DERMAL HEMORRHAGIC NECROSIS INDUCED BY INTRADERMAL ADRENALINE INJECTION IN MAN

Abstract

0.1cc of 1‰ Adrenaline in saline (containing 100μg of adrenaline hydrochloride) was injected indradermally on 241 cases with various diseases and 26 cases of healthy adults and children. 24 hours and 48 hours thereafter the local skin was explored on the existence of local hemorrhagic-necrotic response and the diameter of the lesion was measured when the response was found. The appearance of the dermal hemorrhagic-necrotic area larger than 2×2mm2 in its size was recorded as positive adrenaline cutireaction. The reaction was observed in 3 of 26 healthy subjects and in 6 of 57 ambulant patients with the minimal surgical injuries or malformation. The incidence of the reaction was low amounting 11% in those groups. In the patients with several acute infectious diseases, the incidence of the reaction was significantly high. 30 of 43 patients (70%) of fulminant type of bacillary dysentery (Ekiri) in its acute stage and 17 of 20 patients (85%) of colitis type of bacillary dysentery showed the reaction. In the stage of recovery the reaction decreased i.e., 4 of 16 patients (25%) of fulminant type and 9 of 22 (41%) patients of colitis-type showed the reaction. Patients with diphtheria showed also high incidence of the reaction, i.e. 8 of 13 cases showed positive reaction and especially the patients with the large destructive foci showed higher incidence. 15 in 20 cases suffering several types of ileus showed also the positive response and some of them showed somewhat larger hemorrhagic necrosis as compared with the other diseases. Such evidences suggest the significance of bacterial polysaccharides in the positive cutireaction in the patients with bacillary dysentery, ileus and diphtheria, and of tissue polysaccharides in the patients of diphtheria, especially with the severe destruction of the tissues, because in the other experiment of the authors similar positive adrenaline cutireaction was found on several animals treated with the intravenous administration of several bacterial and tissue polysaccharides capable of eliciting the host response of Landy and Shear. So that some of the positive adrenaline cutireaction, which was found on those patients, may be considered as a representation of the host response which indicates the generalized injury of the endothelial cells of the blood vessels or the intravascular blood coagulation due to the invasion by some high molecular weights substances. Patients suffering from hypertension, (4 of 4, positive) and nephritis, (4 of 7, positive) showed somewhat higher incidence of the reaction. The mechanism involved in those cases is not clear and the exploration is now under way.