[Compromised tissue perfusion for defective microcirculation in children].
After a brief review of the anatomic and physiological features of the microcirculatory system, the Authors describe a new interpretation of skin edema in acute diffuse infantile glomerulonephritis, in Henoch-Schönlein's purpura, in epidemic parotitis and in Kawasaki's disease. They attribute the cellular swelling typical of elastic oedema of these diseases to respiratory deficiency due to reduced tissue perfusion following insufficient circulation in real capillaries. The ensuring drop in energy is rapidly resolved by use of very small doses of a calcium antagonist, chloropromazine, which also affects hemorheology. The Authors refer to works which regard the microcirculatory hypothesis in encephalic pathology (similar to that arising in subjects who live at high altitudes where oxygen is scarce), in cranial trauma and in psychic depression. The Authors describe the surprising find, following a fortuitous observation, that in certain forms of hepato-splenomegaly--among which a case of splenomegaly with hepato-megaly and initial cirrhosis--three hours after the administration of doses of chloropromazine ranging from 0.5 to 1.0 mg/kg, the liver and spleen considerably reduced in volume, followed by the patients' ensuing excellent general conditions and functionality of their organs. The article then references many other Authors who in the course of time have acknowledged the fact that hypoxia stimulates proliferation, even of osteoblasts. Mention is made of the fact that many medications and therapeutic measures may cause vasoconstriction at microcirculatory system level, similarly to several antineoplastic drugs, X-rays, hyperbaric oxygen treatment, as well as traumas, low environmental temperatures and surgical operations. For this reason, in order to contrast vasoconstriction in many pathological conditions and in certain therapies, the Authors suggest the addition of the use of calcium antagonists to usual therapy. This conclusion is reached in consideration of the fundamental fact that the energy deficiency arising in the hypoperfused tissue areas allow an accumulation of amino acids, mainly deriving from protein disgregation, used with a low consumption of energy to synthesize a great number of simplified proteins. Final reference is made to the concept expressed on hypoxia and simplified structural proliferation in an article published in "Medical Hypotheses" of 1995 referring to neoplastic promotion.
Malossi
M
M
Già Primario Ospedale Infantile S. Chiara di Trento, LD in Clinica Pediatrica, Italia.
Malossi
R
R
D000208:Acute Disease; D002648:Child; D005260:Female; D005921:Glomerulonephritis / Q000503:physiopathology*; D006801:Humans; D011695:IgA Vasculitis / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000503:physiopathology*; D009080:Mucocutaneous Lymph Node Syndrome / Q000503:physiopathology*