Trunecek Serum

TRUNECEK SERUM, Serum inorganicum Trunecek, proposed in 1901 by physician Trunecek (Prague), is a solution of alkaline salts (sodium and potassium) of normal human blood serum, taken in the same proportion as in the serum (according to Hoppe-Seyler, 1877), but at a tenfold concentration, namely: per 100 g of distilled water, 4.92 g of sodium chloride, 0.44 g of sodium sulfate, 0.21 g of sodium carbonate, 0.15 g of sodium phosphate (Na₃P0₄) and 0.40 g of potassium sulfate (later the author replaced the latter with 0.35 g of potassium chloride due to less pain from it in subcutaneous injections). For preparing the serum, Trunecek recommends first testing the salts in their pure form, then heating them to 100° to free them from crystallization water, and only then weighing them in the specified amounts (one can use antisklerozin tablets, see) and dissolving them in distilled water free from any organic substances; such a solution should be heated to 110° and kept at this temperature for 2 hours for sterilization. It must be sterilized in a closed vessel to prevent evaporation of water and consequently change in the composition of the solution. The result is a colorless transparent liquid with a salty taste and strongly alkaline reaction (pH = 8.5); at 20° it contains 6.12% salts and has a specific gravity of 1.04. The serum later proposed by Trunecek, twice as dilute as the original, at 15° contains 3.06% salts by weight, has a specific gravity of 1.02208 and a freezing point of -1.705°. Before injection, Trunecek recommends neutralizing the alkalinity (with litmus), requiring 21.5 cm³ of decinormal acid per 100 cm³ of the serum of the latter composition. Against the proposals of other authors to add antiseptic agents to the serum (for example, resorcin up to 1%), Trunecek objects, since the serum itself has antiseptic properties and antiseptic agents change its composition. Trunecek proposed his serum as a remedy for arteriosclerosis, considering this disease to be caused by disturbance of salt metabolism, depletion of the body with sodium chloride with age (in accordance with the results of Bunge's research on tissues of animals of different ages) and generally with alkaline salts, as evidenced by the strong acidity of urine. Under these conditions, calcium phosphate [Ca₃(PO₄)₂] in the blood, in Trunecek's opinion, 'precipitates' on the walls of blood vessels. Trunecek bases this position on the fact that calcium phosphate is the only salt in the blood that in in vitro experiments does not dissolve in distilled water, but easily dissolves in solutions of sufficient concentration of sodium chloride and sodium and phosphates. To increase the alkalinity of the blood and thereby better dissolve calcium in it, Trunecek considered the introduction of sodium chloride into the body insufficient, as it does not change the alkalinity of the blood, while the introduction of sodium carbonate into the stomach is irrational, as the gastric juice will convert it to sodium chloride. Therefore, Trunecek proposed to introduce a concentrated solution of alkaline salts parenterally (under the skin or into a vein). He believed that his serum not only promotes the dissolution of calcium phosphate deposited in the walls of arteries, but also enhances combustion processes, brings intracellular exchange closer to a normal level and thereby has a regulatory effect on the functions of various organs, especially the heart and blood vessels. Since under the influence of Trunecek's serum, Trunecek observed in elderly people a decrease in desquamation and formation of normal epithelium, he believed that in a similar way it would also help in the regeneration of vascular endothelium altered by arteriosclerosis. The author recommended introducing the serum under the skin of the forearm, applying 10% boric ointment to the injection site afterward, and applying a warm compress for an hour, which reduces pain. Usually, treatment courses begin with the injection of 1-2 cm³ of serum, repeating the injection every 2-7 days, each time increasing the dose by 0.2-0.5 cm³ (and even by 1.0). The maximum dose in Trunecek's practice was 7.5-10 cm³ per injection, but he believes that there is usually no need to exceed 5 cm³ per injection. When more than 1 cm³ needs to be injected, the author recommends to avoid excessive stretching of the skin and severe pain, first injecting only 0.5 or 1 cm³, and then, leaving the needle in place, injecting the remainder in additional portions (after several minutes); thus, an injection of 5 cm³ over half an hour is painless. Only in very severe cases is it recommended to make daily injections, carefully increasing the dose. Other authors varied this treatment scheme, starting with smaller doses (e.g. 0.25-0.5 cm³), repeating injections every other day (1 cm³ each time), and injecting the serum into muscles and rectum as well. The total number of injections by individual authors ranged from 10 to 125. Opinions on the value of T. s. as a therapeutic agent were sharply divided. While some (Huchard, Lang, Trakhtenberg and others) gave it a negative review, other authors (L. Lévi, Thiroloix, Francois-Frank, Goldschmidt, Weil and many others) saw brilliant results from its application. Particularly good effects were noted in cardiac asthma, sclerosis of large arteries, coronary vessels, cerebral vessels, sclerosing otitis, chronic joint lesions (rheumatic, gonorrheal), as well as in neurasthenia and hysteria. In some cases, a decrease in the size of the heart and aorta, lowering of elevated blood pressure, restoration of visual and hearing acuity, cessation of noise and ringing in the ears, headaches, dizziness, improvement of appetite and sleep, memory and disappearance of various unpleasant sensations were noted. A decrease in tension (CO₂) in the alveolar air was noted, i.e., a decrease in the alkaline reserve of the blood (both experimentally and clinically), some shifts towards an increase in calcium content and decrease in salts in the blood, etc.-S. F. Maykov believes that the different assessment of the therapeutic properties of T. s. by different doctors is explained by the quality of the preparation and the methodology of its application to patients. Serum prepared in the usual way is not free from calcium, which is released together with silicic acid from the glass of ampoules (N. A. Shilov); the solution therefore gradually becomes saturated with calcium and loses part of its activity. Shilov assumes that the hypertonic salt solution introduced into the body increases the concentration of all normal blood salts except calcium salts; thus conditions are created in which the adsorption of calcium salts by the vessel walls is delayed, namely, the electrocapillary and adsorption equilibrium between the walls of blood vessels and the blood washing them is disrupted in the direction of decreasing and slowing down the adsorption of calcium salts. Attaching great importance to the anions of the blood, Shilov believes that when HCO₃- ions accumulate in the blood (as a consequence of blood acidosis), the adsorption of carbon dioxide (as HCO₃- ions) on the vascular wall finds more favorable conditions and leads to a change in the properties of the vascular wall (the first chemical stage of sclerosis). In special cases, this can lead to the secondary deposition of calcium carbonate. Maykov and Shilov proposed instead of T. s. a preparation called hypersol, in which the amount of sodium phosphate is increased to 0.45 g and instead of sodium carbonate, sodium bicarbonate is taken in the amount of 0.42 g per the otherwise same composition of T. s. The alkalinity of such a solution is brought to pH = 9-9.5. The preparation prepared according to Prof. Shilov's method is a colorless transparent liquid with a salty taste, specific gravity 1.022, absolutely sterile and contains no calcium salts or any other salts except those specified in its formula above. It is sold in ampoules of quartz Jena glass in 1-2-3 cm³ portions. It is injected under the skin or into muscles, starting with 0.5 cm³ and adding 0.2-0.5 cm³ daily, up to 2 cm³ per day, which dose is injected for 10 consecutive days and then every other day. For a lasting improvement of the condition, it is usually necessary to inject a total of 100 cm³ under the skin. Less frequently (almost exclusively in syphilitic vascular lesions, usually together with novazurolum), it is injected intravenously 1 cm³ daily for 10 days, then 50 injections every other day. When taken orally, the effect is unreliable; it is given 1 tablespoon 2 times a day before meals (less often after meals), washed down with a sip of boiled water (unpleasant taste); it is taken continuously for 3-4 months, then a pause for 6 months and again taken for 3-4 months, etc. A more reliable effect is achieved by administration in enemas, but it is easy to get intestinal irritation; 60 enemas are given consecutively (1-2 tablespoons of hypersol in 100 cm³ of warm water), then a break for 6 months and, if necessary, the treatment course is repeated.

As with the use of T. s., a number of authors obtained favorable results with hypercalcium in atherosclerosis of the vessels and diseases arising from this basis (angina pectoris, hypertensive, arteriosclerotic and essential hypertension, etc.), with sharp fluctuations in calcium content being noted (Travina). At the same time, it turned out that both with T. s. and with hypercalcium, complications are observed in the form of petechiae, pinpoint hemorrhages into the cornea, sometimes extensive skin hemorrhages, profuse pulmonary hemorrhages (in pulmonary t.b.c.), exacerbations of the tuberculous process in the lungs, hemiplegia (in cerebral vessel sclerosis), as well as a number of subjective unpleasant sensations (headache, dizziness, etc.). The use of T. s. and hypercalcium must be very cautious in advanced arteriosclerosis and vasomotor disorders, is contraindicated in febrile diseases, malignant tumors, pulmonary t.b.c., and in all conditions with a decreased level of calcium in the blood; Trunecek did not recommend its use with neutral or alkaline urine reaction. At present, it is hardly possible to recognize the specific action of T. s. or hypercalcium, but this does not deprive them of their significance as a therapeutic agent.