習慣性アンギーナの臨床的考察

CLINICAL OBSERVATIONS ON HABITUAL ANGINA

　I．緒言

　「習慣性アンギーナ」habitual angina（以下習アと略）は臨床でひんぱんにつかわれるわりには，漠然として，その実体が把握されていない。

　抗体を産生する生理的炎症臓器としての扁桃（口蓋扁桃を主に）は他臓器とちがい，常時慢性の炎症状態下に在り，それによつて抗原が摂取されるので，正常と異常（病態）の区別はつけにくい。言葉をかえていえば，新生児や滅菌動物のを除き，あらゆる扁桃は機能的，組織学的にみて慢性扁桃炎であるといつても過言ではない^1）。故にわれわれが臨床でみる扁桃は慢性扁桃炎でなければ，それの急性増悪像である。そして，これらの中で急性増悪をひんぱんにくりかえすのが習アではないかと理解され，つかわれているようである。

　From clinical observations on 250 cases of habitual angina, the following results were obtained ;

　1) It occurred most frequently at the age around 10 and 20 years, and there are no sex difference.

　2) Though frequent attacks of sore throat and fever were the chief complaints, most of them were fine at the intervals, but they complained foreignbody sensation and symptoms commonly seen in chronic tonsillopharyngitis.

　3) A-β-streptococcus, staphylococcus aureus and pneumococcus were 3 main pathogens isolated from tonsils in habitual angina. Among them pneumococcus was isolated very rarely, and A-β-streptococcus was decreasing year by year.

　4) Habitual angina had a close relations with renal diseases (especially acute glomerulonephritis), rheumatic diseases (esp. acute rheumatic fever) and several skin diseases esp. pustulosis palmaris et plantaris (P.P.P.).

　5) After tonsillectomy, the symptoms of repeated attacks of angina with fever were improved most effectively in contrast to the results of irrigations of the tonsillar lacunae and other conservative treatments. Regards to focal infections, skin diseases such as P.P.P., renal diseases such as acute glomerulonephritis and fever due to unknown cause were most effectively treated by tonsillectomy after complete examinations including tonsilar provocation tests were performed.

　6) In 30 cases (12%) the abnormal E.C.G. findings were obtained, and 1/3 of them were sinus tachycardia, and 57.1% of sinus tachycardia recovered completely after tonsillectomy or tonsillar irrigations.