Acta medica Academiae Scientiarum Hungaricae最新文献

In the period 1968 to 1973, 177 patients were vagotomized. Endoscopy had to be performed because of definite symptoms in 37 of these patients on 56 occasions between 1971 and 1979. Vagotomy had been selective in 22, truncal in 15 cases. The intervention, regardless of its type, had failed to give the expected benefit in 21% of the patients, a proportion not inferior to the postresection figures. On the other hand, in 12% it was a recurrence of the ulcer which accounted for the symptoms. This is greatly in excess of the recurrences recorded after gastric resection either of the Billroth I or the Billroth II type. This has been attributed to inadequate technique, unsuitable indication or inappropriate selection of the type of surgery.

The ultrastructure of the streak gonad was studied in 12 cases. Under the electron microscope the streak gonad displays fibroblasts, collagen fibres with the usual periodicity of 64-65 nm, and capillaries. The ultrastructure of the fibrous tissue of the streaks was similar in each patient regardless of the associated chromosome complements, and indistinguishable from that of polycystic and normal ovaries. The finding might suggest that the fibrosis in the streak gonad might be the result and not the cause of the early degeneration of the gonad.

The mechanism and electrophysiologic manifestations of concealed re-entry were studied in human electrocardiograms and intracardiac recordings. Previously described patterns of concealed re-entry were documented in 49 patients. In seven cases concealed re-entry was involved in the genesis of Wenckebach periodicity and alternating Wenckebach periodicity in the AV node, and "reversed" Wenckebach periods in the His-Purkinje system. These manifestations of concealed re-entry were not described so far. In five cases re-entry was apparently concealed. Complete (but hidden) circus movement of the supraventricular impulses in these patients were detected by intracardiac recordings and by analysing the effects of echo beats on timing of the subsequent sinus beats. Concealed re-entry of the cardiac impulse is a well-documented electrophysiologic event which explains many common and peculiar manifestations of impulse formation and impulse conduction in the human heart.

The interpretation of post-extrasystolic parameters and their significance is discussed. Programmed extrastimulation according to Strauss was carried out in 49 cases, before and after atropine and propranolol administration. The result was a computable sinoauricular conduction time (SACT), a chaotic picture, or an ascending line without plateau. The patients were selected on basis of their intrinsic heart rates (IHR). If the total SACT exceeded 250 ms, the chaotic post-extrasystolic picture and the ascending 1st phase without plateau were considered pathologic, then after drug testing the ratio of pathologic parameters decreased from 54 to 22% in cases with normal IHR. Including cases with pathologic IHR the ratio increased from 55 to 90%, especially in asynchronous chaotic pictures. After drug testing the chaotic forms were always replaced by a plateau in cases with normal IHR, but in pathologic ones the chaotic picture appeared to be a dominant electrophysiological parameter. It follows that the autonomous nervous system has its part in the development of chaotic post-extrasystolic pictures. A plateau in the post-extrasystolic curve could mean a functional organization and synchronism rather than a conduction disturbance; to the latter a high-level plateau would correspond.

The proportion of T-lymphocytes and monocytes was estimated by the alpha-naphthyl-acetate-esterase-(ANAE)-reaction in blood smears of patients with systemic lupus erythematosus and normal controls. A parallel and significant reduction in the number of T-lymphocytes identified on the basis of both the ANAE and the E-rosette test was found in SLE. In the active periods of SLE more T-cells were identified by the enzyme histochemical study than by the E-rosette test, which points to a functional damage to the T-cells. A marked reduction in the number of the cells considered to be of the suppressor type was demonstrable by both methods in the active period. A distinct reduction in the number of monocytes was also demonstrable by ANAE in the patients with SLE, which may be one of the manifestations of deficient immunoregulation in this disease.

Healthy subjects aged 70-90 and 20-40 years were investigated for the level of reverse triiodothyronine (rT3). The mean level in 57 old subjects was higher and the triiodothyronine (T3) level lower than in 30 young persons. No negative correlation was observed. A serum T3 elevation caused by liothyronine administration (5-15 micrograms/day for two weeks) was not followed by a change of the mean rT3 level in 12 old subjects. After a single intramuscular thyrotropin (TSH) injection, the rT3 elevation lasted 24h longer in 19 old persons than in the 9 control ones, though the early rT3 response was similar in both groups. Propranolol administration (40 mg t.i.d. for a week) caused a similar rT3 elevation in old persons (n = 18) as in 12 young ones. From the indirect data it is concluded that the serum rT3 elevation in old age is a result of faster peripheral generation and not of increased production in the thyroid gland. The data do not indicate any change of rT3 metabolism. T4-T3 and T4-rT3 conversion are provoked by different enzymes. The elevation of rT3 might be a cause of the observed decrease in peripheral T3 generation in old subjects, acting by an inhibition of the T4-T3 conversion.