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Role of the globulin constituents of the fibrinoid substance in the histogenesis and classification of the so-called collagen diseases


, : Role of the globulin constituents of the fibrinoid substance in the histogenesis and classification of the so-called collagen diseases. Presse Med 66(30): 661-663

It is rational to revise the concept of the collagen diseases in the light of newer data concerning the structure of the fibrinoid substance. Fibrinoid is no longer to be regarded as a result of metamorphosis of the fundamental substance. It is the result of the precipitation of fibrinogen in a particular medium presenting at least 1 g/100 g albumin or a glutathione rate equal or superior to 0.05/100. Histochemically there are 2 varieties of fibrinoid, 1 intravascular, rich in lipids, potassium, aldehyde radicals, carbonyl and sulfhydril, the other extravascular and having none of the latter substances, as though union could only be effected in a medium where they are profuse and mobilizable at the time of precipitation of the substance. Histologically there are thrombotic intravascular lesions associated with the "turgescence of the fundamental substance" which is in fact but the result of the extravasation, then of the precipitation of a fibrinous edema through the wall of either a serous membrane or a capillary, or also an arteriole under certain conditions of environment. Thus the notion of exudation through the wall of a vessel and of the intravascular transformation of fibrinogen into fibrin should be substituted for the hypothesis of a metamorphosis of the fundamental substance. Occurrence of localized thromboses is evidence of the regional action of certain thrombo-plastic substances. Generalized thromboses result from cancer of necrotic type or having a proteolytic potency, e. g. digestive or pro-static carcinomas. The syndrome of intravascular coagulation has been well defined in obstetrical accidents. Its mechanism proceeds from the release of thromboplastic substances from peri-ovular or peri-fetal membranes. Such sudden phenomena are to be compared with toxi-infectious phenomena, blood transfusion accidents, toxic and traumatic shocks. Their immuno-allergic nature is suggested. Electrophoretic investigations as well as experimentation have shown that a-globulins produce in animals some important vascular lesions of thrombotic type, whereas the injection of gamma-globulins is followed by almost no effect. Thus one could wonder whether such histo-logical reactions as obtained in the so-called collagen diseases are not dependent upon const tuents of the extravasated fibrinoid substance, according to the latter being rich in a-globulins or gamma-globulins. On the basis of these data a newer classification of these diseases has been attempted, as no longer called "of the collagen substance".

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