Neomyographic examinations were made by the authors on 28 patients. The extent of reconvalescence was measured on the basis of changes in the values recorded by the myograms taken before and after the treatment.</p

Haberl, A.

Juranyi, R.

English

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Acta Medica OkayamaVolume 15, Issue 5 1961 Article 5OCTOBER 1961Evaluation of Dr. Szirmai’s method of treatingthrombosis with neomyograms resp.neomyographsR. Juranyi∗ A. Haberl†∗Laboratory of the” Arpad” City-Hospital,†Laboratory of the” Arpad” City-Hospital,Copyright c©1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.Evaluation of Dr. Szirmai’s method of treatingthrombosis with neomyograms resp.neomyographs∗R. Juranyi and A. HaberlAbstractNeomyographic examinations were made by the authors on 28 patients. The extent of recon-valescence was measured on the basis of changes in the values recorded by the myograms takenbefore and after the treatment.∗PMID: 14452851 [PubMed - indexed for MEDLINE] Copyright c©OKAYAMA UNIVERSITYMEDICAL SCHOOLActa Med. Okayama 15, 329-334 (1961)EVALUATION OF DR. SZIRMAI'S METHOD OF TREATINGTHROMBOSIS WITH NEOMYOGRAMSRESP. NEOMYOGRAPHSR. JURANYI and A. HABERLLaboratory of the" Arpad" City-Hospital, Budapest IV, Arpad ut 126, HungaryReceived for publication, June 10, 1961Aetiology, diagnosis and therapy of thrombosis have been treated of in anumber of publications. There are, however, many unknown factors leftover in connection with the problem of the origin of this disease. Someresearch workers suggest the influence of meteorlogic and cosmic circumstancesas its origin. Others (e.g. OCHSNER) stress the importance of smoking and traumaand the vasospasmodic effects to be responsible. TROSSEAU and his collabo-rators point out the part played by tuberculosis and cancer, BURK.E emphaszesheredity and constitution as the determining factors. As a matter of fact, wehave no satis.£actory solution for this problem up to the present, in spite of bothresearch work and scientific observations being carried on with a persistentendeavour adequate to the importance of the disease. Besides the simple methodsdepending on the external symptoms of thrombosis (changes of temperature,colour of the skin, etc.) we succeeded in clearing up the microscopic, physicaland colloid-chemical conditions of the coagulating process with the aid of moresensitive apparatuses. We know about the fine structure of the blood-disks, theirdisposition for pseudopody and coagulation. We also know that prothrombin,thrombin and thrombokinase. are coagulating and anti-thrombin and antikinaseare inhibiting factors. We know that coagulating factors are combined withglobulin, that inhibitory factors are combined with albumins. We know thatheparin develops in the special cells+ of the reticula-endothelial system, not inthe hepatic cellules, etc.Aetiological research has naturally led to the corresponding changes ormodifications of therapy. The discovery of the anticoagulants (heparin and di-cumarol) marks a considerable progress in this field. Experiments had beengoing on for a long time to make u~e of anticoagulants, such as hirudin, sodi-um oxalate and sodium citrate. They did not, however, stand the test becauseof the toxic symptoms caused when given in higher doses. The discovery ofheparin described by McLEAN in 1916 and put to use by CRADFORD was ofrevolutionary importance. Then dicumarol was added to the list by LINK in+ .. Ehrlichsche Mastzelle"3291Juranyi and Haberl: Evaluation of Dr. Szirmai's method of treating thrombosis withProduced by The Berkeley Electronic Press, 1961330 R. ]URANYI and A. HABERL1940, and this (with its derivatives) proved to be an effective though not aharmless means for fighting thrombosis. In addition, RAPPERT was the first todescribe, in 1952, a treatment of thrombotic cases with hydergineqanthesis.Besides these simple procedures the clinician is aided in establishing a dia-gnosis or in controlling the ensuinganti coagulant treatment by the LoWENBERGtest as well as by the macro-and microhaematological examination methods ofQUICK (1), SoULIER (2), SZIRMAI (3, 4). SZIRMAI's examinatinations by meansof the myograph present a novelty in registering thrombophlebitis resp. throm-bosis in the lower extremities.As it is well known, circulation in the extremities as a rule is not fullyarrested by the thrombi of the vessels, as the collateral tracks generally remainactive. The fact should not, however, be ignored that, in such cases, collateralfunction also is disturbed by contraction occurring through reflex courses.According to the grade of collateral capacity, symptoms may vary considerably.In addition to the external symptoms of thrombosis (changes in temperature andcolour of the skin), the respective musculature generally feels slack as a resultof the decrease of blood supply in the motor nerves. Under certain circum-stances musculature falls into a state of ataxic weakness and even a completemotoric ataxy may occur. (7)In cases of other diseases we 'have already been able to register with themyograph changes in the values of contraction and tonus resulting from insuffici-ent blood circulation.Our actual examinations had the purpose to state whether, by means ofSzirmai's neomyograph (Fig. 7) an apparatus far more sensitive than the myo-graph the results of our anticoagulating treatment could be registered, indepen-dently from the subjective feelings of our patients, on the mere basis of thechanges in the tonus and contraction values of the muscles. Therefore, besidesphysical examination methods, we observed prothrombin activity and'made amyogram with each patient before starting the actual treatment. During theanticoagulating treatment itself we have concentrated our attention on prothrom-bin activity and have made another myogram when the cure was completed.According to the respective prothrombin level of our patients, we startedthe anticoagulating treatment with administering thromasal pills containingphenylindandiona product of the Pharmaceutical Factory Asal+. The treatmentwas continued by local and peroral administration of vasodilators until objectiveand subjective symptoms disappeared.Above examinations have been executed on 28 patients. Results are summedup in Table 1.+ We herewith wish to express our gratitude to the Pharmaceutical F~ctory Asal, Berlin,for granting the use of Thromasal pills for our research purposes.2Acta Medica Okayama, Vol. 15 [1961], Iss. 5, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol15/iss5/5Evaluation of Szirmai's MethodTable 1.331Prothrombin- Neomyogram inactivity before Result ofName Diagosis and after myotonstreatment before and after therapy96 treatmentH.T. Thrombosis cruris 1. sin. 127 66 1.5 11.0 goodK. S. Thrombophlebitis 1. sin. 109 74 2.0 10.0 goodK.K. Thrombosis cruris 1. d. 110 58 1.0 9.0 satisfactoryT.K. Thrombosis cruris 1. sin. 120 80 3.5 12.0 good1. }. St. p. Thrombosis cruris 106 60 2.0 10.0 goodGy.S. St. p. Thrombophlebitis 119 72 1.0 10.5 goodK.A. Thrombosis cruris 1. utr. 138 86 0.5 8.5 satisfactory1. G. St. p. Thrombosis cruris 103 56 0.5 6.0 badA. T. Thrombophlebitis cruris 1. d. 108 70 2.0 13.0 goodB.P. St. p. Thrombosis cruris 1. sin 114 80 0.5 11.5 goodR.S. St. p. Thrombosis cruris 1. d. 107 74 1.5 10.5 goodL.A. Thrombosis cruris 1. d. 129 73 2.5 9.5 satisfactoryG.S. St. p. Thrombophlebitis 1. sin. 106 40 0.5 8.5 satisfactoryT.M. Thrombohlebitis cruris 1. d. 112 48 3.0 11.5 goodM.L. Thrombosis cruris 1. sin. 105 63 3.0 10.5 goodM.S. St. p. Thrombophlebitis 1. d. 109 68 2.0 7.5 badF.B. St. p. Thrombosis cruris 1. d. 119 60 1.5 10.5 goodCs.S. Ulcus cruris 107 75 1.0 6.5 badD.T. Thrombosis cruris 112 66 1.5 9.6 satisfactoryB.H. Ulcus cruris 106 68 0.5 6.0 badN.}. Thrombosis cruris 109 55 1.5 7.0 badM.Cs. Thrombosis cruris 121 72 2.5 11.0 good0.5. St. p. Thrombophlebitis 136 62 3.0 6.5 badS.}. Thrombosis cruris 103 54 2.5 10.0 goodTy.A. Thrombosis st. p. partem 105 63 1.0 6.5 badV.T. Thrombosis cruris 102 48 1.5 6.0 badSz.M. Thrombosis cruris 107 60 2.5 10.0 goodGy.B. Thrombosis cruris 117 76 3.0 11.0 goodTable I. shows that, under a pressure of 30 myotons applied on ourpatients before starting the treatment, the amplitudes of the myograms generallygive values of 1-2 myotons (1 myoton=lmm), 3 myotons rarely. Contraryto these, in normal cases under similar conditions amplitudes of 10 to 12 myo-tons are recorded. We may observe further, that as a result of the treatment,control examinations present a rise in myogram values in 20 of the examinedcases, while in the remaining 8 cases postthrombotic syndromes and subjectivecomplaints were observed at repeated examinations.3Juranyi and Haberl: Evaluation of Dr. Szirmai's method of treating thrombosis withProduced by The Berkeley Electronic Press, 1961332 R. }URANYI and A. HABERLOur examinations have a double significance. They verify Szirmai's earlierexaminations (5, 8, 9) registering influence of decreased circulation on muscula-ture. Furthermore, an exact record is compiled on the cure of our patients.Summing up the above, we may state that neomyographic examinati00sare along with the other mentioned methods very valuable in setting up diagno~sis of thrombotic cases. The special advantage of the neomyograph shows inenabling us after the complaints of the patients have ceased and when bloodcoagulating factors are normalized to make exact measurements of the status of1qo~o8,07,0§ qO~ 5;0::is .It/o3,02,01,0A Bbefore the after thetreatment treatmentFig. 1. Average results of changes oftonus-and contraction-values in 28 ex-amined cases.1.1,01S0120110* 100::: 90;.c 80 I-§ 70..s 60-ocl:: 50 ~40:5020 ..10 I-A Bbefore afterthe treatmentFig. 2. Average percentage of prothrombin activityin 28 cases examined.53,4%Fig. 4. Neomyogram, characteristic of a case ofthrombosis in both lower extremites. Passive (A) aswell as active (B) movements show equally small am-Fig. 3. Therapeutical results based on plitudes. (To read from right to left)changes in the myogram-values expres·sed in percentages.4Acta Medica Okayama, Vol. 15 [1961], Iss. 5, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol15/iss5/5Evaluation of Szirmai's Method 333B AXiFig. 5. a. Neomyogram, characteristic of a case ofthrombosis in the right lower extremity (X2). The left limbtoo shows a circulation worse than normal.Fig. 5. b. After treatment in both limbs an essential improvementis observed, strikingly shown by the myogram taken before and thatafter the treatment.Fig. 6. An a-year old thrombotic case with slight oedema in the left lower and a dis-tinct one in the right lower limb resulting a restriction of the movement. This myogram showsclearly that the active (B) movements of the left limb (XI) are severely confined, while thevalues of the right limb (X2) are in the case of passive (A) as well as active (B) movementsabout O.the disease by registering tonus and contraction changes resulting from the im-provement of circulation in the musculature.5Juranyi and Haberl: Evaluation of Dr. Szirmai's method of treating thrombosis withProduced by The Berkeley Electronic Press, 1961334 R. JURANYI and A. HABERLFig. 7. Szirmai's NeomyographSUMMARYNeomyographic examinations were made by the authors on 28 patients.The extent of reconvalescence was measured on the basis of changes in thevalues recorded by the myograms taken before and after the treatment.REFERENCES1. QUICK; L. HALLMANN, Klinische Chemie und Mikroskopie 538 (1950) (Clinical Chemistryand Microscopy)2. SoUl..IER: Le Sang 17, (1946)3. SZIRMAI, O. R,: Arztl. Wschr. 52 (1953).4. SZIRMAI. O. H.: Med. Technik, H.1. Berlin 1956.5. SZIRMAI, E.: Zbl. Chir. 45 (1953).6. JURANYI, R.: Zschr. inn. Med. 13, 150 (1958).7. MEszARos and BUGAR; Diagnostik, Path. und Ther. der Gefasserkrakrankungen.8. SZIRMAI E.: Pharmazie 5 (1957).9. SZIRMAI, E.: Arztl. Praxis VIII. 14, 1 (1956). Progr. Intemat. Contr. Intemat. Society It.Medicin, Philadelphia, U.S. A. 1958. Apr. 23-26, p. 16-56; Fol. haemat. 75, 2 (1957);76, 1 '(1959) and 77, 1 (1960).6Acta Medica Okayama, Vol. 15 [1961], Iss. 5, Art. 5http://escholarship.lib.okayama-u.ac.jp/amo/vol15/iss5/5

Evaluation of Dr. Szirmai's method of treating thrombosis with neomyograms resp. neomyographs

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