STUDIES ON THE BODY FLUID PROTEINS IN PATIENTS SUFFERING FROM INTERNAL DISEASES ATTENDED WITH EXUDATE OR TRANSUDATE

Abstract

In two hundred cases of internal diseases with exudate or transudate we carried on a research in pathogenesis of body fluid proteins and capillary permeability for blood proteins, as a part of its mechanism, change from albuminuria to proteinuria into tissues in reference to clinical pictures.
1) In general blood proteinogram in these cases indicates lower albumin-, higher globulinand fibrinogen-emia than in normal subjects, and in detail shows pathognomonic pattern. In floating protein, albumin quantity is decreased but that of total globulin and fibrinogen are increased. (Cf. tables I-15, II-2)
2) Exsudate or transudate has co-relation to blood of same individual in its concentration and composition respectively, and regression line can be drawn. In general the proteinogram of the former shifts to the right as compared with that of the latter, and the higher the total protein concentration of the former is, the nearer stands in composition of the latter, T. P. of the former becomes lower and lower, the composition of the former shifts more and more to the right, so stands Urine proteinogram at its extremity. (Cf. tables I-3, -11, -12, 14).
3) When the case improves, in exsudative pleurisy, blood proteinogram shows lower albumin and higher globulin during the exsudative stadium, and total protein and albumin of blood increase in resorption stadium. Albumin of exsudate varies parallel to that of blood so it increases during resorption, but globulin of exudate decreases in spite of the continuation of high globulin-emia. In cases of severe attacks, high globulinemia and high globulin-concentration of exudate becomes more prominent, therefore A/G is low. In cases of unfavorable prognosis, blood globulin decreases from high to low concentration but in exudate globulin, it increases to the contrary, and exudation acts as internal plasmapheresis.
(Cf. tables I-1, -2, -4, -5, -6, -8, -16, II-9 (iii), -10)
4) In these cases, when water is loaded or deprived, the attitude of blood protein is complex in the change of plasma volume. (Cf. tables II-9, -11) So we conclude as follows.
The increase of permeability affects proteinogram of blood, and proteinogram of exudate or transudate develops subject to modification in accordance with variability of permeability. Exudation or transudation, however, is not simply a mechanism of the above explanation, but is, we have to acknowledge, a phenomenon in which very complicated and varied living body reactions take part, and in exudation especially, local tissue actions are also responsible.