Acta medica Iugoslavica最新文献

The total hepatic blood flow measured with radioactive colloidal gold and the portal blood flow with the echo-Doppler method were investigated in 19 healthy examinees and 63 patients with chronic diffuse liver diseases. In the group of healthy examinees, the average values of the total hepatic blood flow was 1254 +/- 231 ml/min and of the portal one 1104 +/- 227 ml/min. The lowest blood flow values were obtained in patients with decompensated cirrhosis, especially in the hepatic (704 +/- 186 ml/min) and the portal blood flow (562 +/- 198 ml/min). In all the groups of examinees, registered values of the total hepatic blood flow were significantly higher than the values of the portal blood flow. The relations of the values obtained by both methods, among groups, were similar. By both methods decreased values are not obtained in liver steatosis and chronic persistent hepatitis in relation to the normal values. In patients with more serious forms of chronic diffuse liver diseases (cirrhosis and chronic active hepatitis) significantly lower blood flow values than the normal ones were obtained. Both methods contribute to the investigation of liver circulation disturbances, liver function damages, and to the follow-up of the liver disease course. The possibility of an indirect evaluation of the arterial hepatic blood flow from the difference of hepatic and portal blood flows may mean a new approach to the investigation of pathophysiological liver occurrences.

To estimate the influence of the pulmonary (Qp) and systemic (Qs) blood flow on the size of the orifices of the pulmonary trunk (PT) and aorta (AO), the early systolic diameters of the orifices of both great vessels were measured from the cineangiocardiograms in 33 children with ventricular septal defect (VSD), 30 with atrial septal defect of the secundum type (ASD), 24 with patent ductus arteriosus (PDA), and 29 with tetralogy of Fallot (TF). They were compared to 35 normal children (N). An excellent linear correlation between the ratio of squared diameters of PT and AO orifices (PT2/AO2) and Qp/Qs was found in patients with ASD (r = 0.80, P less than 0.001), good in VSD group (r = 0.57, P less than 0.001), weak in TF (r = 0.36, P less than 0.028) and no correlation in the PDA group. PT2/AO2 was significantly greater in ASD (2.38:1 +/- 0.56) and VSD (1.76:1 +/- 0.44), and smaller in TF (0.20:1 +/- 0.10) (P less than 0.005). There were no significant differences between PDA (1.33:1 +/- 0.25) and N group (1.22:1 +/- 0.17) (P greater than 0.05). The size of PT2 per 100 cm of body height was increased in ASD, VSD and PDA, and decreased in TF (P less than 0.005). The corresponding value for AO2 was increased in PDA and TF (P less than 0.005).

A case of a rare anomaly of the human karyotype--ring chromosome 21--is presented. By analysing the prenatal amniotic fluid of a 38-year-old woman asking genetic advice, primarily because of a cystic fibrosis burdening her first pregnancy, the authors discovered this chromosomal anomaly and made the karyotype of both parents which showed that mother was a carrier of the same anomaly as observed in her unborn child. The karyotyping of her second 7-year-old child also revealed ring chromosome 21, identical with that in its mother and unborn sister.

The prevalence of some diseases was studied in 238 android and 720 gynoid obese women and 180 android obese men with the aim to establish the relationship between the type of obesity and relevant diseases. In the selected group of obese patients (25 android and 90 gynoid obese women and 26 android obese men) fed on a reducing diet (1000 kcal--4.2 M.J.) 67 women were engaged in intensified physical activity during the 90 days of dieting. The relationship between the weight loss and the type of obesity as well as the relationship between the weight loss in women engaged in intensified physical activity and those abstaining from it was investigated. The investigation has shown that the prevalence of hypertension, coronary heart disease and diabetes was much higher in men and women affected by the android type of obesity than in women affected by the gynoid type of obesity. The prevalence of gallbladder's as well as venous system diseases and spondylosis in women affected by both types of obesity was much higher than in android obese men, but the prevalence of constipation was higher in gynoid obese women. From data relating to response to reducing diet it is concluded that the weight loss was equal among the women affected by the android and gynoid types of obesity, but the weight loss in android and gynoid obese women engaged in intensified physical activity was significantly higher than in those abstaining from it.2+herefore, for the prevention and

A 40-year-old man who developed acute myelomonoblastic leukemia (M4) after 7 years of treatment for multiple myeloma with the alkylating agent melphalan and steroids is presented. Leukemia was treated with courses of adriblastin, cytosine arabinoside, and thioguanin (DAT protocol), with a 8 months' survival.

In the group of 85 patients with coronary artery disease the exercise and 24-hour ambulatory electrocardiograms were recorded in order to analyse the frequency of asymptomatic episodes of myocardial ischemia and to determine differences between symptomatic and asymptomatic episodes of myocardial ischemia. All patients had ischemic ST-segment depression (greater than or equal to 1 mm) on the exercise electrocardiogram. During exercise testing, 23 (27%) patients had ST-segment depression without anginal pain or dyspnea. On the 24-hour ambulatory electrocardiogram transient episodes of myocardial ischemia were found in 50 (58.8%) patients. In 16 patients all episodes were asymptomatic, in 9 all episodes were symptomatic, and in 25 patients some episodes were symptomatic and some asymptomatic. During a 24-hour electrocardiogram in 25 patients with both types of ischemia, 175 transient episodes of myocardial ischemia were recorded. Most of them (125, i.e. 71.4%) were asymptomatic. The heart rate in symptomatic and asymptomatic episodes was similar. The magnitude of ST-segment depression in symptomatic episodes was higher than in asymptomatic episodes (P less than 0.01). There was not significant difference in the duration of the two types of myocardial ischemia. This study suggests: 1. During daily activities, in patients with the positive exercise test, asymptomatic episodes of myocardial ischemia are more frequent than symptomatic episodes. 2. The magnitude of ST-segment depression is the main factor in the determination of the presence of anginal pain.

Considering schizophrenia as the result of the deficiency of ego functions and existing conflicts, the author proposes a psychotherapeutic method based on a constructed integral psychotherapeutic model which departs from the classical or orthodox psychoanalytical approach but unites the principle of the structuring and the principle of the analysis of the conflicts at hand. By the use of this psychotherapeutic method, in a sample of 20 schizophrenics, he achieved better and quicker therapeutic results regarding the increased ego capacity, fuller remissions, and significantly more successful functioning in reality than in the control group of the same size treated with neuroleptics alone. In this integral psychotherapeutic method the author sees possibilities for a scientific investigation of mechanisms and regularities in schizophrenic processes and phenomena and emphasizes the need for its development.

The authors present 2 patients with cirrhosis of the liver associated with alpha-1-antitrypsin deficiency. The patients are two children (brother and sister aged 4 and 13). The manifestation of the disease in these two children was a prolonged neonatal icterus. The symptoms of a decompensated cirrhosis of the liver appeared at the age of 2 and 4 years. There were several attacks of obstructive bronchitis etiologically associated with the same cause. The boy died at the age of four of hepatic coma preceded by several bleedings from esophageal varices. Splenectomy was performed in the girl on account of distinct signs of hyperplenism and two and a half years later mesentericocaval shunt because of the extensive bleeding from esophageal varices and the fundus of the stomach. The diagnosis of alpha-1-antitrypsin deficiency was made on the basis of low values in the serum and on the basis of liver biopsö and findings of typical PAS positive inclusions in the endoplasmic reticulum of hepatocytes. The values of A1A parents are also lower. The finding of Pi phenotypification is significant--the SZ phenotype was found in two patients (brother and sister), which is seldom described in patients with cirrhosis of the liver.

The ego of a psychosomatic patient enters the relations with the external world in a very archaic way. In new traumatic situations such a personality structure possesses a very poor repertoire of adaptation mechanisms. Owing to the lack of intrapsychic elaboration of the trauma, the conflict is solved in an "interpersonal" way. The authors emphasize the importance of interpersonal conflict as an actual necessity of maintaining the connection with reality. Such a response in the development corresponds to the fixation or regression to the conflict with the object from the subphase of practising. Unpleasure, because of the early forbidding of pleasurable activities by the object, is experienced as actual, thus the object becomes a hindrance in itself. The increased hostility is being discharged through the interpersonal conflict with the object. The quality of the actual object (the therapist) affects the development of the conflict, i.e. it either allows a more successful reparation of the patient's personality structure or brings about a deeper regression.

In order to study the mitral cusp pliability and calcification "in vivo" on the basis of the difference in the maximal and effective valve area, the Doppler-echocardiographic and computer tomographic method was used. The cusp pliability on the basis of the difference between the maximal and effective mitral valve area in absolute measures of cm2 was significantly smaller in patients with mitral stenosis, but in the deviations from normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, there were no significant differences (normal values 0.00 +/- 27%). The normal relationship of the difference between the maximal and effective mitral valve area in absolute measures (y = cm2) and the maximal mitral valve area (x = cm2) is formulated with the regression equation: y = 0.317x - 0.245. The linear correlation of the normal mitral valve area and the stroke volume at rest in patients with the normal mitral valve is very tight. The stroke volume is significantly lower in mitral stenosis, and the time-velocity integral in the diastole or the mitral stroke distance was significantly greater. The relationship of the percentual deviation from the normal indexed values of cusp pliability excluding the influence of the anatomic or maximal orifice area, on the one hand, and the computer-tomographic approximation of calcium incrustation in mitral leaflets on the other are defined with a tight linear correlation. One could conclude that the magnitude of cusp pliability or calcification can be approximated by the Doppler-echocardiographic method.