排泄性尿路撮影像に対する自律神経系薬剤の影響に関する実験的研究 第1編: 尿路X線像の鮮明度及び形態に及ぼす影響並びに尿路自律神経と全身性自律神経系との関連性に関する研究

Abstract

The effects of various vegetative nervous drugs upon in t ravenous excretory urograms were observed in experimental animals, rabbits. In few minutes or at the same time w ith the injection of contrast media, certain kinds of such drugs were given intramusculary or intravenously. Roentgenographies were undertaken (at 3, 15 and 30 min. thereafter). Immediately after the last one, urine excreted into the bladder during the examination was catheterized in every rabbit for measurements of volume and amount of excreted contrast media. The grades of sharpness, or visibility of urograms were rated in accordance with certain criteria. The cerrelations between the grades of visibility and the conditions of renal excretions of contrast media were analysed stochastically. The various experimental groups were compared on the grades of sharpness of urograms as well as the shapes of pyeloureterograms. For clinical application of such drugs, they were tried for improvement of excretory urograms, and for interpretation of the autonomic nervous conditions of the. urinary tracts. Histological examinations of renal parenchyma of the rabbits were performed to study a possibility of any pathological changes due to the large amount of contrast media given with autonomic nervous. drugs. A series of 154 patients with neurosis were subjected to search complicated urol o gical diseases, especially, urolithiasis. The main points o f the results are as follows : 1) Rating the grades of sharpness of urograms based on accurately defined criteria, it is possible to prove stochastically the correlation between the visibility and the condition of renal excretions of contrast media. 2) It is suggested that ce rtain kinds of autonomic nervous drugs, such as pilocarpine mecholyl and triomin-finalin, are able to imorove the sharpness of excretory pyelograms in rabbits when a sufficient dose of contrast media is given to exceed the maximal tubular secretory capacity(Tm), although the mechanism of them is widely varied according to the sort of drug. 3) A s a rule, visibility of excretory urograms depends on the concentration of excreted contrast media, and therefore, a positive correlative coefficient is calculated between them. However, especially in the upper urinary tracts, the visibility may be influenced more remarkablly by the activity of the ureter, because the value of the coefficient is somew hat too small to be said "strictly significant" On the contrary, if given with diuretic, neophyllin, the visibility is completely dependent upon the excreted amount of contrast media. Hence, a positive, strictly significant coefficient is calculated between them in the neophyllingroups. 4) Comparing the results presented in mecholyl-group and neophyllin-groups, it is assumed that there are at least two types of mechanism to promote tubular excretion of contrast media, and that it is not always necessary to have innervation of tubular excretion as the mechanism considering on dynamic aspects of biochemistry. 5) The most promising drugs to improve urograms of r abbits are pilocarpine, mecholyl and atropine ; however, atropine must be given with neophyllin, and it may distort the shape of pyelogram causing dilatation. 6) Performing pilocarpine- or mechlyl-test simultaneously with I. V. P., correlations between the conditions of the vegetative nerves localized in the urinary tract and of systemic ones are obviously recognized to some extent. But in these cases, organ-specificities are also recognized ; namely, when pilocarpine is used both salivary hypersecretion and hypertonic state of the ureters are observed, and when mecholyl is given both salivary hypersecretion and higher concentration of excreted contrast media appear . 7) No neurotic patient subjected here has ever suffered from urolithiasis . However, of course, it is entirely unreasonable to decide that neurotic patients are not apt to urolithiasis, because the number of the patients inquired is too small , and more extensive investigations are necessary. 8) Histological findings of renal parenchyma are almost essentially normal , and there are not found any irreversible changes .