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2編: 造影剤皮下注射法並びに副交感神経機能阻止による観察

Abstract

The effects of some autonomic nervous drugs were observ e d in subcutaneous urographies as well as the different behavior of Pilocarpine and Mecholyl under conditions of parasympathetic nerve block. Their effects up o n intravenous urographies had been studied, and some interesting facts had been found. However, they might be recognizable merely when the concentration of the contrast medium in the blood was so high. Therefore, it seems to be necessary to perform another experiment under a condition in which it is as low as in clinical cases. For this purpose, subcutaneous urography with 30 ml of diluted aqueous Urografin-solution (12.5%) containing hyaluronidase (Sprase 500 units per 120 ml of the solution) was undertaken (Exp. I). Dru g s given intramuscularly with or without intravenous Neophyllin-injection were Atropine, Pilocarpine and Mecholyl. The methods of administration and the doses of those drugs were as same as in the previously reported intravenous urographies. The roentgenograms in each animal were obtained at 15, 3 0 and 60 minutes after the injection of the contrast medium. Immediately after th e final roentgenography, urinary quantity, concentration and excreted amount of contrast medium were measured. On such experimental material s as well as the changes in the sharpness of urograms in each animal, correlations between two phenomena were speculated mathematically. On the other hand, comparisons of those results between intravenous and subcutaneous urographies were made, because the author had expected that the results in the latter would not necessarily coincide with those in the former. By the way, the effects of Pilocarpine and Mecholyl had been studied with a special interest in Part I, and there were found several differences between them, especially the modes of mechanism in affecting the renal tubules and some other secretory glands. And then, the author had concluded the innervation of cholinergic nerve to the urinary secretion as well as the correlation between the systemic autonomic nervous condition and the renal function. But it seems to be too hypothetical to convince them. Hence, their effects to the tubular excretion and the u rograms were observed under a condition of parasympathetic nerve block ensued from intramuscular administration of Triomin-Finalin which was supposed to be the most effective blocking agent (Exp. II). The main points of the results are as follows : 1) Subcutaneous pyelograms of diagnostic valu e in rabbits can be obtained by use of parasympathicomimetic drugs, such as Pilocarpine and Mecholyl, under a diuretic condition ensued with Neophyllin. 2) It is su g gested that the effect of Neophyllin to promote the excretion of contrast medium is widely different in accordance with the concentration of the latter in the blood. If the concentration is higher than the value of tubular maximum, remarkable increase in excretion of the contrast medium is ensued ; and on the contrary, if it is lower than the value, the excretion does not increase essentially, although the urinary quantities increase to some degree to promote the sharpness of pyelograms in both cases. These phenomena can be explained as a result of th e different percentages of its component filtrated by glomeruli and secreted by tubules. 3) The mode of correlation between grades of sharpness of pyelograms and the conditions of excretion of the contrast medium in subcutaneous urographies is somewhat different from that in intravenous urographies, especially in both Neophyllin-groups ; namely in Neophyllingroups, i. e., Neophyllin-. Atropine+ Neophyllin-, Pilocarpine+ Neophyllin- and Mecholy1+ Neophyllin-groups, a positive correlation is recognized between the concentration of excreted contrast medium and the sharpness, and negative one between the urinary quantity and the sharpness. Those are the same relations as in Non-Neophyllin-groups in intravenous urographies. This fact can be explained reasonably from the difference of Neophyllin-effect upon the excretion of the contrast medium in both methods of excretory urographies. 4) It is shown experimentally that the urinary tracts can be cont rasted easily or hardly among various animals and that excretory urography in rabbit is probably one of the most difficult cases. The m ost probable causes for this fact are found in the different states of diuresis and ureteropelvic peristalses. 5) It is con firmed strictly that the grades of sharpness of the pyelograms in excretory urographies are dependent upon the concentration of excreted contrast medium and upon the degree of partial stasis of urine in the renal pelvis. 6) Under the condition of parasympathetic n erve block, Mecholyl can show the same effect upon the tubular secretion as well as the salivary secretion as strong as in the case without nerve block ; however, Pilocarpine is quite ineffective upon those secretions. Hence, it is obviously reasonable to conclude that Pilocarpine prod u ces the effects affecting the cholinergic nerve and that, on the contrary, Mecholyl does directly afftecting the cells of secretory glands. 7) It is proved that the changes of the renal function caused by Mecholyl reflect essentially the sensitivity of the secretory cells of renal tubules to the choline-like substances. From the conception, it seems to be possibly true that the diseased kidney of uroli thiasis is in a state of persistent parasympathicotonia. 8) As mentioned above, the effect of Mecholyl does not show the tonus of autonomic nerves itself. Therefore, the value of the Mecholyl-Test is questionable when the result of the test is determined merely by the changes of the blood-pressure. Especially, such conceptions as Type-S=Sympathicotonia and Type-P=Parasympathicotonia should be strictly criticized.