcutaneously.
10) In the dumping syndrome, the difference of symptom in the same type of patterns may described by/or from the neurological element or factors.
11) For the purpose of prevention to the changes of blood amines level, Reserpine or Decadoron was administered to the dumper and effective results were obtained in all cases. Also, the changes of blood amine levels after the meal was not observed. These drugs may be effective to the treatment of dumping syndrome.