Czechoslovak medicine最新文献

As sepsis develops, the patient passes through four stages of haemodynamic and metabolic disturbances. The stages are compensated sepsis, metabolic insufficiency, respiratory insufficiency and cardiac insufficiency. Once the septic process has become uncontrollable, the patient dies in septic shock. On the contrary, all the above stages are potentially reversible if appropriate therapy is instituted. Typical development of the haemodynamic and endocrinologic changes, values of blood gases including metabolites affecting acid base balance as well as changes in the metabolism of carbohydrates, lipids and proteins are described. The article points to aspects that still make accurate sepsis staging difficult.

The case of a strange type of generalized xanthogranulomatosis, ending by a lethal kidney complication, is described in a woman aged 68. The clinical symptoms of the patient were not characteristic and did not lead to the actual diagnosis. The process was located along the basal brain arteries, it adhered to the adventitia of the descending thoracic aorta and of the coronary arteries. An identical xanthogranulomatous infiltrate was found in the peripelvic adipose tissue of both kidneys, where it led to stenosis of the proximal ends of both ureters; to a lesser extent such infiltrates appeared also in the periportal areas of the liver and in the bone marrow. Histological findings grant the possibility of the Erdheim-Chester disease. Differential diagnosis is subjected to discussion.

Myocardial contrast echocardiography is a new method enabling detailed evaluation of blood flow distribution within the myocardium. It is performed by means of intracoronary injection of small volumes of carrier solutions containing small microbubbles of a size similar to that of red blood cells. The perfused myocardium opacifies densely, while the ultrasonic backscatter of nonperfused areas does not change. This method enables evaluation of the physiologic impact of coronary stenosis, diagnosis of "small vessel disease", collateral blood flow assessment, infarct size measurement and, with the help of videomemory and a computer, also regional myocardial blood quantification. This paper reviews all hitherto published studies with myocardial contrast echocardiography in humans including some studies only recently submitted for publication. These studies examined a total of 169 patients. No complications of intracoronary injection of microbubbles were described. Transient ECG and haemodynamic changes of less than 30 seconds' duration are less pronounced than during routine coronary arteriography. This paper describes the methodology, safety, physiology and potential clinical usefulness of myocardial contrast echocardiography.

Hybridoma cells were derived from a mouse immunized with freshly obtained primary human uveal melanoma cells. Supernatants from the resultant hybridoma clones were screened for positive antibody binding to uveal melanoma cell membranes and negative binding to membrane preparations of fibroblasts, retinal and uveal cells of healthy donors using sandwich radioimmunoassay and indirect immunofluorescence. Extensive specificity tests showed that the antibodies produced by ten clones bound strongly to fresh, and/or short-time cultivated primary human uveal melanoma tumour cells (UMEL-H, UMEL-K). Weaker binding occurred in a human uveal melanoma cell line (VUP-1), and/or in human skin melanoma cell lines (HMB-2, B-HM8). Binding assay of carcinoma cells, fibroblasts, uveal and retinal cells was negative. Intensive screening of this type is now under way.

In a group of 25 men after myocardial infarction (MI) at an age under 40 years the occurrence of risk factors of ischaemic heart disease, the results of both invasive and noninvasive investigations as well as other special examinations within one year after the attack of acute MI were analysed. In 36% there was a normal finding or nonsignificant stenosis on the coronary arteries (less than 50% lumen obstruction at coronary angiography); a significant stenosis was found in 64%, out of which only one coronary vessel was affected in 32%. Dominant risk factors were: smoking, lipid metabolism disturbances, hypertension and a positive family history. The average number of risk factors in the group with a normal finding on the coronary arteries was 2.55, and in the group with a significant coronary sclerosis 4.85. The risk of myocardial infarction is increased by the coexistence of heavy smoking habits and vigorous physical activity. No correlation was found between the extent and location of coronary sclerosis and the functional parametres and wall motion of the left ventricle. An analysis of occupational status before MI revealed that 52% of the patients were workers, 40% professional drivers and only 8% were clerks.

The occurrence of blood isoantigens, demonstrated using an immunofluorescence technique in urothelial tumours of 40 blood group A, B, or AB patients who had been treated and followed up during the years 1977-1983, has been compared with their histological grading and clinical course. In both of the 2 papillomas and 35 grade I papillocarcinomas, a positive expression of the relevant isoantigens could be demonstrated, while all of the 19 grade III papillocarcinomas just as the 22 anaplastic carcinomas always proved negative. In a group of 34 grade II papillocarcinomas, 21 of the tumours proved positive and 13 negative; with all tumours showing signs of invasiveness being always negative. Correlation of these results with the clinical courses of the disease did not exhibit such unequivocal results, even though, in a group of 7 patients who had died of a generalized urothelial carcinoma verified by post-mortem, all of the 19 examinations that have been performed proved, with the exception of one, to be negative. These results confirm the fact that identification of blood isoantigens may help to reach a more accurate prediction of the biological behaviour and prognosis of urothelial carcinomas, especially, among grade II papillocarcinomas since loss of the antigen expression appears to be related to the tumour's capacity of invading the mucous stroma.

The authors present their experience with the outcome of gastrofibroscopic sclerotherapy of oesophageal varices, performed in a total of 70 patients with portal hypertension. All patients were classified in classes B and C according to Child's criteria, and 68 of them had variceal bleeding before receiving sclerotherapy. Acute bleeding was successfully arrested in seven cases, and elective sclerotherapy in between bleeding episodes was carried out in 60 cases. To date, complete obliteration has been noted in 34 patients. An effect of previous sclerotherapy was observed during the next therapeutic session in 18, and eight patients died from progressive hepatic insufficiency. In the discussion section, the authors analyse current concepts on the technique of sclerotherapy related to complications, on instrumentarium and sclerosing solutions, and on the significance of prophylactic, acute and elective sclerotherapy, with the importance of endoscopic sclerotherapy of oesophageal varices perceived mainly in comparison with the results of surgery from the point of view of long-term patient survival.

The authors offer a retrospective appraisal of a technique for the treatment of malignant ventricular tachyarrhythmias using the automatic implantable cardioverterdefibrillator (AICD) in a patient with right ventricular arrhythmogenic dysplasia. Device function after the first implantation and reimplantation was checked by repeated (63 times) outpatient 24-hr ECG monitoring. All recordings suggested a reliable detecting and defibrillating function of the AICD. The patient died two years after the first implantation. The probable cause of death was failure of the mechanical myocardial function.

New interrelations between the distensions of the 5th, 6th and 7th ribs and low back pain were studied in two groups of patients: 1) one hundred out-patients with prevalent pseudoradicular symptomatology and 2) fifty patients hospitalised for graphically verified (CT, PMG) lumbar disc herniation and pronounced radicular symptomatology. We have introduced some measurements to document asymmetrical holding of the body and limbs: the distance between the sternoclavicular joint-spina iliaca ant. sup. and the distance between the acromion and spina iliaca post. sup. We found that in the distension (blockade) of the 5th rib, constant spasms are present in m. abdominis obliquus ext., in the most lateral part of the adductors and in the most medial part of the great gluteal muscle. In 6th rib distension, spasms in the external part of the m. rectus abdominis, and in the mediolateral fascicles of thigh adductors and in the external part of m. glutaeus max. could be palpated. In 7th sternocostal distension there are spasms in the most medial parts of m. rectus abdominis, and of thigh adductors and m. glutaeus medius of the same side. After mobilization, statistically significant improvement of body asymmetry (p less than 0.01), improvement of anteflection, bending to the side, Laségue's and Patric's phenomena were found. Surgery was indispensable only in 6% of our patients suffering from severe lumbar disc hernianion (in 3 out of 50). The CT appearance of the prolapse remained unaltered even after clinical remission. There were some changes before and after mobilization in the CT picture of sternocostal joints. The importance of strengthening of the great pectoral muscles--in which preexistent relative weakness was found--is stressed. The beneficial effect of mobilization of the respective sternocostal blockade on the pain syndrome, body asymmetry and mobility is described.