1. The electrocardiogram during spinal anesthesia was taken in 79 urologically operated cases and its changes of spinal anesthetic shocked patients were observed.
2. Low spinal anesthesia by that cardiac accelerater nerves are not paralyzed was used, and in order to keep the hypotensive anesthetic effect, blood transfusion, fluid transfusion and cardiotonic drugs were limited in this study. Electrocardiogram was observed by osilloscope at all times and recorded if necessary.
3. Electrocardiogram does not change so much except gradually prolonged R-R duration. This prolonged R-R duration appears with the gradual decrease of the blood pressure and it is thought as a result from vagotonia occured by sympathetic paralysis during spinal anesthesia.
4. Secondarily, the changes of electrocardiogram in the so-called spinal anesthetic shock occured about three minutes following the spinal anesthesia were investigated. R-R duration prolonged rapidly with the rapid decrease of blood pressure and the patient often complained of vomiting and sleepness simultaneously in the cases so called spinal anesthetic shock. It is resumed that this shock may be the first type of shock due to vagal reflex as Shibuzawa called. This type of shock usually recovers after about 15 minutes, but it may not be asserted that this vagal reflex would not change to serious and irreversible shock.
5. Nine percent of spinal anesthetic shocked patients was found by uncontinuous measurement of blood pressure during operation, but on the electrocardiogram, it was found fifty percent of rapid and temporary prolongation of R-R duration in it. I call this condition as an invisible spinal anesthetic shock. Prolongation of P-Q interval, A-V block, nodal rhythm, superventricular premature beat, A-V dissociation and S-A block were also obseeved,
6. The temporary increase of P wave amplitude was observed in about half cases immediately after the spinal anesthesia, it continued about 10 to 20 minutes and may be thought as a pulmonary P caused by the temporary insufficiency of respiration.
7. T wave increased in amplitude gradually after the spinal anesthesia. T wave immediately after the termination of the operation is higher than T wave before operation. It is thought that elevated serum potassium by operation takes an important role for the gradually inceased T wave amplitude.
8. Depression of ST segment was observed frequently in the old patients and the patients with the abnormal electrocardiogram before operation. It is not a specific sign of the so-called spinal anesthetic shock.
9. Rapid elevation of blood pressure and marked prolongation of R-R duration was seen in some cases following the injection of noradrenaline, and nodal rhythm and superventricular premature beat were also observed.

抄録全体を表示

The following conclusions were obtained from the histochemical and electron-microscopic findings of the interstitial tissue of the testes in the studies of the experiments using rats and of the clinical materials.
1) Interstitial cells (Leydig) are thought to be originated from tunica propria of the seminiferous tubules and the endothelial cells of capillaries.
2) The life history of the interstitial cell could be divided in four stages from the electronmicroscopic observations. Smooth-surfaced endoplasmic reticulums, which have close connection with active production of the male sex hormone, are present abundantly in the cells of stage II and III. Such cells are demonstrated by ordinary hematoxylin-eosin stain to be a polygonal cell, cytoplasma of which is large and well stained with eosin.
3) Primitive interstitial cell has a bipotentiality of differentiation either to be a secretory cell or to be a connective tissue cell. Cessation of the gonadotrophic function brings about the connective tissue cells. However, administration of the gonadotrophic hormone has no influence upon thus transformed cells to regain secretory function.
4) Electron-microscopic studies revealed that administration of androgen caused the interstitial cells to fall into inactive atrophy, while estrogen destructed the interstitial cells.
5) Thickening of the walls of the seminiferous tubules is due to increase of the layers of the endothelioid cells in tunica propria. In such a case collagen fibrils appear remarkedly in the interstitial tissue. Both changes, which can be recognized easily by azan stain, reveal the pathologic process of the testes as well as the changes of Leydig's cells.
6) In testes of hypergonadotrophic hypogonadism, hyperestrogenism and cryptorchidism, the interstitial cells with lots of pigment granules were observed frequently by the electronmicroscope. Such cells are thought to correspond with the cells which show positive reaction with PAS stain.
7) Fibrosis of the interstitial tissue is especially prominent in the testes of the hypergonadotrophic hypogonadism.
8) Fibrosis of the interstitial tissue is conspicuous also in the undescended testes. This change remains unrecovered after orchidopexy. The interstitial cells with pigment granules are observed on both operated and non-operated sides of an undescended testis after adolescence.
9) In a case of hyperestrogenism interstitial cells consist exclusively of cells with pigment granules or showing marked destruction.
10) Fibrosis of the interstitial tissue was found in the testis of a 27 year old patient who had been impotent since trauma of his back.
11) Conclusively, three methods of staining, that is, hematoxylin-eosin, azan and PAS stain, are essential for the daily practice of the histological study of the testes.

抄録全体を表示