Acta medica Academiae Scientiarum Hungaricae最新文献

Regulation of limb circulation was studied by the use of the venous isotope dilution technique in 35 patients with leg varicosities. The circulatory parameters of 54 patients with normal limb circulation served as control. The various types of varicosity revealed characteristic circulatory patterns. (i) In the cases of congenital, "juvenile", varicosity limb blood flow is high, the limb AV-O2 difference is very slight and limb O2 uptake is normal. (ii) In secondary varicosity consecutive to thrombophlebitis the limb (total) blood flow is slightly reduced, the limb AV-O2 difference is smaller than normal and O2 uptake by the extremital tissues is diminished. (iii) In non-congenital, primary varicosity, i.e. in the most common form, limb blood flow is normal, the limb vascular resistance is slightly increased. The possibilities of the production of an AV shunt and the clinical implications of the circulatory changes accompanying the various types of varicosity are discussed.

In diabetic patients with poor metabolic control (Group I) and with repeated hypoglycaemic crises (Group II) the serum concentration of cholesterol, triglyceride, of LDL, VLDL and HDL-cholesterol, as well of VLDL and LDL + HDL-triglyceride were measured before and after metabolic control and before and after control of the hypoglycaemic crises. Parallel with the control of diabetic metabolism in Group I, achieved in 15 +/- 6 days, a significant increase in HDL-cholesterol concentration was demonstrable, together with a decrease in the mean value of blood glucose and of daily urinary glucose excretion. In the diabetic patients of Group I, the LDL-cholesterol, serum triglyceride and VLDL-triglyceride levels were significantly higher, the HDL cholesterol levels significantly lower before as well as after metabolic correction, than in the control group. In Group II the serum lipid and lipoprotein lipid concentrations remained unaffected by the control of the hypoglycaemic crises. The results indicate that lipid metabolism in diabetes may considerably be affected by insulin deficiency, but it will respond to an intensified insulin effect. An increase in the concentration of the antiatherogenic HDL-cholesterol is an essential factor of the improvement.

The effects of the natural gonadotropin releasing hormone (LH-RH) and of a long-acting analogue, desgly10-D-leu6-LH-RH ethylamide, on the serum FSH, LH, testosterone and oestradiol-17 beta levels were studied in healthy men. The basal value for FSH was 3.58 +/- 0.47 mU/ml (SE), for LH 6.33 +/- 1.19 mU/ml. Following an intravenous dose of LH-RH the values increased by 3.40 +/- 0.88 and 25.99 +/- 5.67 mU/ml, respectively. After intravenous administration of the long-acting analogue, the peak FSH exceeded the basal value by 12.89 +/- 6.95 mU/ml, while LH increased by 41.27 +/- 4.72 mU/ml. The effect of the analogue on FSH and LH lasted 693 min and 862 min, respectively. Neither preparation changed the serum testosterone or oestradiol-17 beta levels essentially. The results suggest that the long-acting variant of LH-RH is more suitable than the natural hormone for examination of the FSH and LH reserves in men.

A case of isolated granulomatous gastritis observed in a 66-year-old female patient is reported. The gastric granulomatosis gave rise to pyloric stenosis, and at the first explorative laparotomy the change was misdiagnosed for an inoperable tumour. Gastroscopy then revealed the presence of a peptic ulcer, which healed completely on drug therapy. At the second surgical intervention undertaken on account of a relapse after 2 years, Billroth II type resection of the stomach led to complete recovery; the patient has been free from complaints ever since. It is suggested that in addition to peptic ulcer and tumour, isolated gastric granulomatosis should be taken into consideration as the underlying mechanism of pyloric stenosis.

The sera of 211 patients with histological evidence of chronic diffuse liver disease were studied for antibody to hepatitis-B virus core antigen (anti-HBc), hepatitis-B virus surface antigen (HBsAg) and antibody to the latter antigen (anti-HBs) by radioimmunoassay, using Abbott-RIA kits. The frequency of anti-HBc-positivity was found to be six times as high as HBsAg-positivity and twice as high as anti-HBs-positivity. In 20 of the patients with chronic liver disease the anti-HBc-positivity was the only indicator of past infection with HB-virus. The detection-rate of HB-viral infection provided by the highly sensitive radioimmunoassays was 59 per cent in liver cirrhosis of 45 per cent in chronic hepatitis, 26 per cent in fatty degeneration of the liver. Anti-HBc having been found to be the most sensitive indicator of HB-viral infection, the importance of its assay is therefore emphasized.

Antibody-positivity to thyroid specific antigens (Htg, microsomal) and/or lymphocytic infiltration of the gland's parenchyma were observed in 207 (55%) of 377 patients with Graves's disease. Only in 48 (12.7%) of the cases were the findings in agreement with the criteria of chronic lymphocytic thyroiditis. Human thyroid stimulating antibody (HTSab) was detected in 135 (65%) of these 207 patients. In cases of Graves' disease associated with chronic lymphocytic thyroiditis, this proportion was found to be as high as 89.6% and attained even 100% in cases of Hashitoxicosis (39 patients). The presence of HTSab thus seems to form one of the features of patients with Hashitoxicosis. Infiltrative ophthalmopathy also showed a remarkably high incidence (59%) in this porcess. The typical prevalence of Graves' disease in females in the present material attained a 15:1 female-to-male ratio when the disease was associated with chronic lymphocytic thyroiditis. The results of the present study suggest that chronic lymphocytic thyroiditis associated with Graves' disease promotes the formation of thyroid stimulating antibodies.

Six patients subjected to jejuno-ileal bypass surgery for obesity were studied for vitamin B12 absorption by the use of the Schilling test, together with measurement of the serum B12 level preoperatively and at 2, 6, 12, 18 and 24 months after the operation. During the follow-up period of 2 years, the serum vitamin B12 level gradually declined to abnormally low values. A postoperative fall of the originally normal vitamin B12 absorption to abnormal values was found. Oral administration of tetracycline resulted in a transitory improvement of the results by the Schilling test, but after its discontinuation serve vitamin-B12 malabsorption was again demonstrable. The importance of parenteral vitamin B12 administration after jejuno-ileal bypass surgery is emphasized.

A review of the clinical features, laboratory findings and course in 50 cases of IgA glomerulonephritis confirmed by biopsy is presented. The onset and clinical course of the process was oligosymptomatic in the majority of the cases with a predominance of microhematuria and persistent proteinuria. By the end of the observation period more than 50 per cent of the patients became hypertensive and in 16 cases serum creatinine levels attained 132 mumol/l (1.5 mg per 100 ml) or more. Proteinuria in excess of 1 g/24h, hypertension and an impaired concentration capacity at the onset heralded early progression.

The pathomechanism of arrhythmias consecutive to a prolonged electrical systole --the long QT syndrome--was studied by local hypothermia in the heart. Local increase in the QT-interval (long QT with unhomogeneous repolarisation) was induced at a circumscribed area of the right ventricle by perfusion of the mid- and end-sections of the right coronary with cooled blood. The effect of local prolongation of QT on the arrhythmic susceptibility of the heart was studied by means of programmed electrical stimulation. Induced local hypothermia of the heart was found to increase the QT-interval of the ECG-tracings, also if QT had been corrected for heart rate. The local ECG tracings showed a considerable increase of the QT-interval at the selected right ventricular area under the effect of induced hypothermia but in relation to QT (ERP/QT) it diminished. The long QT in association with an unhomogeneous repolarization went hand in hand with an increased irritability of the heart. Early ventricular impulses were found to elicit extrasystolic runs, ventricular tachycardia or ventricular fibrillation. The results indicate that the cause of tachyarrhythmias consecutive to the long QT-syndrome may be ascribed to the inhomogeneity of repolarization on the one hand, and to the shortness of ERP in relation to the QT-duration on the other.