Pathomorphological Study of lleus Shock

Abstract

Histamine had been, and still is, believed to be responsible for ileus shock, but Prof.Matsukura has now long been advocating acetylcholine in the blood stream, and nothistamine there, to be the causual factor of it.
The present paper is the result of the writer's attempt to compare pathomorphologicalchanges in the shock, and also to see which of the two to be the real cause.
Five autopsies of ileus patients and other materials from dogs, rabbits, and guineapigs were used for the study. Some animals were set to complicated ileus with theirintestine together with the mesentrium, ca 40 cm. below Treitz's band, tied. Some werealso given either histamine or acetylcholine to induce shock.
The results were at follows.
I.
(1) Liver: The liver had circulatory disturbances such as central congestion, stasis, thrombosis, and the edema, of Glisson's capsules, as well as degenerations like theatrophy of the cords of liver cells, dissociation, cloudy swelling, hydropic degeneration, eosinophilic degeneration and necrosis of the liver cells, that had nuclearvacuoles, karyolysis, and pyknosis. In an advanced stage, localized necrosis oflobules the were seen.
(2) Kidneys: The circulatory hindrance of this organ was marked congestion in thecortex and in the medulla. The stagnation or ischemic condition of the glomeruliwas present. Bowman's space and the tubules had protein-like substance in them.High grade cloudy swelling of the tubular epithelium with karyolysis, desquamation, destruction, and necrosis at some places, were the changes.
(3) Adrenals: Congestion of the cortex and the medulla. Pyknosis and karyorrhexis, disappearance of the nucleus, dark cells, were observed mainly in the fasciculatedzone. In the medulla, collapse or vacuolization of the eclls were also noticed.Both cortex and medulla were exhaustive, too.
(4) Spleen: This organ was markedly congested, with bleeding, edema of the lymphnodules, hyperplasia of the red pulp cells. There was also sinus catarrh.
(5) Heart: Generally congested and was edematous. The degenerative changes werethe diffusive turbidity and acidophilic degeneration or necrosis of the muscle. Theedematous swelling of the coronary arteries and the fibrin-thronbosis and penvascularinfiltration of the plasma cells were another.
(6) Lungs Emphysematous in general. They had congestion, stasis, bleeding, andedema. Edema of the arterial walls, fibrinoid necrosis, nucleal vacuolation of thewalls, were there, too.
These two pathomorphological changes, i. e., circulatory and degenerative changes, were well in accord with those proposed by Prof. Matsukura et al. on ileus shock. Hestated that general circulation under the condition of ileus shock is impaired very rapidlyand to a great extent, while the liver, kidney, etc. will suffer from marked anoxia.
II.
The first shock caused by acetylcholine gave, mainly congestion in the liver, kidneys, adrenals, etc. and only a slight or mild degree of cloudy swelling in thecells. But as the number of shocks given to the animals increased, not onlycongestion, but also bleeding, edema, etc. enhanced that is, parenchymal disturbancesincreased, dark cells and necrosis appeared, perivascular infiltration of plasmacells and mononucleal leukocytes, especially granuloma in an advanced stage, followed. These changes observed in the acetylcholine-shock were again in strictaccord with those in the pathomorphological picture referred to in the aforegoingparagraph.
III.
Shocks due to histamine were slightly weaker than those caused by acetylcholine, though there was little difference qualitatively.
It seems to the writer that the result of his clinical and experimental pathomorphologyof ileus shock provides Prof. Matsukura's acetylcholine advocation with ground.