Thromboangiitis Obliterans and Results Obtained by Pyretotherapy Using Malaria

Abstract

Thromboangiitis obliterans (Buerger’s Disease) is considered to be a clinical and pathologic entity with sufficient characteristic diagnostic criteria to enable the differentiation from other peripheral vascular diseases.

In the last 3 years 114 patients were diagnosed and treated in the Institute of Dermatology having Buerger’s Disease. The most of them were men (106) and the first clinical manifestation of the disease appeared mainly up to the age of 35 years (80,9%). The youngest patient being 18 years old.

Regarding the occupation of the patients 60% of them were physical workers exposed to various environmental factors. A great number of them were common unqualified workers doing outer heavy physical work (loggers, Street cleaners, construction workers etc.) and a small number were administrative employees (13%).

The great majority of the patients are or have been heavy smokers (95,6%) what is considered as a most important factor in the pathogenesis of Buerger’s Disease.

In patients who have continued to smoke in spite of treatment the disease in the rule has progressed and in almost all patients in whom after successful treatment lesions recurred were patients who whether did not stop smoking at all or started to smoke again.

For routine treatment of Thromboangiitis Obliterans in the rule a conservative attitude was adopted and only in quite exceptional instances surgical procedures have been applied.

Generally, besides the usual conservative therapeutic procedures used in the treatment of thromboangiitis obliterans (anticoagulant therapy, vasodilating drugs, vitamin E, local treatment of gangrene, complete abstinence from smoking) pyretotherapy by inoculation with malaria tertiana (Plasmodium vivax) was applied in addition. Some of the patients (32) were treated with malaria only.

The inoculation was carried out by injecting malarial blood (i. m. or i. v.) from patient to patient.

Usually it was allowed in one course of malarial treatment t6 advance 5—7 fever attacks reaching in total about 40 hours of raised temperature of 38,5° C or more. The termination of the infection was achieved by administration od Resochin and Primaquine.

This kind of treatment was applied in 114 patients — 90 of them were previous' treated by various drugs or surgical procedures (sympathectomy or ganglienectomy in 41 patients, amputation in 22) without satisfactory results. The most of them were in the Progressive stage (stage IV) of the disease.

Already during the fever attacks in most instances certain improvements could be noticed and in follow up during the period from 12—36 months 66,67% of patients were improved. In patients with ulcers or gangrene healing could be achieved in 63%. Recurrence of the disease usually with Progressive ulcerative gangrenous lesions was observed during the observation period in 26,3% whereas such episodes before treatment were occurring in 50% of patients. In almost all such cases the patients started to smoke again or had encountered an exogen trauma. Sometimes a heavy psychogenic insult could be considered as the course of the recurrent episode.

Of all 114-malaria treated patient’s amputation was carried out in 4 only predominantly because the patient was not able to tolerate the pains.

In general, it could be concluded that pyretotherapy by malaria inoculation has a very favourable effect in treatment and arresting the progression of Buerger’s Disease.