原著

Original Article

The clinical evaluation of intravenously injected k-strophanthin (Strophosid "Sandoz") was performed upon the various kinds of cardiac diseases and the indication permitted hitherto was re-investigated in each case. Generally speaking, the superiority of k-strophanthin to digitalis can be summarized as follows, i. e. in the cases with nearly all cardio-vascular emergencies, acute cardiac failure, poor resorption of digitalis, gastro-enteric disturbance due to digitalis. The favourable results were obtained with k-strophanthin in the case which showed the refractoriness against "Digicorin" fraction (Case No. 1) Furthermore k-strophanthin is often effectual in heart failure without cardiac hypertrophy, myocarditis, coronary sclerosis, various sorts of infectious diseases, cardiac failure in obesity, and so-called bradycardic decompensation. Before 30 years Filip took up the position that digitalis should be used for the cardiac failure with auricular fibrillation whereas strophanthin for the cases with sinus rhythm. However strophanthin which was administered in mitral stenosis with auricular fibrillation removed both decompensation and arrhythmia, consequently it is evident that there are many exceptions to Filip's opinion. But some disadvantage in strophanthin treatment must be mentioned. Strophanthin has to be administered parenterally, especiall by the intravenous injection, therefor this may not always be acceptable to any case owing to relative expensiveness and troublesomeness; as a rule the oral medication of digitalis is chosen for the maintenance. K-strophanthin must be cautiously used in the case with severe cerebral arteriosclerosis. There exsists also the refractoriness against k-strophanthin. Patients who were suffered from severe extracardiac complications or complicated with advanced arteriosclerotic diseases, above all, with coronary sclerosis were often found refractory against k-strophanthin. The combined use of "Parmanil" (Hoechst) sometimes soomths the display of k*strophanthin effect.

The fatal pulmonary edema was experienced in one case with, marked mitral stenosis, i. e. so-called fish-mouth stenosis after the intravenous injection of 0.25 mg k-strophanthin ; the possible explanation was discussed inclusive of findings at autopsy. The decompensation of aortic valvular diseases tends usually to necessitate a high degree of myocardial damage; this is sure to be one of chief reason of the relative low efficiency of digitalis and strophanthin. In small part of cases with Hegglin's syndrome k-strophanthin elicited nausea, vomittnig and ventricular extrasystoles, however, as a rule, even in these cases k-strophanthin was found more effective than g-strophanthin. In one case suffered from so-called coronary failure complicated with Hegglin's syndrome, k-strophanthin showed the excellent results. Formerly the cases with recent coronary thrombosis as well as with angina pectoris were thought to be contraindication of the use of strophanthin chiefly from theoretical point of view. Prof. S. Saitoh and his colaborators had re-examined and assured Bing's results by the coronary sinus catheterization and concluded that k-strophanthin in proper dosage may be helpful to economize in oxygen consumption of the left ventricle. My practical experience indicated also that k-strophanthin in adequate dosage was impressive in the cases with myocardial infarction, especially at its initial shock stage as well as at the following cardiac decompensation. When the pathological changes of myocardium have been already very high in degree, the effect of strophanthin, of course, can not strikingly be expected. When k-strophanthin in proper dosage was used in combination with protoveratrine A or B (Sandoz) in hypertensive cardiac disease, there could not be elicited any excessive vagal reaction. ; In uremic condition of the malignant hypertension strophanthin was used under careful consideration upon the speed of dehydration and showed the improvement although its effect was only transitory.