J.Jpn. Surg. Soc.. 56(4): 433-455, 1955
THE STATISTICAL STUDIES ON SPONTANEOUS GANGRENE
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First Surgical Department, Nagoya University Medical School (Director: Prof. Y. Hashimoto) S. SHICHINO, K. SAKAKIBARA |
(1) Sex : As well as the other statistics, male cases are far more than female. But it is a speciality that the rate of female is higher in Japan compared with that of Europe or America. For instance, it shows 12 per cent in our cases, although the rate is only 0.6 per cent in Buerger's cases.
(2) Age : It is an established theory that spontaneous gangrene often affects middleaged persons. In our cases, the patients from 30 to 49-year-old are 66 per cent.
(3) Anamnesis: 301 patients have had some historical episodes. General infectious diseases were experienced by 143 patients, and pulmonary tuberculosis containing pleuritis is the most frequent. Pneumonia and typhoid fever follow the next. One hundred and ninety-one cases were suffering from sexual diseases in which gonorrhoea, syphilis and soft chancre were included. Disorders having some relations with spontaneous gangrene come up also to fairly high percentage. But among them there are some diseases which are analogous to the initial symptoms of this disease as beriberi or neuralgia.
(4) Taste : Most of our cases are also smokers as the others and more than half of them are oversmoking.
(5) Initial symptoms : The pain of the limbs is the first. Feeling of coldness follows next and feeling of numbness the third.
(6) Chief complaint: The pain is still foremost, but ulcer or necrosis remarkably increases and ranks the second. Feeling of coldness becomes the third. This tells us advancing of the disturbance of blood circulation.
(7) Localisation: According to our data, the attack-rate for upper limbs indicates 26 per cent. This is far more than the others. The percentage of right arms is higher than that of left side with significant difference.
(8) Local views: Cyanosis holds the first rank. Ulcer or necrosis and coldness follow after. Peripheral arteries of attacked limbs are merely almost pulsless, but also in pretty many arteries of the intact side pulses are not found.
(9) Blood-pressure: The greater part of our cases are inclined to hypotension. Hypertension is only 12 per cent. Hypotension seems a factor causing this disease.
(10) Blood examination for syphilis: Only 13 per cent of 225 cases who were examined are postitive for Wasserman's or other reactions.
(11) Function of autonomic nervous system: Judging from the results of medicinal tests by adrenaline, atropine and pilocarpine, it is hard to say that all cases are always sympathicotonia.
(12) Arteriography : Obstructions were mostly seen in such distal arteries as the radial and ulnar arteries in upper limbs or the popliteal, fibular and tibial arteries in lower limbs.
(13) Methods and results of treatments: Sympathetic ganglionectomia (so-called sympathectomy) has been performed on 284 cases, but 49 patients had to be amputated reluctantly. In a few cases, periarterial sympathectomy, resection and exstirpation of obturating arteries and extirpations of the carotid bodies have been done. When leaving hospital, 85 per cent of our cases had been getting better. Sending the inquiry letters for 375 cases except of 22 cases who died already in hospital, we gained 131 answers. Sixtyseven per cent of them have showed the satisfactory results.
(authors' abstract)
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