Zeitschrift fur die gesamte innere Medizin und ihre Grenzgebiete最新文献

A review of 1097 consecutive coronary angiograms performed for evaluation of angina pectoris or valvular dysfunctions showed 3 patients with arteriovenous fistulas (0.25%), 6 patients with malpositions (0.55%), 29 patients with aneurysms (2.65%) and 59 patients with myocardial bridging (5.4%). The clinical significance of coronary artery anomalies as variation or malformation was evaluated. A malformation has been found in Bland-White-Garland syndrome, arteriovenous fistulas, congenital coronary stenosis and atresia. In case of clinical symptoms surgical correction should be considered. There is a controversy on the clinical significance of muscular bridging. Further clinical investigations are needed for a better understanding of coronary artery anomalies.

As in all forms of food, contaminants can also be present in meat. Because of the growing awareness of ecological and health issue, more tests with sophisticated equipment are now being implemented, thus reducing the risk of consuming contaminated meat. Meat has become the most heavily inspected form of food. In contrast to vegetable matter, animals can discharge many contaminants. Meat, with the exception of the liver and kidneys, is therefore less likely to be contaminated than vegetables. Facts show that meat is a highly nutritious food which, if consumed moderately, can contribute to our well-being. Meat contains the right combination of amino acids for protein synthesis in the human body, and especially it contains plenty of essential amino acids. Above all, meat contains many vitamins, trace elements, and iron. Large amounts of these substances are particularly necessary for growing children and people who are doing hard physical work. A reduction of meat consumption is only necessary in the case of a few illnesses. Some other illnesses actually require an increase in protein, and thus an increase in meat in the diet.

Many patients suffer from symptoms related to pathomorphologically healthy organs. Typical symptom patterns may be defined as functional disease entities. No demonstrable pathomorphologic alterations mean normal clinical findings, normal results of laboratory tests and function studies, absence of abnormal findings in imaging techniques, and normal results of cytologic or histologic investigations. Symptom patterns of functional diseases are usually impressive and clear, allowing a primary diagnosis, which of cause must be verified by excluding possible differential diagnoses. Early diagnosis has a heavy impact on later course and prognosis. From a certain point of chronicity, functional diseases become more or less refractory to therapy. Neglection of the correct diagnosis may therefore promote chronic disease. The main reason for a misleading diagnosis is the unreadiness of physicians and patients to accept and to face the functional, non-organic nature of symptoms. The main etiologic factor is psychosocial stress in most cases. Treatment is based on four different approaches, which may well be combined with each other: oral communication to clarify and to explain the nature of the disease, changing the all day way of life, supporting drug therapy, and specific psychosomatic treatment.

We studied 259 patients (m: 204, f: 55) admitted to our observation ward after drinking alcohol with blood levels above 3.9 g/l. Epidemiological data, clinical and laboratory data and therapeutic procedures were registered. Our analysis showed that such high blood levels of ethanol were only tolerated by a definite age-group of chronic alcoholics with mild organic injuries. Elevated mean cell volume and gamma-glutamyl transpeptidase and additionally low BUN may be useful markers for chronic alcohol consumption.

Patients comparable in disease, therapy and serum bilirubin concentration were either treated with mezlocillin intravenously or not at all. The bile of each patient was collected either from a T-drainage or from a percutaneously placed drainage into the bile ducts. The concentrations of GGT and AP, which were liberated by destroyed liver cells, and of bilirubin and mezlocillin, which were secreted actively, were analysed. Those patients who had normal serum bilirubin concentrations had a significantly higher biliary bilirubin excretion than those with high serum bilirubin level. The maximum excretion was after 4 hours. While the biliary concentration of bilirubin decreased, the concentration of secreted mezlocillin increased. Due to destroyed liver cells those patients with pathologically elevated blood bilirubin levels had a 50-fold lower mezlocillin excretion than those with normal blood values.

A 17-year old girl presented with recurrent seizures, strokes, fatigue, vomiting, cerebellar ataxia, dementia and hypertrichosis. Further examinations showed jerking left-sided arm reflexes, partial internal deafness and myopathy. CT and MR of the skull revealed radiolucencies within the cerebral matter of the cortex and the medulla. Laboratory tests showed increased levels of lactate and pyruvate in serum and cerebro-spinal fluid. Microscopic examination of muscular tissue showed "ragged red fibers". Electron microscopy yielded crystal inclusions in mitochondria. The symptoms represented the complete picture of the so-called MELAS/MERRF-complex, which can be easily misdiagnosed as strokes and seizures of unknown cause.

An attempt is made to estimate the value of intraventricular injection of contrast media in the procedure of angiocardiography for registration of a latent disease of the myocardium. For this purpose the parameter of the cardial function of 350 patients are analysed depending on the severity of the coronary heart disease. Under resting conditions the left ventricular end-diastolic pressure (LVEDP) of patients with coronary heart disease was 19.9 +/- 7.98 mmHg. The LVEDP of patients with the angina pectoris syndrome but normal epicardial coronary arteries was 15.6 +/- 5.45 mmHg. The LVEDP of the most of the patients rose after injecting contrast medium in the left ventricle independent of the resting level. Patients with coronary heart disease had a LVEDP of 23.7 +/- 9.48 mmHg after injecting the contrast media, while patients with normal coronary arteries had a LVEDP of 19.2 +/- 7.21 mmHg. The left ventricular systolic pressure and the parameters of contractility did not change significantly after injecting contrast media. The injection of contrast medium into the left ventricle--i.e. the ventriculography--is in a qualified sense a volume stress to the left ventricle. That means an increase of a normal LVEDP after an injection of contrast medium uncovers a preclinical disease of the left ventricular myocardium.

The quality of diabetes care in the former GDR 1989/90 and in former West Germany 1990/91 was compared in a case control study. The study group consisted of 83% of the diabetic patients registered in the local diabetes care unit in Jena who were on insulin. The patients (86 women, 104 men; 131 Type-I and 59 Type-II, aged 16-60 years) were in the care of the local diabetes care unit. The control group consisted of randomly selected diabetic patients of the outpatient department of the university of Düsseldorf (matched pairs). Despite a different strategy of therapy the HbA1c (Jena/Düsseldorf) was the same: 154%/153% of the mean normal value in type-I and 178%/175% in type-II. The prevalence of retinopathy in type-I and type-II and proteinuria in type-I was not different, whereas the prevalence of proteinuria in type II- and of hypertension in both types of diabetes was higher in Jena.