著者

川崎 武 浅野 武彦 牧田 茂雄 吉田 忠正 柿沼 光明

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.51, no.3, pp.246-252, 1962-06-10 (Released:2008-06-12)

参考文献数

12

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56才の男.食餌性蕁麻疹を二,三度経験した以外にアレルギー疾患の既往なく,家族にもアレルギー疾患はない.ビタミンB110mgの静注後1分以内に急激な血圧降下,冠不全,全身の発赤,顔面蕁麻疹様膨疹をきたし失神した.ノルアドレナリン,プレドニソロンの静注および酸素吸入が奏効し,ショック状態より回復した.ビタミンB1に対する皮内反応強陽性, Prausnitz-Küstner試験陰性,白血球融解現象陽性, ACTHテスト正常であつた,ビタミンB1を用いて減感作に成功にした.減感作後に皮内反応は陰性化した.更にビタミンB1,アリナミン,コカルボキシラーゼ,ピリミジン誘導体4種,サルゾールSおよびチアゾールイエローに対する皮内反応を試み,ビリミジン核を有する薬剤に共通して皮内反応が陽性となることから,本症例においてビタミンB1の抗原としての決定群はピリミジン核残基であろうと推論した.

著者

吉田 忠正

出版者

社団法人日本循環器学会

雑誌

JAPANESE CIRCULATION JOURNAL (ISSN:00471828)

巻号頁・発行日

vol.28, no.9, pp.704-711, 1964

被引用文献数

1

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Recently, the hepatic circulation in hemorrhagic shock has been investigated by HEINEMANN, BRADLEY, SELKURT, FRANK and others. However, the opinions among the authors have not yet been in agreement but rather controversial, par icularly, as to the relationship between hepatic blood flow and cardiac output. HEINEMANN reported that hepatic blood flow fell sharply following hemorrhage and then returned spontaneously the control level in absence of the restoration of blood pressure. While, the others reported that hepatic blood flow did not recovered and remained in decreased level, having the same trend in blood pressure change. It seems likely that such a controversy will be partly due to the difference of the methods employed in measuring hepatic blood flow and partly to the confusion in recognizing the stage of shock, because the sequence of respective hemodynamic phenomenon is considerably different at the period of observation in this condition. The purpose of the present paper is to classify the relationship of hepatic blood flow and cardiac output throughout the entire course of hemorrhagic shock and its bearing on the irreversibility of shock. Oxygen utilization in the splanchnic viscera was also studied. The Relationship between Hepatic Blood Flow and Cardiac Output 1) Methods : Hepatic blood flow was measured by modified Frank's method. Twenty-two dogs ranging in weight from 8 to 20 kg were used and anesthetized with intravenous pentobarbital sodium of 25 mg/kg. A polyethylene catheter was passed through a right external jugular vein into the hepatic vein and then wedged into one of hepatic lobar veins. The outer end of the catheter in the hepatic vein was fixed at the level of the vena cava and allowed to drain continuously. The rate of hepatic outflow was measured by a graduated cylinder and stop watch. The blood collected was returned by transfer to an elevated burette draining into a left external jugular vein. Heparin (3-5 mg/kg) was given intravenously during the experiments. Cardiac output was calculated from indicator dilution curves according to the STEWART-HAMILTON principle. Two different procedures were used. In one method <SUP>32</SUP>P labelled red cells were used as an indicator and injected intravenously. Blood samples were collected successively from the femoral artery. In another cases, radio-iodinated serum albumin (RISA) was injected as an indicator. Cardiac output was calculated from radio-cardiograms by using a scintillation detector at the heart region and a rate-meter. 2) Results : We could distinguish the following two stages in hemorrhagic shock in relation to hepatic blood flow and cardiac output. a) The first stage : In the early stage of shock, hepatic blood flow decreases in parallel with the changes in cardiac output. b) The second stage : After same delay from the initial bleeding, hepatic blood flow decreases progressively without marked reduction in cardiac output. Consequently, a difference or "gap" appears in percentile changes of hepatic blood flow and cardiac output. c) Effects of transfusion : Complete recovery of arterial pressure, cardiac output and hepatic blood flow can be obtained by a transfusion performed in the first stage. Whereas, the transfusion made in the second stage give rise only transient recovery of arterial pressure and cardiac output.

著者

吉田 忠正

出版者

The Japanese Circulation Society

雑誌

JAPANESE CIRCULATION JOURNAL (ISSN:00471828)

巻号頁・発行日

vol.28, no.9, pp.704-711, 1964

被引用文献数

1

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Recently, the hepatic circulation in hemorrhagic shock has been investigated by HEINEMANN, BRADLEY, SELKURT, FRANK and others. However, the opinions among the authors have not yet been in agreement but rather controversial, par icularly, as to the relationship between hepatic blood flow and cardiac output. HEINEMANN reported that hepatic blood flow fell sharply following hemorrhage and then returned spontaneously the control level in absence of the restoration of blood pressure. While, the others reported that hepatic blood flow did not recovered and remained in decreased level, having the same trend in blood pressure change. It seems likely that such a controversy will be partly due to the difference of the methods employed in measuring hepatic blood flow and partly to the confusion in recognizing the stage of shock, because the sequence of respective hemodynamic phenomenon is considerably different at the period of observation in this condition. The purpose of the present paper is to classify the relationship of hepatic blood flow and cardiac output throughout the entire course of hemorrhagic shock and its bearing on the irreversibility of shock. Oxygen utilization in the splanchnic viscera was also studied. The Relationship between Hepatic Blood Flow and Cardiac Output 1) Methods : Hepatic blood flow was measured by modified Frank's method. Twenty-two dogs ranging in weight from 8 to 20 kg were used and anesthetized with intravenous pentobarbital sodium of 25 mg/kg. A polyethylene catheter was passed through a right external jugular vein into the hepatic vein and then wedged into one of hepatic lobar veins. The outer end of the catheter in the hepatic vein was fixed at the level of the vena cava and allowed to drain continuously. The rate of hepatic outflow was measured by a graduated cylinder and stop watch. The blood collected was returned by transfer to an elevated burette draining into a left external jugular vein. Heparin (3-5 mg/kg) was given intravenously during the experiments. Cardiac output was calculated from indicator dilution curves according to the STEWART-HAMILTON principle. Two different procedures were used. In one method <SUP>32</SUP>P labelled red cells were used as an indicator and injected intravenously. Blood samples were collected successively from the femoral artery. In another cases, radio-iodinated serum albumin (RISA) was injected as an indicator. Cardiac output was calculated from radio-cardiograms by using a scintillation detector at the heart region and a rate-meter. 2) Results : We could distinguish the following two stages in hemorrhagic shock in relation to hepatic blood flow and cardiac output. a) The first stage : In the early stage of shock, hepatic blood flow decreases in parallel with the changes in cardiac output. b) The second stage : After same delay from the initial bleeding, hepatic blood flow decreases progressively without marked reduction in cardiac output. Consequently, a difference or "gap" appears in percentile changes of hepatic blood flow and cardiac output. c) Effects of transfusion : Complete recovery of arterial pressure, cardiac output and hepatic blood flow can be obtained by a transfusion performed in the first stage. Whereas, the transfusion made in the second stage give rise only transient recovery of arterial pressure and cardiac output.