Journal of Okayama Medical Association
Published by Okayama Medical Association

Full-text articles are available 3 years after publication.

胆嚢症に関する研究 第2編 岡山県日生地方における胆嚢症の臨床的検討

田中 隆士 岡山大学医学部第一内科教室
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Observing the clinical symptomes of the cholecystopathy patients in this distrit the following results were obtained. 1. 45.1% of the cases represented prodromal symptomes. Nausea and chilly sensation were most common. Fatigability, stiffness of the shoulders, vomiting, anorexia and fullness in the epigastrium were frequent in this order. 2. The abdominal pains were usually colic or severe in nature, and their localizations were mainly in the right hypochondrium or epigastrium. 45.5% of the abdominal pains were radiated to right shoulders, right back and to right hemithorax. The durations of the abdominal pains; 28.9% of the cases were less than 24 hours, in 79.4% of the cases disappeared within 10 days. 3. 59.9% of cholecystopathy cases were febrile and 25.3% were icteric. Serum bilirubin was determined in 50 relapsed cases and 80% of those were less than 2.0 mg%. Severe jaundice was seen in few cases. 4. In their entire clinical courses, the patients who represented all three cardinal symptomes, fever, abdominal pain and icterus, were only 12.4% on the other hand, cases with abdominal pain and fever were 45.1%, and the cases only with abdominal pain were 39.4%. 5. Vomitings were seen in 30.5% of the cases. There was a tendency of obstipation, which was seen in 28.9%. 9.4% of the cases had diarrhoe. 6. 43.2% of the cases had enlarged livers. The palpable gall bladders were noted in 22.4%. The palpable spleens and/or enlarged splenic dell area were observed in 9.8% of the cases. 7. Liver function tests; positive urine urobilinogen reactions in 62.4%, positive serum Takata reactions in 18%, positive Gross reactions in 11.4%, positive cepbalin cholesterol floculation tests in 35.2%, positive thymol turbidity tests in 23.2%, positive Cobalt reactions in 24.4% and positive Bromsulpbalein tests in 37.2% of the cases. 8. Duodenal juice; greenish tone in 32.1%, abnormal outflows in 25%, thin appearing B-gall in 25.2%, presence of gall sands in 7.1%, and presence of parasites eggs in 7.2%. Bacteriological investigations of the duodenal juices revealed that colis in 64.8%, diplococci in 23.2%, streptococci 5.4% and staphylococci were 3.6%. 9. Gastric juices; hypo- or anacidity in 65.2%, presence of ascaris eggs in 26.7% and presence of anchylostoma eggs were noted in 9.3% of the cases. 10. Hemograms; an increase in leucocytes was seen in 33.7% of the cases. 11. The cholecystopathy patients who had subjective symptomes, even during the periodes in which there was no sign of acute exacerbations, were 36.8% of the cases. The subjective symptomes were mainly discomforts and/or heavy sensations in the right hypochondrium or epigastrium. These patients still had some impairments of the liver, namely, positive urine urobilinogen reactions in 29.2%, hyperbilirubinemias (over 1.0 mg%) in 32.7% and positive serum Takata reactions in 16.7% of the cases. 12. Observing 21 cases who underwent cholecystectomy, 23.8% of these cases were completely cured. In them 11 cases had gall stones. Remote prognosis were worse in those who had no gall stone. 13. It was thought that the functional disorders of gall bladder played a major roll in getting cholecystopathy. Repeating the following; dyskinesia inflammation organic change, and then turned to be irreversible organic changes at about the age of 40 years. Ascariasis did not appeared to be a main cause of cholecystopathy in this district.