Journal of Okayama Medical Association
Published by Okayama Medical Association

Full-text articles are available 3 years after publication.

急性腹膜炎ノ心臟ニ及ボス影響特ニEKG及ビ組織學的變化ニ就テ(實驗的研究)附. 出血トEKGトノ關係

平井出 正三 岡山醫科大學津田外科教室
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The literature on the influence of acute peritonitis upon the heart is very rare, and especially the investigation of this subject by electrocardiography is only published by Steinberg so far, whose description is not clear enough and not sufficient. Attempting to examine experimentally the changes of the heart due to acute peritonitis during the whole course from its beginn to the end, the author took the electrocardiogram changing all the time during the life period of the experimentally diseased dog by bacterious infection or artificial perforation. Bacterious infected acute peritonitis were produced by streptococcus haemolyticus, coli bacillus, Fraenkel's bacillus and mixed strains of all these kinds, and artificial perforation was performed in different dogs in stomach, ileum, jejumum and colon to ploduce acute perforated peritonitis. The careful studies comparing the changes of the electrocardiogram, clinical symptoms, postmortem findings, histological changes and bacteriological features revealed the following fact. As a preparatory experiment the statistic investigation of the electrocardiogram of 31 dogs which were employed to the research was made and proved difficult to define the typical form of the graph. The end wave T of the electrocardiogram varied complicatedly and in spite of various explanations given experimentally and theoretically by many writers the definite meaning of the alteration in the T wave of the electrocardiogram is not still decided. Investigating in healthy dogs the alteration in the T wave related to the depression of the bloodpressure caused by the haemorrhage from carotid, femoral and internal mammary artery and also from femoral vein, and on the other hand to the elevation of the bloodpressure due to the injections of Locke's solution, adrenalin and other cardiacs, the author revealed an important relationship i.e. the elevation of the bloodpressure caused a depression in the T wave, and the lowering of the bloodpressure made T wave enlarged. In the pathological heart this relation was not evident. Standing the systolic period of the heart and the number of pulse in geometrical relation, the increase of the latter causes the shortening of the former. Finding the average value of both factors in the electrocardiogram in 22 healthy dogs the author found a parabora shown in the following formula; A=139.57 P-0.374236 A is the systolic period, P is the nomber of pulse. In the same way the relationship between the period of heart beat (B) and the systolic period (A) was shown in the next formula; A=4.5167 B0.373227 Considering the error between the calculated value by these formulae and the measured value, the maxinum error should be 0.09 second. Therefore the greater difference than 0.09 second between the measured and calculated values means pathological heart conditions. The average life duration in the dogs suffered from acute experimental peritonitis due to bacterious infection was about 32 hours concerning with only lethal ending animals. Although in most of cases by Fraenkel's bacillus only death did not occur, the mixed infections by Fraenkel's bacillus and other germs showed a serious condition. The average life duration in the dogs produced acute experimental perforated peritonitis in them was 24.5 hours which was much shorter than in the former group, and another evidence was that no case of complete recovery was recorded, nevertheless among the former group some of cases were recovered. Among the perforated peritonitis in various parts the animal of the perforation in stomach died in the earliest stadium, and in jejunum in the latest, in ileum and in colon between them. In the bacteriological examination of the ascites in the perforated peritonitis Fraenkel's bacillus was found in all cases, coli bacillus in most of cases. In some cases of the short life duration after the ouset of the disease Fraenkel's bacillus was only recognized, on the contrary in cases of long life duration after the onset of the disease streptococcus was discovered most frequently, Speaking only about the perforated peritonitis the prognosis does not appear to depend on the sort of bacillus of abdominal infection, but on the site of the perforation.In most cases of streptococcus infection very quick weakness caused by malignant diarrhoea was observed, and in spite of the relative long life duration the features in abdominal cavity were malignant, and the heart was affected seriously showing endocarditis in some, destruction of the muscles of heart and karyolysis in the other, and subsequently the findings in the electrocardiogram suggested these changes of the heart.In some cases the irritant condition was seen after the onset of the disease, but there was no relationship to the prognosis and the findings in the heart.As the result of the postmortem findings, the. presence of gas, the character of the ascites and the changes of the parenchymatous organs did not show any. parallel relation to the physiological and anatomical changes of the heart, i.e. in cases of high grade affection in abdominal cavity only slight changes in the heart were recognised. In seven cases, 30 per cent of the peritonitis affected animals the changes in thoracic cavity especially in the lobe of the lung; congestion of the lobe, pneumonia and gangrene of the lung were detected, and in seven cases, 30 per cent, the congestion of the coronal artery was found in high grade, but not always parallel to the changes in the lobe of the lung, but speaking generally the changes of pleura and the lobes of the lung in high grade accompany the heart disorder. The heart of the animals of the infection of Fraenkel's bacillus and of short life duration after the onset of disease showed systolic stoppage. but the heart of mixed infected animals and of those which continued the serious condition in long period showed diastolic stoppage. In a case accompanied by serious pneumonia, the right ventricle in the diastolic stoppage and systolic stoppage of the left ventricle were observed.As the result of the investigation of the electrocardiogram in acute peritonitis the following facts should be noticed.P wave shows temporary enlargement, specially in cases of the haemorrhagic peritonitis the changes are most significant. In the animals of prolonged life duration and of weakness in high grade P becomes smaller and some times shows diphasic and inverted at times, but there was no parallelism to the pathological changes of the heart. In cases of abnormal prolongation of the auriculoventriclar transmission of stimulus could not find any histological changes of the heart.When the swelling of the abdominal cavity, the upwards compression of diaphragm and the dislocation of the heart to the left side by the accumulation of gas and ascites in the abdominal cavity and also by the paralysis and distension of the digestive tract were observed after the onset of peritonitis, the principal ventricular waves Q R S show laevogram very frequently, but not so often before death. Laevogram was observed in cases of the congestion of the coronal artery in high grade, and in cases of the pathological changes of the lobes of the lung or pleura laevogram was seen in many occasions.After the onset of peritonitis cases of the depression of S T line increased gradually and became 52% of cases before death, and even in cases of nondepression, non-typical form was observed. In most cases of the depression of S T line the heart showed diastolic stoppage, and the destruction of the muscles of the heart, and karyolysis were detected and sometimes occurred endocarditis,The granuler mitochondria was stained thin in various size and irregular arrangement. It is understood that the depression of the S T line or non-typical form represents the weakness of the heart or the cardiac diseases.After the onset of peritonitis T rises always temporarily and shows a large normal type as the depression of the bloodpressure, and when the animals died in the early stadium by the acute haemorrhagic peritonitis the electrocardiogram resembles to that of the animals before death by loss of blood. But when the animals lived long time and the weakness of the heart increased gradually, T became smaller and sometimes showed an inversion or diphasic. Coronal T was observed in cases of high grade changes of the heart accompanying pericarditis, pneumonia or gangrene of the lung as a complication or in pregnant cases.Investigating the influonce of peritonitis upon the time of the transmission of stimulus by the resistration of the curve and the comparison of the measured values to the calculated values, the author recognized that the time of the auriculoventriclar transmission of stimulus and the systolic period of ventricles were shortened together, as the progress of peritonitis, but when the changes of the heart increased in high grade, showed evident prol ongation of the time and greater value than maximum error.When pneumonia appeared, Sm enlarged greatly and Tn, m showed large normal type and at the same time the depression of S T line proved significant, and it was proved that the socalled dominance of the left ventricle or laevogram appeared similarly in the complication of peritonitis with pneumonia as well as in oases of simple pneumonia. But in one of the peritonitis affected animals suffered from the gangrene of the left lung, empyema and pericarditis as complications dextrogram was experienced.