疫痢の治療に關する研究補遺

後篇生化學的觀察

抄録

Attempts have been made by the author to improve the treatment of ekiri in conformity with the author's investigations on the essential factors in this disease. Venoclysis by means of venous catheterization has been introduced in the therapy since August 1952, and has brought remarkably successful results. For a further improvement in the treatment comparative investigations were carried out on 334 clinically confirmed ekiri cases, which were admitted to the Komagome Hospital up to March 1955 and treated with venoclysis. Biochemical and pathological findings, as well as clinical observations, were taken into consideration to reach the fallowingg conclusions.
1) The age distribution had its peak at 3 to 5 years. Although no sex difference was observed in the incidence rate, the case mortality rate was higher in the female.
2) The above-mentioned 334 cases included 76 mortal cases with a case mortality rate of 22.8% and 4 cases with sequelae. When recovery took place, the alleviation of symptoms could be noticed promptly and in a few hours after the beginning of treatment. A practical restoration was reached generally in 10 odd hours. The treatment was especially effective in controlling circulatory disturbances.
3) The results by venoclysis were superior to those by subcutaneous infusion in every respect, clinical and biochemical, though there was a certain limit even to venoclysis in its therapeutic effect.
4) The results obtained by the treatment varied naturally according to the severity of clinical symptoms, which generally reached their maximum points within 10 odd hours, On the other hand, a close relation was confirmed between the therapeutic results and the time elapsed since the onset of the disease to the beginning of treatment, indicating the importance of early initiation of therapeutic measures.
5) The development of therapeutic effect in the first few hours had a decisive influence on the further course of the disease. The infusion in this period was most adequately adjusted to a rate of 7-9 cc/kg/hour, and the quantity of infusion fluid must be: controlled according to clinical symptoms and hematocrit value.
6) Hypophyseal and adrenocortical hormones, angiospasmolytica and lipotropic factors exerted only ambiguous effects on the clinical course of the disease. The significance of these medicaments in the treatment remained undetermined.
7) Hemoconcentration, acidosis and a decrease in plasma sodium were characteristicf eatures at the height of the disease. This condition returned to normal hand in hand. with the restoration of the patients. Hemoconcentration was attributed to an abnormal. water distribution in, rather than to a loss outside, the body.
8) Plasma potassium, at the height of the disease, had an average value in the normal. range with a wide deviation in its individual values. Accordingly, potassium-free infusion fluids were regarded to be preferable at the initial stage of the disease. Characteristic to re convalescence were hypokalemia and hydremia. The hypokalemia was attributable to an insufficient potassium supply to cover the loss of intracellular potassium, at the height of the disease. No causal relation was confirmed between hypokalemia and hydremia.
9) On the basis of predominance of one of the two important clinical symptoms, cerebral symptom and circulation disturbance, the disease could be classified into a clinical types, cerebral, circulation-disturbed and intermediate. Urine excretion rate (rate of urine quantity during the venoclysis to that of infused fluid), elevation in hematocrit value and, the severity of diarrhea and vomiting were remarkably higher in the circulation-disturbed, than in the cerebral type.
10) Venoclysis caused no untoward side effect during, and of ter the procedure.