Szirmai, Endre

Okayama University Digital Information Repository

Treatment of peripheral vascular diseases, in particular of ulcerative forms with Solcoseryl

Okayama University Scientific Achievement Repository

Acta Medica OkayamaVolume 21, Issue 1 1967 Article 3FEBRUARY 1967Treatment of peripheral vascular diseases, inparticular of ulcerative forms with SolcoserylEndre Szirmai∗∗Technische Hochschule,Copyright c©1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.Acta Med. Okayama 21, 15-21 (1967)TREATMENT OF PERIPHERAL VASCULAR DISEASES,IN PARTICULAR OF ULCERATIVE FORMSWITH SOLCOSERYL*Endre SZIRMAIDepartment of Nuclear HematoZogy and Radiation BioZogy, Institute ofNuclear Energy, Tec/inische Hochschule, Stuttgart, F. R. GermanyReceived for publication, November 15, 1966Due to the constant increase of peripheral disease the physician is alwaysmore frequently obliged to diagnose and treat disorders of peripheral bloodcirculation in the limbs. In a mixed group of out-patients having disorders ofthe peripheral blood circulation 15 % of the diseases concern the arterial vessels;70 % of the affections are purely venous, while 10 % concern the arterial aswell as the venous vessels (Kappert). The following distinctions fall under thegeneral notion of peripheral disease in its widest sense:I Affections of Arteries and Arterioles1. Organic forms (Figs. 1 and 2)a) Arterial occlusive diseases: Arteriosclerosis obliterans, arterial embolismarterial thrombosis, thromboangiitis obliterans, arteritis of different origins,diabetic angiopathy and gangrene, aortic arch syndrome, disorders due to lesions,disorders due to cold or humidityb) Non-occlusive organic arteriopathies: Arterial aneurysm, arteriovenousfistula2. Functional Formsa) With tendency towards vasoconstriction: Digitus mortuus Raynaud'sdisease and Raynaud's phenomenon, acrocyanosis, arterial pseudoembolism,crural erythrocyanosis, lividity, neurovascular shoulder-girdle syndrome, brachi-algia statica parestheticab) With tendency towards vasodilation: ErythromelalgiaI I Venopathies: Varicosis, thrombophlebitis and phlebothrombosis, phleg-masia cerulea dolens, migrating phlebitis, postphlebitic and post-thromboticsyndromes, venous varicose ulcerI I I Capillary Disease: Vascular purpuraIV Disease of the Lymphatic Vessels: Lymphangiitis, lymphedemaV Tumors and Dysplasia of the Blood Vessels: Hemangioma, etc.,*This work was supported by the Scientifical Divisiou of the Solco Basel, Switzerland.151Szirmai: Treatment of peripheral vascular diseases, in particular ofProduced by The Berkeley Electronic Press, 196716 E. SZIRMAIbenign as well as malignant forms.Ulcerative and/or necrotic lesions of a series of the above-mentioned formsof peripheral circulatory disease are particularly crucial. These may be due todisorders of the arterial as well as the venous peripheral blood circulation, andare the manifestations of the metabolic catastrophy taking place in the dependanttissues.There are countless methods for their treatment, which indicates that thetherappeutic results are not satisfactory.In the last few years numerous well-known authors have reported on theuse of a deproteinized calf-blood extract in the treatment of disorders of theperipheral blood circulation, more particularly of the ulcerations that accompanythem.This deproteinized calf-blood extract is marketed under the brand nameSolcoseryl. The biological action of Solcoseryl consists in improving the utiliza-tion of oxygen and thereby increasing the metabolism of animal and vegetabletissues about three-fold in relation to the controlled measurement in Warburg'smicrorespirometer (JAEGER, SZIRMAI).Investigations made by JAEGER and MITTENZWEI on isolated liver mitochon-dria revealed that the oxygen consumption of tissues incubated with Solcoserylor of mitochondria treated with So1coseryl is higher than that of the controls,it being essential that the PIO quotient remains unchanged, i. e. that the increasein respiration runs parallel with an increase in phosphates rich in energy. Thisis not a decoupling of oxidative phosphorylation, nor an isolated substrateeffect, as that which can be observed when certain substrates are added. Theincrease in respiration inside the tissues, which the above-mentioned authorsobserved, lies markedly above the values that can be obtained with the knownsubstrates.The results of numerous animal experiments and clinical trials in hypoxydo-tic conditions correspond with those obtained by the above-mentioned authorsshowing that proresses in which So1coseryl intervenes are favoured by a highrequirement of energy (ion exchange, healing of wounds, regeneration of tissues)and that the tolerance of noxae and oxygen deficiency is considerably increased.Thus WICKINGEN was able to prove on a total of sixty-six swines with sacrificeof identical form and size that Solcoseryl significantly accelerated the healingprocess in comparison to that of the untreated controls and without producingany retraction of the borders of the wounds. This replacement of substance incases of fairly deep loss of tissue was also observed by other authors (COUCOURDEand SCHIFINO). Granulation and epithelialization of the wounds are accelerated,retraction of the borders is insignificant, and scarcely any cicatricial contractionis noted. Heavily secreting and suppurating wounds clean rapidly, and blood2Acta Medica Okayama, Vol. 21 [1967], Iss. 1, Art. 3http://escholarship.lib.okayama-u.ac.jp/amo/vol21/iss1/3Treatment of Peripheral Vascular Diseases 17circulation is improved both.in the affected area and in the trophically disturbedsurrounding area. Granules appear in the depth of the wound and they con-verge forming a granular mass progressing from the center towards the borders,thus making up for the loss of substance. Strips of epithelium project from theborders towards the center. The epithelialization occurs along with and aheadof the replacement of the substance. In no instance did there appear any wildover-growing granulation. It is most impressive that improvement takes placeafter only a few days' treatment and subjective discomforts such as pain, pares-thesia, or cold limbs gradually disappear.Complete healing takes comparatively little time, if one considers the usualduration and habitual resistance to therapeutics of such lesions. The vasculari-zation of the skin covering these wounds is usually good, the skin is soft andpink with smooth elastic scars. Practically no cicatricial hypertrophy has everbeen observed. It is absolutely essential to persist in the treatment with Solce-seryl even if the results do not seem encouraging at first.In cases of gangrene in which amputation is contemplated, an intensivetreatment with Solcoseryl can frequently ensure a partial amputation only.Demarcation of the necroses allows one to distinguish between irreversibly losttissue and repairable lesions. In diabetes it is, of course, necessary to controlthe basic illness.The following general1ines should be taken into account for the treatmentof all severe cases: 1. In disorders of arterial blood circulation intraarterialinfusions of 1 to 5 ampules of Solcoseryl with glucose added (for diabetics withsorbitol) should be given daily. 2. In disorders of the venous blood circulationtreatment should consist of 1 to 2 ampules daily in intramuscular or intravenousinjections. 3. In disorders of arterial and venous blood circulation the physicianshould choose the method which proves to be most successful; but in any caseit is advisable to combine parenteral therapy with topical applications of 5%Solcoseryl ointment or 20% Solcoseryl jelly. It is recommended to cover heavilysecreting, suppurating and necrotic ulcers daily with a layer of Solcoseryl jellyof the thickness of a knife blade, until the ulcer is clean, necroses have fallenoff, and the secretion has subsided. The treatment should be continued withointment applied to the wound on cloth until healing is complete. At the sametime the parenteral treatment should be reduced to an appropriate maintenancedose of 1 to 2 ampules threce times a week.In extremely severe cases, particularly after amputations or in very ex-tended and deep ulcers with scarce healing tendency, daily spraying of thelesions with 1 to 2 ampules of Solcoseryl or local injections of Solcoseryl intothe border of the lesion or in the healthy area immc:diately surrounding the same,have proved useful.3Szirmai: Treatment of peripheral vascular diseases, in particular ofProduced by The Berkeley Electronic Press, 196718 E. SZIRMAIIn the above described manner numerous clinicians have obtained healingof more than 8096 of trophic lesions which had resisted treatment for over 20years. These lesions were due to disorders of blood circulation of the mostvaried origin, even of mal perforans leprosum (SZIRMAI, MANCOSU, UGO, ERBAand CASATI, GORI·SAVELLlNI and MELONI, ERBA, KAPPERT, POHL, AZAM,STRATMANN, MEHREz, HAMMAN and SHAFIK, MEYTHALER, ELL and DERLATZ,WOLFRAM, WySS and BASTI).OWN OBSERVATIONSI first began using Solcoseryl in 1955 and 1956 in CI Arpad" Hospital inBudapest, and first reported on the results, especially for the treatment of cruralulcers, in 1959 (Table 1, 1955--1966). As I had used most known methods inTable 1 Own Observations (1955-1966)DiagnosisINumberI-gOOdResultsof cases middle no changeAffections of arteries and arterioles1. Organic formsa) Arterial occlusive disease 150 100 30 20 (sevre ecases)b) Non occlusive organic arteriopathies 190 160 28 22. Functional formsa) with tendency towards vasoconstriction 96 90 5 1b) with tendency towards vasodilatation 52 38 10 2II Venopathies 320 270 36 14III Capillary disease 146 120 20 6IV Disease of the lymphatic vessels 46 38 5 3V Tumours and dysplasia of the blood vessels 34 30 2 2VI Radiation reaction 140 128 4 8VII Ulcus ventriculi et duodeni 130 97 20 13this field for about eighteen years, I can affirm that I have obtained very satis-factory results with Solcoseryl in a considerable number of cases. From theoutset I recorded blood circulation and various other factors in all cases treatedwith Solcoseryl not only with the methods known at the time but also with anas yet little known apparatus which I have developed, viz. the myotonometer(Fig. I-a, b), the angiomyograph, and the mechanical myograph. Myappara-tus, in particular the angiomyograph, records capillary functions, through themodifications of muscular volume, that the oscillometer does not register. Thusit is possible to control with the angiomyograph acute and chronic activity testsof medicaments on arteries, veins, muscles. tissues, edema, innervations,eet.4Acta Medica Okayama, Vol. 21 [1967], Iss. 1, Art. 3http://escholarship.lib.okayama-u.ac.jp/amo/vol21/iss1/3Treatment of Peripheral Vascular Diseases 19~x, r,Dl~O--;;I~:----:20t-'---:~;--;,o::::----:35;-""'""'":4D:--~4~5 --:-50:--~S5a bFig. 1-a The angiomyogram of a crural ulcer which was treated with Solcoseryl. X: leg, Y: thigh, A: passive movement, B: active movement.Fig. 1-b Is an angiomyogram of the same patient. The amplitude of this angiomyogram is muchwider, which shows that improvement of the ulcer was accompanied by the improvementof blood circulstion.Fig. 2-1 This electron micrograph of a human meningeal arteriole from a patient with hyper-tension shows a thickened basement membrane (hyalinosis of light microscopy) X6,000Fig. 2-2 This electron micrograph shows the intimal coat with an atheromatous haemorrhagicplaque in an artery of the human brain. Seven red blood cells lie in Cl cleft within thethickened basement membrane. A fibrinous clot surrounds the red blood cells. X 6,000I frequently observed that pain subsided when the treatment with Solcoserylwas successfnl. This can be explained by my "oxygen insufficiency theory"(=OIT) according to which every pain is due to a state of hypoxemia or ano-xemia, in which cell combustion takes place only in part, and the half-burntcellulose irritates the nerve endings. This is a chemical process, like that takingplace in an oven, in which insufficient ventilation causes lack of oxygen supply.The so-called oxygen insufficiency can be favourably influenced by an improvedblood circulation, i. e. an improved oxygen supply. (My so-called GTopc-theory5Szirmai: Treatment of peripheral vascular diseases, in particular ofProduced by The Berkeley Electronic Press, 196720 E. SZIRMAI= general therapy of improved oxygenation of the peripheral circulation).Thereby every pathological condition can be favourably influenced and everypain (except in cancer) calmed without anesthetics.From the above it can be inferred that every pain and every pathologicalcondition in connection with disorders of the blood circulation, which indirectlyaffect various organs, can be favourably influenced and possibly healed withSolcoseryl (Table 1).ACKNOWLEDGEMENTSFor the electron micrographs I thank to Professor Alfonso MARTINEZ, Director of the Depart-ment of Pathological Anatomy of the University of Concepcion, Chili.REFERENCES1. JAEGER, K. H. and MITTENZWEI, H.: Die Erzeugung einer Splenomeaalie bei Kalbern.K/in. Wschr. 36, 441. 19582. WICKINGEN, H.: Uber die Wirkung eines Blutextraktes auf did Wundheilung. Wien. med.Wschr. 110, 90, 19603. AZAM, SH.: Trophic ulceration of foot in leprosy and the use of an organ extract of animalblood. The Hea/er (Pakistan) 1, 12-16, 19624. CoucouRDE,F. and SCHIFINO, A.: L'impiego di un nuovo farmaco nella cura delle radio-dermiti, Minerva Radiologiea fisioterapica e Radiobiologica 19645. ERBA, G.: Su un raro caso di necrosi simmetrica delle estrcmita distali. - Trattamento conun nuovo derivato di sangue deproteinizzato. Gazz. med. ita/. 119. 281-'282, 19606. ERBA, G. and CASATI, c.: Sull'impiego di un nuhvo farmaco nella terapia delle ulceregastroduodenali e varicose. Res Medicae (Torino) 1, 34-48, 19597. GORI.SAVELLINI, D. and MELONI, N.: Considerazioni sulle propireta cicatrizzanti di unestratto deproteinizzato di sangue (Soleoseryl). Dermat%gia (Napoli) 11, 59-62, 19608. KAPPERT, H.: Person. Commun. 28 Oct. 19659. MANCOSU, A.: Sull'azione cicatrizzante di un nuovo preparato. G-iorn. ita/ Derm. 100,92.....103, 1959 ref,: Derm. Wschr. 142, 919, 196010. MEHREz, 1., HAMMAM, A. S. and SHAFIK, A.: Modern Surgery in the Treatment of theDiabetic Foot. Kasr-E/-Aini Journ. Surgery (Cairo) 4, 137-144, 196311. MEYTHALER, F. ELL, O. and DERLATH, S.: Erfahrungen mit "Actihaemyl" bei del'Behandlung peripherer arterieller DurchblutungsstOrungen, Munch. med Wschr. 105, 1945.....1947 and 1956-1957, 196312. POHI, W. H.: Uber die Behandlung von Strahleuschaden der Haut mit Solcoseryl. Strah/en-therapie 117, 279 .....287, 196213. STRATMANN, F. W.: Behanplung der diabetischen Angiopath(e. Aerztl. Praxis. 11, 51.....53, 196014. *SZIRMAI, E.: Meine Erfahrungen mit der Solcoseryl (NKB)-Behandlung der ulcera ventri-* On Solcoseryl. Lecture presented in three parts in Portugese, Spanish and English languagesin Sao Paulo/ Brazill part of a lecture/, Hospital de Servidores Sigur. at 11h. 30 min. a. m.Oct. 28, 1965, at 14h. 30 min. at 28 Oct. 1965 at University, School of Medicine CampinasS. P. / Brazil and at Oct. 30, 1965, 10h. in Montevideo, University, School of Medicine-Treat-ment of Peripheral Vascular Diseases with Solcoseryl and H. A. H., Des Moines, Iowa, USAfLecture/, College of O. Medicine and Surgery, Staff Meeting, Room 102, April 6, 1966 7h.30 p. m. -Tratamiento con Solcoseryl de radiorreacciones. Nuclear Hematology, London, June 6.173--176, 1966.--6Acta Medica Okayama, Vol. 21 [1967], Iss. 1, Art. 3http://escholarship.lib.okayama-u.ac.jp/amo/vol21/iss1/3Treatment of Peripheral Vascular Diseases 21culi et duodeni und desulcus cruirs. Ztscllr. ges. inn. Med. 14, 769-772, 195915. UGO, A.: Recenti esperienze in tema di terapia dell'ulcus cruris flebopatico. Folia Angiol.6, 316-321, 195916. WYSS, J. L. and BASTI, H.: Contribution ci l'experimentation du Solcoseryl dans Ie traite-ment des ecsarres et des gangrenes des membres. Praxis 53, 1955-1901, 196417. WOLFRAM, ST.: Moderne Therapie bei Hautkrankheiten, Monatsk. iirztl. Fortbild. 2,520-524, 19597Szirmai: Treatment of peripheral vascular diseases, in particular ofProduced by The Berkeley Electronic Press, 1967

Treatment of peripheral vascular diseases, in particular of ulcerative forms with Solcoseryl

Abstract

Similar works

Full text

Available Versions

Okayama University Digital Information Repository

Okayama University Scientific Achievement Repository