Die allgemeine Pathologie des Blutkreislaufes

Arteriosclerotic ulcer of legs without occlusive arterial disease

Twenty-one patients with arteriosclerotic ulcers of the legs are presented. All had normal blood pressure and had not a diabetic background, varicosities, or arteriosclerosis obliterans of the lower extremities. Histo logic examination is shown to be the best procedure for establishing the correct diagnosis. Changes in small arteries, between 100 and 300 microns in diameter, are characteristic. Two types of lesions were observed in these vessels: type I, consisting of hyperplasia of intima and media; and type II, consisting of enlargement and fibrosis of the intima and media. The type II lesion was found to be useful in separating arteriosclerotic ulcers from hypertensive ones, as well as from diabetic ulcers. The treatment consisted of local surgical resection and grafting. In five cases, because of multiple ulcers and/or severe dysthrophic skin changes, a sympatectomy was also performed.

[The influence of loss of blood and alcohol intoxication on early vital wound reactions (author's transl)]

The influence of loss of blood and alcohol intoxication on wound reactions in the first 12 hours after incisions into the skin of the back of guinea pigs was examined. As the most important result we found differences in the cellular and zymohistochemical reactions: while begin and progression of the dermal leucocytosis were not influenced, the parallel running activation of different structure bound enzymes was significantly delayed and decreased. Considering the first result and the haematogenous origin of the leucocytes there is reason to believe that in the hierarchy of the biological control circuit-at least in guinea pigs-the local reflex hyperaemia of the wound area certainly is primary to the dermal vasoconstriction during collapse. The animals with haemorrhagic shock showed a retardation in the liberation of histamine and serotonin. This decrease of the local mediators of the stromae dissociation is considered the reason of the impaired initial enzyme activities in the mesenchymal tissue.