1
Tohoku J. exp. Med., 1975, 115, 385-392
Digital Plethysmographic Responses to Auditory
Stimuli in Patients with Vibration Disease1
TSUNETAKA MATOBA,* HISAO KUSUMOTO, HOZUMA OMURA,
TATAYU KOTORII, HIROSHI KUWAHARA and MAKOTO
TAKAMATSU•õ
Laboratory of Clinical Physiology, Yufuin Kosei Nenkin Hospital, Yufuin, Oita 879-51 and Department of Environmental Hygiene,f
Kurume University School of Medicine, Kurume 830
MATOBA, T., KUSUMOTO, H., OMURA, H., KOTORII, T., KUWAHARA, H. and TAKA.MATSU, M. Digital Plethysmographic Responses to Auditory Stimuli in Patients with Vibration Disease. Tohoku J. exp. Med., 1975, 115 (4), 385-392 Digital plethysmographic responses to auditory stimuli in 15 healthy men and 82
patients with vibration disease were analyzed in order to clarify the functional conditions of autonomic nervous system in this disease. The auditory stimuli
given to healthy men caused a rapid decrease in the amplitude of the plethysmograms. After cessation of the auditory stimuli the decreased amplitude recovered to the control value within 30 sec. In the patients with vibration disease, however, the recovery of the decreased amplitude was delayed. The
plethysmographic changes in the patients with vibration disease were divided into 4 types: normal (N), intermediate (I), delayed (D) and poor response (P) types. Each type of I, D and P was altered to type N by treatments consisting of therapeutic exercises, hot spring cures and so on. All healthy men showed type N. There were no significant differences between the time courses of the recovery of the plethysmographic changes and the amplitudes of the plethysmograms before the auditory stimuli. The results obtained seem to indicate that the autonomic nervous system in the patient with vibration disease is in disorder, and that the digital plethysmography with auditory stimuli is instrumental to detect the functional changes in the autonomic nervous system. plethysmogram; auditory stimuli; vibration disease; activity of autonomic nervous system
A digital plethysmography has been reported to be able to detect the condition of the sympathetic activity in man (Ackner 1956). Several investigators have described that the auditory stimuli given to a human body stimulate the hypothalamus and the limbic lobe of cortex in the brain (Kluge and Friedel 1933; Lehman 1957; Sakamoto 1957). The higher centers of autonomic nervous system are situated in the hypothalamus and the limbic lobe of the cerebral cortex (Green 1972).
Received for publication, December 2, 1974.1 Presented at Japan-USSR Seminar for Vibration Disease, Yufuin, Oita, September
29-30, 1974.* Present address: Department of Medicine, Kurume University School of Medicine,
Kurume 830.
385
386 T. Matoba et al.
Vibration disease induced by the mechanical vibration has been reported to impair not only the functions of the peripheral nervous system and circulatory system and mobility in the upper extremities, but also the function of the central nervous system (Matoba et al. 1974). The main causes of this disease are presumably noises and vibrations generated by a vibrating tool and coldness in the environment. The noises, vibrations and coldness would be regarded as the so-called stressors against a human body. Therefore, it is of interest to know the changes in the function of the autonomic nervous system in the patients with vibration disease.
The purpose of the present paper is to clarify the function of the autonomic nervous system in patients with vibration disease as expressed by a digital plethysmo
graphy in response to the auditory stimuli.
SUBJECTS AND METHODS
Fifteen healthy men with averaged age of 43.8•}3.1 were selected from 37 of the members
of Japanese Self-Defense Force after the examination of blood pressure in order to exclude
those with hypertension and after the test of Cornell Medical Index for the purpose of
screening of the body condition. Their blood pressures were 123.9•}12.5 mmHg in systole
and 74.9•}8.8 mmHg in diastole. Eighty two male patients with vibration disease had
been engaged in forestry as chain-saw operators. Their averaged age was 48.6•}7.3. The
mean blood pressures were 129.3•}12.5 mmHg in systole and 77.5•}10.5 mmHg in diastole.
The severity of the disease was the third degree according to Andreeva-Galanina's criteria
(Mei.mxa 1973).
The digital plethysmograms and their responses to auditory stimuli were recorded
by means of a plethysmograph (Takachiho Instrument. Co., PG-102) in a sound-proof room.
Noises given as auditory stimuli were those recorded from a chain-saw and given by a head
phone for 10 sec. The intensity of noises was 98 to 102dB.
The drugs used were tolazoline hydrochloride (Yamanouchi Pharm. Co.), one of
the imidazoline derivatives with alpha-adrenergic blocking properties (Carriet 1972), and
sulpiride (Fujisawa Pharm. Co.) which has an inhibitory action against hypothalamus
(Fukuda and Takaori 1969). The chemical structure of sulpiride is shown below.
All observations were performed at room temperature (22-24•Ž).
RESULTS
Digital plethysmographic responses to the auditory stimuli in healthy men and patients
with vibration disease
Observations were made on the changes of digital plethysmograms induced
Digital Plethysmographic Responses to Auditory Stimuli 387
by auditory stimuli. A typical pattern of the digital plethysmographic response was shown in Fig. 1.
In healthy men the auditory stimuli caused a prompt and marked decrease in amplitude of the plethysmograms. After cessation of the auditory stimuli, the amplitude tended to recover toward the control level within 30 sec (Fig. 1-A). In the patients with vibration disease, on the contrary, there were poor responses to the auditory stimuli (Fig. 1-B). The recovery of the amplitudes was also incomplete, less than 80% of the control value even at 60 sec.
Fig. 2 shows the analysis of the digital plethysmograms taken from 15 healthy men and 82 patients with vibration disease. In the patients with vibration disease the recovery of the amplitude of the plethysmogram once reduced by the auditory stimuli was retarded as compared with that of the healthy subjects. The time course of the recovery varied considerably from patient to patient.
Fig. 1. A typical patten of the digital plethysmogram responded to auditory stimuli in a healthy man and a patient with vibration disease. In a healthy
man, there is a good response to the auditory stimuli and the excellent recovery of the reduced amplitudes (A). On the other hand, the response and the recovery are poor in a patient with vibration disease (B). Arrow marks indicate the auditory stimuli for 10 sec.
Fig. 2. A diagram of digital plethysmograms taken from 15 of the healthy
men and 82 of the patients with vibration disease. •ü, healthy men (n=15); •œ
, vibration disease (n=82).
388 T. Matoba et al.
Classification of the digital plethysmographic responses to the auditory stimuli in the
patients with vibration disease
The patterns of plethysmographic responses obtained in 82 patients with
vibration disease could be divided into 4 types as shown in Fig. 3: normal (N),
intermediate (‡T), delayed (D) and poor response (P) types. The number of the
subjects was 24, 17, 26 and 15 in the types of N, ‡T, D and P, respectively. These
types were classified on the basis of the following criteria: In type N, the reduced
amplitude elicited by the auditory stimuli recovered to the control value within 30
sec. In type ‡T, the reduced amplitude was recovered more than 80% of the control
value at 60 sec. In type D, it was less than 80% of the control value at 60 sec. In
type P, the response to the auditory stimuli was poor; the reduction of amplitude
Fig. 3. Typical four types of the digital plethysmographic responses to
auditory stimuli in patients with vibration disease. The types of normal
(N), intermediate (‡T), delayed (D) and poor response (P) are shown in A,
B, C and D, respectively. The reduced amplitude due to auditory stimuli
recovers promptly to the control value in N type (A). In type ‡T, the
reduced amplitude is recovered more than 80% of the control value in 60
sec (B). In type D, it is less than 80% (C). In type P, the response to
auditory stimuli is poor (D).
Fig. 4. A diagram of 4 types of the digital plethysmograms in the patients
with vibration disease. •ü, N type (n=24); •œ, P type (n=15); •¢,‡T type
(n=17); •£, D type (n=26).
Digital Plethysmographic Responses to Auditory Stimuli 389
TABLE 1. Changes of the digital plethysmographic types by the treatments
was less than 30% of the control value . The time courses of responses of four types were illustrated in Fig. 4.
Fifteen healthy subjects revealed type N response in the plethysmograms .Each type in the patients with vibration disease was shifted to the other
types by the treatments, consisting of therapeutic exercises, hot spring cures and drugs of vasodilators. These data were summarized in Table 1. Namely, type I altered to type N. Type D altered to type I or N. Type P changed to type I or N.
Mechanism of the digital plethysmographic responses to the auditory stimuli in the
patient with vibration disease
The experiments were designed to find out the principal cause of the altered response to the auditory stimuli and the delayed recovery of the plethysmogram with a particular interest in knowing its central or peripheral origin.
Fig. 5. A digital plethysmographic response to auditory stimuli in the patient with type D under the influence of alpha blockade. The auditory stimuli decrease the amplitude (1). The intramuscular injection of tolazoline hydrochloride, 20 mg, results in poor responses to auditory stimuli (2 to 4). The phenomena at 15, 40 and 50 min after the administration are shown in the figures of 2, 3 and 4, respectively.
390 T. Matoba et al.
Fig. 6. A digital plethysmogram in the patient with type D under the influence of sulpiride. The good responses to the auditory stimuli are observed (1 to 4). The reduced amplitudes elicited by auditory stimuli can not recover to the control value within 60 sec (1). Sulpiride leads to become faster recovery in amplitudes after cessation of the auditory stimuli (2 to 4). The digital
plethysmograms at 15, 40 and 50 min after the administration are shown in the figures of 2, 3 and 4, respectively.
A patient with type D was intramuscularly administered with 20 mg of tolazoline
hydrochloride. After 50 min, the responses to the auditory stimuli became poor
without changes in the time course of the recovery (Fig. 5). This indicates that
tolazoline blocks alpha-adrenergic receptors of the blood vessels in the fingers,
and that the responses to the auditory stimuli are manifested after the transmission
of autonomic nerve impulses to the blood vessels in the fingers.
Intramuscular injection of 50 mg sulpiride, given to the same patient, caused
no changes in plethysmographic responses to the auditory stimuli as compared with
those of control even after 50 min as shown in Fig. 6. The recovery of the
reduced amplitudes, however, tended to become faster. The time course of the
recovery became similar to that of type N. This finding clearly suggests that
the time course of the recovery after cessation of the auditory stimuli shows the
continuity of vasoconstriction of small arteries. In other words, it represents the
functional condition of the autonomic nervous center. The condition of the
autonomic activity in type D seems to be hyperreactive.
Without tolazoline or sulpiride, there were no significant changes of patterns
in the digital plethysmograms responded to the auditory stimuli within at least 60
min.
Relationship between the amplitude of the digital plethysmogram before the auditory
stimuli and the digital plethysmographic response. to the auditory stimuli
The mean amplitudes of the plethysmograms before the auditory stimuli in
15 healthy men and 82 patients with vibration disease were 4.5•}0.9 and 3.8•}1.3
mV/V, respectively, the difference being statistically significant (p<0 .05). The 82
patients were divided into three groups by the degree of amplitudes before auditory
stimuli. Forty eight patients were included in group B, having the amplitudes
Digital Plethysmographic Responses to Auditory Stimuli 391
Fig. 7. Correlation between the amplitudes before the auditory stimuli and
the patterns responded to the auditory stimuli . The subjects with mean
•} s.D. of the amplitude are included in group B . The patterns responded
to the auditory stimuli are indicated to be almost the same in each group.
•ü, A (h•…2.4 mV/V) (n=16);•¢ B (2.4<h<5.1 mV/V) (n=48); •œ, C (h•†5.1
mV/V) (n=8).
from 2.4 to 5.1 mV/V. Group A with amplitudes of less than 2.4 mV/V and group
C with more than 5.1 mV/V had 16 and 8 patients, respectively. As shown in
Fig. 7, there were no significant differences among those three groups. The mean
amplitudes of the plethysmograms in types N, I, D and P were 4.1•}1.5, 3.7±1.0,
3.9•}1.2 and 3.4±1.0 mV/V, respectively. There were no significant differences
among them.
DISCUSSION
Small arteries in the fingers are innervated with autonomic nerve fivers. The sympathetic vasoconstrictor nerves apparently exert their action on smooth muscle fibers with so-called alpha-receptor sites (Rushmer 1970). The degree of vasoconstrictions is directly proportional to the quantity of the nerve impulse of sympathetic nervous system (Yamagishi 1974).
Noises given as auditory stimuli, on the other hand, is known to produce the excitation of the limbic system in the brain (Kluge and Friedel 1933; Lehman 1957; Sakamoto 1957).
As demonstrated in the present study, the digital plethysmographic responses to the auditory stimuli and the time courses of the recovery of the response in patients with vibration disease are different from those in healthy subjects. The reduction of amplitudes induced by auditory stimuli manifests the transmission of autonomic nerve impulses to the blood vessels, and the time course of the recovery of the response shows the continuity of vasoconstriction of arteries. These digital plethysmographic patterns are divided into 4 types. Each type has been shifted from one type to another by the treatments. One of the treatments has been therapeutic exercises. A proper amount of physical exercises results in vagotony. Thus, these types would represent the level of the activity of autonomic nervous system. Namely, types I and D may be of hyperreactive, and type P of hyporeactive. In fact, a patient with vibration
392 T. Matoba et al.
disease complains of the disturbance of sound sleep, forgetfulness, the abnormal increase of palmar sweating, the disturbance of circulation and so on (Matoba et al. 1974).
It is concluded that the patients with vibration disease are associated with the disorder of autonomic nervous system. It would be also accepted that the digital
plethysmography combined with auditory stimuli is one of the excellent indicators of the level of the activity of autonomic nervous system.
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