VENOUS PRESSURE AND LIVER FUNCTION Author(s) ME

Title
Author(s)
Citation
Issue Date
URL
EXPERIMENTAL STUDIES AND CLINICAL
EXPERIENCE IN CONSTRICTIVE PERICARDITIS:
VENOUS PRESSURE AND LIVER FUNCTION
MENJO, TAKESHIGE
日本外科宝函 (1959), 28(5): 1666-1695
1959-06-01
http://hdl.handle.net/2433/206894
Right
Type
Textversion
Departmental Bulletin Paper
publisher
Kyoto University
1
6
6
6
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REFERENCES
1
)A
r
a
k
i
,H
.
:Hypoproteinemiai
np
e
r
i
c
a
r
d
i
t
i
s
.Jap.C
i
r
c
u
l
.o
fJ
o
r
n.
,1
9
,2
8
4
,1
9
5
5.
2
)A
l
t
s
c
h
u
l
e,M.D
.
:P
h
y
s
i
o
l
o
g
yi
nt
h
eh
e
a
r
tandl
u
n
g
s
,3
8
9
,1
9
4
9
.
3
) B
l
a
l
o
c
k
,A
.andC
.S
.B
u
r
w
e
l
l
.:T
h
o
r
a
c
i
cd
u
c
t lymphp
r
e
s
s
u
r
ei
nc
o
n
c
r
e
t
i
oc
o
r
d
i
s
.J
.Lab.
andC
l
i
n
.M
e
d
.
,2
1
,2
9
6
,1
9
3
5
.
4
) B
e
u
c
k
,R
.J
.J
.
,H
.G
r
i
n
d
l
a
y andH
.B
. B
u
r
c
h
e
l
l
.: Experimental c
o
n
s
t
r
i
c
t
i
o
no
fi
n
f
l
o
w
t
r
a
c
t
si
nt
h
eh
e
a
r
t
.Am.J
.P
h
y
s
i
o
l
.
,1
6
9
,4
4
2
,1
9
5
2
.
5
) Idem:Experimental c
o
n
s
t
r
i
c
t
i
v
ep
e
r
i
c
a
r
d
i
t
i
s
.
; A
n
a
l
y
s
i
so
fi
n
d
u
c
e
dc
i
r
c
u
r
a
t
o
r
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a
i
l
u
r
e
.
Am.P
h
y
s
i
o
l
.
,1
6
9
,4
3
4
,1
9
5
2
.
6
) B
o
l
t
o
n
,C
.:Thee
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.J
.P
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andB
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t
.6
7
8
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,1
9
0
3
.
7
) B
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o
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,C
.:Thep
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.J
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) B
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.:I
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,1
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) Holman,E
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.:The s
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s
.S
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g
.
Gynec.andO
b
s
t
.
,8
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,1
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9
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9
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9
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1
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) Holman,E
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.J
.A
.M.A
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,1
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7
,7
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,1
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5.
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) Halmagyi,D
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,B
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.Z
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,M.Tenyiand Z
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1
和文抄録
収縮性心膜炎に於ける実験的並ぴに臨床的研究
乙就いて
特に静脈圧，肝機能 l
京都大学医学部外科学教室第 2講座 （指導：青柳安誠教授）
毛
受
実験的慢性収縮性心膜炎を作製し P 主 と し て 肝 機
武
重
肝欝血によっての肝表面か らのリンパの洩出が設 も重
能，静脈圧の面からその病態生理に関して検討を加え
要な腹水生成因子をなすものである．
併せて 4例の臨床手術例について，同じ観点から検討
また本疾患に於て腹水と共に四肢の浮腫が形成され
る為には，腹水のみの貯溜時よりも更に高い静脈庄を
を加えた結果次のような知見を得た．
投与による静脈圧の変動並びに組織学的
) TEAB
1
必要とする．
所見からすれば，本疾患の特徴である末梢静脈圧の上
VenousTone）の冗進，並びに
昇にはp 静脈壁緊張度（
えられない．
静脈壁の硬化とい う因子の関与していることが考えら
れる．
）本疾患の肝機能検査中プロームサルファレン排
2
池試験は肝障害の程度を知る最もよい指標であった．
実験例並びに臨床例の成績から，本疾患の経過中，
ESP排？世障害は一般に比較的軽度であることが判つ
．
た
従って臨床例に於て 20%以上の障害を示すものは，
肝に相当高度の肝硬変症の存在するものと考えるべき
である．
そしてか〉る肝障害を有する例に於てはp 心膜切除
術の成績も不良であった．
y
l
o
) 本疾患の特徴とされる腹水の早期貯溜は P
3
sの部分症状，或いは肝機能障害のみによる
i
t
i
s
o
r
e
s
ものとは考えられず，胸腔内下空静脈狭窄実験による
腹水発生に於けると同様に，中心静脈庄の上昇による
) 本疾患の低蛋白血症は本疾患特有のものとは考
4
実験的にはp 高蛋白濃度の腹水の排除による蛋白の
喪失が最も重要な因子であった．
又低蛋白血症の著しいもの程予後は不良であり p 従
って腹水穿刺を必要とする時期には速かに外科的療法
を施行すべきである．
) 心膜切除術に際しては，右心膜のみの切除でも
5
可成りの程度まで静脈圧の下降をみるが p 更に完全な
低下を期待するには左心膜をも含めた広範囲の切除が
望ましい．
) 心筋障害 を有する時期に於ては，心膜切除によ
6
る効果も少なし叉術後手術侵襲による P 血清蛋自の
干機能障害，その他浮鍾形成因子の加わること
低下P F
によって P 一時的に右心不全症状の悪化する危険があ
．
る
従ってか〉る例に於ては，術前後の血清蛋自の維持
に充分な注意を要する．