Crises

CRISES (from the French crise - turning point, attack), a term used by foreign authors to denote the most diverse changes in the condition of various organs and blood that occur suddenly. In Russian literature, this term is used to denote vascular crises of Pal, blood crises in pernicious anemia, hemoclastic crises of Widal, and visceral crises in tabes dorsalis. Vascular crises, so named by Pal in 1903 but known long before that, apparently represent spasmodic contractions of blood vessels in one or another part of the body, occurring in the form of paroxysms and accompanied by more or less significant elevation of blood pressure (by 20-100 mm Hg). Their symptomatology depends to a large extent on which part of the body the narrowing of blood vessels occurs predominantly, on the size of this area, and on the duration of the spasm. When crises are localized in the extremities, patients complain of a sensation of numbness ("dead finger"), crawling paresthesias, and various other paresthesias, of intermittent claudication. Localization of crises in the blood vessels of the heart leads to anginal phenomena, in the blood vessels of the abdominal cavity - to sharp colicky pains in various parts of the abdomen, spasms of the stomach and intestines, constipation; in the blood vessels of the kidneys - more or less pronounced albuminuria; spasm of cerebral blood vessels leads to cerebral ischemia, of one or another part of it, and manifests itself in the form of dizziness, fainting, transient pareses or paralyses of the extremities, amblyopia, aphasia, epileptiform attacks; spasm of the blood vessels of the optic nerve and retina is accompanied by temporary blindness, etc. A vascular crisis extending to several areas important for life, or a prolonged crisis of cerebral blood vessels, can lead to death with phenomena similar to uremic ones. The pathogenesis and etiology of vascular crises coincide with those of hypertension (see). Crises are observed particularly frequently in people suffering from hypertension of one origin or another, and are caused by intensification of the same factors that determine the latter (nervous-psychic excitement, endocrine disorders, poisonings and auto-intoxications). In particularly severe form, vascular crises manifest themselves in eclampsia of pregnant women. In diagnosing vascular crises, it is necessary to particularly keep in mind angina pectoris of other origin, cerebral hemorrhages and attacks of uremia; the history, corresponding clinical methods of investigation, the course of the disease (comparatively rapidly passing nature of the disorders during crises) make it possible in most cases to make the correct diagnosis. The general treatment of vascular crises coincides with the treatment of hypertension. During the crisis itself, nitroglycerin, amyl nitrite and other vasodilators have a good effect, often rapidly stopping extremely severe and life-threatening attacks. Blood crises were named by Noorden the sudden appearance in the blood of a large number of nucleated red blood cells observed in pernicious anemia. Usually this phenomenon is observed at the moments of the lowest level of red blood cells in the blood and serves as a harbinger of the impending remission. Subsequently, when the number of red blood cells exceeds 2-3 million, erythroblasts again disappear from the blood. In some cases, however, they continue to remain in the blood even during remission; Aubertin considers this a poor prognostic sign, predicting the rapid onset of a relapse. In many cases, blood crises occur spontaneously, in others - they follow the application of one or another method of treatment (blood transfusion, Arsen-stoss according to Neisser, splenectomy) and are usually considered in such cases as a sign of its success. Hemoclastic crises were named by Widal in 1913 as a group of reactions observed in the body during anaphylactic shock: a decrease in the number of leukocytes in the peripheral blood, accompanied by relative lymphocytosis, a fall in blood pressure, an increase in blood coagulability and a decrease in the refractive index of blood serum. All these phenomena were considered by Widal and his disciples as manifestations of the change in the colloidal state of body fluids occurring during shock (colloidoclasis) and were discovered by them in a number of pathological conditions (bronchial asthma, migraine, urticaria and many others) of anaphylactic origin, including in food anaphylaxis. Subsequently (1920) Widal found similar phenomena in some liver diseases after taking protein food and explained this by the fact that the diseased liver loses the ability to retain the products of protein digestion (proteopeptic function of the liver) coming through the portal vein; the latter enter the general circulation and cause shock phenomena (similar to peptone administered parenterally). On the basis of this, he developed a functional liver test, consisting in giving the patient being examined 200 cm³ of milk on an empty stomach and examining the blood and blood pressure before taking milk and 15-30-45-60 minutes after its administration; the detection of a hemoclastic crisis indicates liver insufficiency. However, numerous verification studies did not confirm the diagnostic value of this test. On the one hand, it turned out that this test does not give a positive result in all liver diseases, and on the other hand, the result is positive even with a healthy liver; besides, it is also observed when introducing non-protein substances: carbohydrates, fats, inorganic salts and others. (Glaser, Hoff and Sievers, Holler, Muller). A. Zavadsky and his collaborators Voronov and Ryskin established that, regardless of the intake of any food, the leukocytes of the peripheral blood undergo rather significant fluctuations, capable of simulating one or another outcome of the reaction. Nevertheless, despite the unsuitability of this reaction for functional liver testing, the existence of hemoclastic crises in general remained indisputable, as in particular their appearance in allergic diseases. As for their pathogenesis, it can be assumed that disorders of the function of vegetative centers and in particular vasomotor phenomena play a decisive role in their origin (Glaser and Muller). - Visceral crises in tabes dorsalis are accompanied by various painful phenomena from the organs of the abdominal cavity (see Tabes). Intestinal crises - attacks of pain in the intestinal area - are often observed in lead poisoning (see Lead).