Acta Universitatis Carolinae. Medica. Monographia最新文献

Chronic pancreatitis (ChP) is the most frequent cause of pancreatogenous diabetes mellitus (DM). This kind of DM is a typical case of acquired insulin secretion deficiency. The group under scrutiny consisted of 122 patients with ChP. The average age of the 88 men was 42.9 and that of the 34 women was 54.4 years. According to pancreatography and to the presence of calcifications the patients were divided into four group by gravity of the morphological pictures at ERCP. The control group of healthy persons was made up of 15 men and 10 women. The presence of glucose intolerance was rated by the oral glucose tolerance test (oGTT) after 75 g glucose. The volume of endogenous secretion of insulin was studied by measuring IRI and C-peptide fasting and after stimulation. To measure the damage of pancreatic exocrine secretion we used function test (Spofagnost-Pankenzan test). In our own group of 122 patients we found decreased glucose tolerance in 72 (59%). 41% were cases of DM, 18% suffered from impaired glucose tolerance (IGT). As the results of stimulated C-peptide tests suggest, practically all patients with ChP corroborated by morphological changes in the pancreatic duct system at ERCP have decreased endogenous insulin secretion compared with healthy persons, and that includes even those normal glucose tolerance rated by results of oGTT We were able to prove a statistically significant relationship between the degree of morphological changes in the pancreatic duct system and the values of C-peptide. The mean values of the Spofagnost test showed significant differences between patients with normal glucose tolerance and DM.

An allergic disease may develop in any organ or system. The respective etiological factors include foreign proteins, infectious agents such as various microbes, viruses, moulds, parasites, chemical compounds often in the form of drugs usually designated as haptens, polysaccharides, benign and malignant neoplasms. Of the factors operating in the causal pathogenesis of such diseases the most important one is an exaggerated formation of antibodies, which appears to be uncontrolled and occurring irrespective of the demands of the organism. The essential morphological features in allergic inflammation are rather variegated, their diagnostic value differing in a wide range but being never absolute. The above features include eosinophilic leucocytes, allergic arteritis and phlebitis, fibrinoid necrotic glomerulonephritis, histiocytic granulomatous inflammation or histiocytic granuloma. Granulomatous capsulitis and trabeculitis affecting the spleen and lymph nodes are believed to be of major diagnostic significance. The immunofluorescent and immunoperoxidase methods and electron microscopy are important diagnostic tools. It has been generally acknowledged that many drugs operate as antigens. They may cause death of the respective patient, but allergic manifestations may subside after withdrawal of such drugs. On occasion they operate as a trigger mechanism with the allergy progressing even after treatment had been interrupted. Therefore they have been receiving extreme attention. Our collection of cases a case of giant-cell myocarditis following sulfamethoxypyridazine, anaphylactic shock has been reported to occur after intravenous administration of novocaine, and generalized cutaneous vasculitis developed in the same patient during the subsequent phase. A similar cutaneous finding was reported to have developed after penicillin injection, granulomatous inflammation developed owing to sulfonamide treatment. Allergic tumour-like lymphadenitis developed after administration of anti-anthracic serum; an anticonvulsive syndrome developed after hydantoinate administration. The latter consisted of generalized exanthema, hepatomegaly, splenomegaly and generalized lymphadenopathy. The lymph nodes showed tumour-like lymphadenitis mimicking lymphogranuloma or reticulosis. Allergic diseases appear as either isolated organ lesions or systemic diseases. Thus, isolated and systemic polyarteritis nodosa, isolated nasal, pulmonary or systemic Wegener's granulomatosis have been recognized. Temporal arteritis has been recognized as a localized form of systemic giant-cell arteritis. The haemolytic-uraemic syndrome appears to be a milder variety of thrombotic thrombocytopenic purpura. Allergic diseases or manifestations occasionally affect two or more organs or systems.(ABSTRACT TRUNCATED AT 400 WORDS)

The monograph sums up the problem of CT diagnosis of bones and joints making use of predominantly the authors' own experience based on CT tests of more than 45,000 patients examined at the Department of Radiology, Charles University Medical Faculty of Hygiene teaching hospital in Prague in the years 1980-1988. Specific scans of the skeleton were made in 4,500 patients, mostly for suspicion or closer assessment of neoplasms (43.5%), the radicular lumbosacral syndrome (34.5%), and injuries (12%). The opening chapters sum up basic facts about the principle of computed tomography, the apparatus in use, the evaluation of CT images, CT radiation doses, and the patients' preparation for CT scanning. The use of contrast media is discussed with regard to the possible hazards involved and to the need to hear allergological opinion first. For spinal canal visualization non-ionogenic contrast media are used exclusively. The management of side reactions to contrast medium application is also reviewed. Indications for bone and joint computed tomography now comprise a whole series of traumatological, orthopaedic, oncological, rheumatological, neurological and rehabilitation conditions, each of which is discussed in detail in a separate chapter. CT anatomical studies offer the advantage of being applicable even in patients examined for other than bone or articular diseases. The option of simultaneous soft tissue assessment represents another advantage. The authors describe different anatomical structures in terms of CT images, some of them complete with dimensional and density values. The chapter on anomalies and developmental variants stresses the relevance of computed tomography for precise characteristics of clefts of the spinal column and facial bones and for the diagnosis of anomalies and dysplasias of the spinal column and the chest. A rare case of cephalothoracopagus is demonstrated. As for traumatology, computed tomography is found useful in diagnosing fractures of the orbit and facial bones in general, the atlas, axis and pelvis and in tracing vertebral fragments displaced into the spinal canal. Computed tomography occupies a monopoly position in the diagnosis of post-injury haematomas of intracranial but also thoracic, pelvic and abdominal localization. There is a wealth of illustrations to document a wide range of traumatic conditions. The chapter on degenerative diseases is focused mainly on computed tomography in the lumbosacral radicular syndrome, one of the most frequent and also most effective indications for CT. Protrusion and herniation of the intervertebral disk and sequestra in the spinal canal are all absolute indications for CT scanning where surgical treatment is contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)

Using the NIH two-phase microlymphocytotoxic test, lymphocytes of patients and control subjects were typed for HLA antigens of A and B loci: A1, 2, 3, 9, 10, 11, 28 (or Aw 19, A30, 31), B5, 7, 8, 12, 13, 14, 15, 17, 18, 21, w22, 27, 35, 40. Patients tested: 1. 75 patients with Wilms' tumour, thereof 35 had their whole families tested, 2. 20 patients with neuroblastoma, 3. 26 patients with neurofibromatosis, thereof 21 had their whole families tested, 4. 166 patients with testicular germinal tumours and 41 children with germinal tumours of diverse localization, 5. 48 individuals with haemangioma, 6. 64 women with breast cancer and 50 with dysplasia. We investigated 490 patients and, with the addition of family studies, another 193 individuals, altogether 683 persons. The results were compared with a group of 301 healthy non-related persons or with a group of 116 healthy non-related men, or with 100 healthy women and, in the family studies, with members of 47 healthy three-member families with healthy children. The chi 2 test with a Yates correction or also Fisher's exact test were used for the purpose. The resultant p was corrected using multiplication by the number of the antigens typed. In some cases we used the relative risk (RR) value. The results can be summed up in the following seven points: 1. Wilms' tumour was found to have no significant association either in our population or family studies. The latter seem to testify rather against this tumour's linkage with HLA. Our study was inconclusive as to the significance of the more frequent incidence of HLA-A1 and/or A9 in the diseased children of those families where one of the parents had at least one of those antigens. It cannot be ruled out as a sign of better prognosis. We regards as indispensable the typing of HLA antigens in patients with Wilms' tumour coincident with an inborn anomaly, as well as in members of those patients' families, and also a conclusive elucidation of the possible association with HLA-A1 and/or A9. No other centre has as yet undertaken any family studies. Consequently our possibilities of comparison with other teams' results were meagre. 2. We point to the possible conceivable relationship between neuroblastoma and HLA-B13. We found this association, albeit non-significant after correction, potentially important, especially after comparisons with the results of an only other existing study.(ABSTRACT TRUNCATED AT 400 WORDS)

In spite of the existing huge number of data on palate development as well as the incidence, experimental induction and clinical treatment of orofacial clefts, no unitary concept has been made available that would make possible their sorting out, further interpretation and extrapolation. The aim of this monograph has been to provide firm grounds for managing the data within categories consistent with the general principles of teratogenesis reformulated and extended upon the theory of morphogenetic systems, and, upon this basis, to evaluate the present chances of preventing the origin of orofacial clefts. Chapter 1 introduces the problem of birth defects that possess some distinct features in common with the recognised prime problems of present medicine, that is neoplastic and cardiovascular diseases. Orofacial clefts represent a substantial component of the human birth-defect spectrum that is a mere remnant of the original volume of teratogenesis estimated as affecting about 35% of human embryos. The merciful process of prenatal extinction of abnormal conceptuses, or terathanasia, reduces this eminent figure by approximately one order of magnitude. Basing upon the prevalence of clefts in embryos and infants we may say that the prenatal extinction of individuals with orofacial clefts lies somewhere between 70-90%. Chapter 2 deals with the history of recognising and formulating the general principles of teratology that go back to Isidore Geoffroy Saint-Hilaire. Estimating the contribution of the great personalities such as Dareste, Schwalbe, and J. G. Wilson, the chapter enumerates and describes the ten principles of teratogenesis as having arisen from the known rules extended and reformulated by the original theory of morphogenetic systems. In their sum, the principles constitute a deductive system defining teratogenesis at several levels of bioorganisation, capable of predicting the large-scale effects of environmental impact on animal and human reproduction. Chapter 3 presents the orofacial clefts in the light of the theory of morphogenetic systems. Palatal morphogenesis is accomplished under the conditions of extraordinary spatial complexity and extends over a relatively long period of development. Several morphogenetic subsystems may be distinguished, namely the morphogenetic subsystem (smgs) of facial outgrowths, the smgs of palatal shelves, the smgs of the glossomandibular complex and, eventually, the smgs of the axial cervical region, acting at different phases of palatal development.(ABSTRACT TRUNCATED AT 400 WORDS)

In this paper we are submitting studies on the onto- and phylogenetic development of the superficial muscular and fascial layers of the hand and forearm of mammals. The object of this study was to investigate the following items: the ontogenetic development of the m. flexor digitorum superficialis, of the m. flexor digitorum profundus, of the m. palmaris longus, of the palmaris brevis of the human hand, the nerve supply of these muscles, the development of palmar and plantar aponeurosis and of other fasciae related to the palmar and plantar aponeuroses. We compared conclusions drawn from the studies on the ontogenetic development with observations gained from the phylogenetic development of the structures of the human hand and forearm and applied our findings to various species of mammals. The results of these comparisons are expressed in this study presenting interpretations of the phylogenetic development of superficial muscular and fascial layers of the mammalian hand and foot. Furthermore we ascertained the homology of the superficial muscular and fascial layer of the mammalian autopodion, we reviewed one of the theories on the origin of Dupuytren's contracture and commented on opinions of the developmental origin of certain muscular varieties present in the human hand and forearm. Apart from this we established certain basic data on the development of the fasciae of the human hand and foot. Our findings on the variability of the palmar aponeurotic attachments of the human hand were confronted with the incidence and frequency of one particular finger when affected by a Dupuytren's contracture and we commented on the predisposition of certain fingers or toes for the affliction of this impairment. We conducted 152 series of histological sections through the hand and feet of embryos and foetuses sized 12-100 mm in c.-r. length, as well as 84 series of histological transverse sections through human embryonal hands in order to study the ontogenetic development of superficial muscular and fascial layers of the human hand, forearm and foot. The embryonal extremities were cut transversally, parallel to the palm and several sagittal sections were carried out for control purposes. The phylogenetic development of the superficial muscular and fascial layers of the hand was investigated by specimens processed under a micro-dissecting microscope. 55 specimens of various extremities were thus prepared, obtained from 22 species of mammals. Many animals were selected in order to cover species of mammals significant for their evolution.(ABSTRACT TRUNCATED AT 400 WORDS)

The complex of the symptoms of psychic disorders and of the disorders of sleep, appetite, and food intake often forms the basis of the clinical picture of a mental disease. However, it is only rarely conceived in a complex manner as a set of physiologically interdependent functions. A remarkable proof of the interdependence of these functions is their complex disorder, the Kleine-Levin syndrome. The first descriptions of the symptoms of the Kleine-Levin syndrome can be found in the studies of several authors published as early as at the turn of the century. In 1942, the syndrome was designated by Critchley and Hoffmann after Willi Kleine and Max Levin, who defined it precisely in 1925 and 1929. The syndrome of periodic hypersomnia, megaphagia, and psychic disorders, originally described only in young males, was later found in females as well; the original very strict criteria were gradually broadened and complemented to some extent. At present, the most commonly accepted criterion for the diagnosis of the Kleine-Levin syndrome is the existence of the combined sleep disorder (hypersomnia or insomnia lasting from days to weeks), food intake disorders (megaphagia or anorexia), and various psychic abnormalities accompanying or following the attacks of the affection. We term the syndrome typical if the sleep disorder appears in the form of hypersomnia, food disorder in the form of megaphagia, and if psychic abnormalities are clearly expressed. On the other hand, we term the syndrome atypical if one of the main symptoms is opposite. The incomplete syndrome consists of only two main symptoms. The attacks of the affection set on mostly suddenly, lasting from several days to several weeks, ending suddenly again. The interparoxysmal periods last from several days to several months, sometimes even to several years. The etiopathogenesis of the affection is still unknown. A number of reports indicate a disorder of the diencephalon, perhaps only of the hypothalamus. The pathological-anatomical findings following the death of persons suffering from the disorders of sleep and food intake and from psychic abnormalities mostly reveal lesions in the region of the third brain ventricle. The development of the typical syndrome is benign, however, and morphological studies are not available. The typical Kleine-Levin syndrome can hardly escape the attention of clinicians owing to the richness and clarity of symptoms. The atypical or discretely expressed forms, however, often remain unrecognized even after a detailed medical examination and may lead to diagnostic uncertainty.(ABSTRACT TRUNCATED AT 400 WORDS)

Several new problems in obesitology were pointed out in this book and commented with respect to experiments and experiences of our working group. The problem of the low triiodothyronine (T3) syndrome was treated in chapter 2. The decrease of serum T3 and increase of serum reverse T3 in obese subjects was induced by several factors, namely by fasting. A resistance to administered thyroxine and triiodothyronine was observed in these patients. This energy saving mechanism is at variance with slimming regimens. The prevention and treatment of this awkward complication was discussed. The next chapter (3) is concerned with the hormonal and metabolic effects of diet and motor activity in the course of slimming regimens. The different effects of diet and motor activity on epinephrine and norepinephrine in obese subjects were similar to those obtained by other investigators in nonobese humans. A great importance was attributed to an increased plasma level of cortisol in obese and nonobese subjects in the course of different forms of motor activity and related to a different intensity of exercise. Parallel to several of these experiments, beta-endorphin, thyroid hormones and glucagon were also estimated. It was suggested that motor activity for exercising subjects should not lead to an enhanced secretion of cortisol in view of the health deteriorating effects of increased cortisolemia and in view of an already stimulated secretion of this hormone in obese subjects on basal conditions. Vice versa, a decreased cortisolemia should be obtained in obese subjects treated with an appropriate motor activity and diet. It has been shown that diet without motor activity reduced the level of plasma androgens but in cooperation with motor activity, the level of androgens remained unaltered in the course of the reducing regimen. The conservation of a normal or even higher level of androgens is probably prerequisite for a positive nitrogen balance observed in the course of a combined slimming regimen, while diet without motor activity led in the studied conditions to a negative nitrogen balance. Chapter 4 was devoted to the role of motor activity in slimming regimens. In view of the metabolic effects of motor activity and the clinical late effects of obesity (osteoarthritis of the knees, hips and spine, arterial hypertension, overload of the cardiovascular system, diabetes mellitus etc.), a selection of motor activities was proposed. According to our long experience, we do not recommend jogging, running, jumping and all sports leading to collisions of players.(ABSTRACT TRUNCATED AT 400 WORDS)