Disorders of the arterial blood supply in the upper extremities]

Arteriopathies of the upper half of the body may lead to considerable functional disturbances of the arm and severe deficits on the part of the central nervous system. Due to good comparison they scarcely cause or do not cause any complaints in a no unconsiderable part. The clinical material consisting of 4,162 patients from five annual courses had in 9.2% occlusion and stenoses localized in the supraaortic and brachial region. The in most cases systemic angiopathy here explains the frequently combined appearance with arterial processes in the pelvic and the leg region. According to the height of the occlusion we clinically differ types of carotis, shoulder girdle, upper arm and peripheral-acral obliteration, which in each case show differences concerning frequency, age of manifestation, etiology, distribution of sex and clinical degree of severity. The angiological basic diagnostics is based on the inspection, palpation of the arteries, auscultation of the vessels, bilateral measuring of the blood pressure after Riva-Rocci and functional examinations, such as fist closure test and Allen test, as well as clinical proofs or exclusions of neurovascular syndromes of the shoulder girdle. The special apparative angiological methods comprise the oscillo-, rheo- and vein occlusion plethysmography, the Doppler ultrasound technique, estimations of the ophthalmic pressure, isotopic methods and angiographic exploration. --The individual angiological examination methods are of different importance according to the height localisation of the angioorganopathy. --The incomplete syndrome of the aortic arch is taken into consideration. In short the author adopts a definite attitude to the demands of therapy.     

Screening and genetic diagnosis of haemoglobin disorders

The inherited haemoglobinopathies are large group of disorders that include the thalassaemias and sickle cell disease. Carrier detection methods must be able to detect alpha-, beta- and deltabeta-thalassaemias, HPFH disorders and haemoglobin variants. Carrier diagnosis involves the accurate measurement of MCH, MCV, Hb A(2) and Hb F values in combination with an understanding of the haematological characteristics of the different types of thalassaemia genes and their interactions. The majority of the common thalassaemia mutations and abnormal haemoglobins can be identified by PCR-based techniques. The main applications of molecular analysis for carrier diagnosis are: the analysis of alpha-thalassaemia mutations by gap-PCR to discriminate between heterozygous alpha-thalassaemia and homozygous alpha-thalassaemia; the identification of beta-thalassaemia mutations for patients requiring prenatal diagnosis and for the prediction of the severity of the clinical phenotype of homozygous beta-thalassaemia; to discriminate between deltabeta-thalassaemia and HPFH deletions by gap-PCR.     

Glycosylation products in the early diagnosis and prognostic evaluation of carbohydrate metabolism disorders]

HbAIc and FA were investigated as markers in the diagnosis of early carbohydrate metabolic derangements. A group with normal TSH and a high concentration for glycosylation products was singled out. Carbohydrate metabolic derangements in 89 per cent showed a tendency to progression. Interrelationship between glycemia and PH was noted. The diagnostic and prognostic importance of HbAIc and FA was determined, and their combined use for single investigation of carbohydrate metabolism was recommended, making it possible to exclude "accidental" latent transitory hyperglycemia. TSH determination at early stages can be of low informative value, whereas HbAIc and FA measurements can detect disorders of carbohydrate metabolism early enough.     

Evaluation of the indicators of acid-base equilibrium, oxygen and electrolyte blood levels for early diagnosis of hemodynamic disorders after heart surgery]

In 30 patients operated on under extracorporeal circulation the acid-base, oxygen and electrolytes balance parameters were studied in order to evaluate their potentials as additional diagnostic tests for various clinical forms of acute circulatory disorders in the early post-operative period. Cardiac insufficiency is predominantly characterized by a reduced oxygen saturation of mixed venous blood, an increased oxygen arterio-venous gradient and "lactate excess", hypokalemia and hypernatremia in plasma and erythrocytes. Metabolic and gas parameters of acid-base balance cannot be used for the diagnosis of postoperative cardiac insufficiency. In cases of hypovolemia the changes of the laboratory tests data are determined by the compensatory capacities of the human body in response to circulating blood volume deficit.     

筛查与肝癌的早期诊断

目的研究筛查对肝癌早期诊断的价值。方法将１８８１６名肝癌高危对象随机分为筛查组与对照组。筛查组每６个月作一次ＡＦＰ与实时超声检查。对照组不做主动检查。结果筛查组５年共检出肝癌８６例,其中早期（Ｉ期）占６０．５％、小肝癌占４５．３％。对照组５年共发生肝癌引例,无１例早期或小肝癌病例,差异非常显著（Ｐ＜０．０１）。筛查检出之肝癌病例中,５７例为经过１次或多次阴性检查后,在继续的定期检查中检出之病例,其中早期更高达７７．２％。而未经阴性检查“保护”的２９例筛查检出之病例中只有２７．６％为早期,差异非常显著（Ｐ＜０．０１）。结论筛查为肝癌早期诊断的前提。尤其在一定的人群中进行定期筛查,才能更有效地达到早期诊断的目的。     

The arterial blood supply to the liver in cirrhosis.

Of 21 patients with cirrhosis of the liver 9 had collateral arterial flow to the liver from the superior mesenteric artery. The degree of collateral arterial flow in cirrhosis was related to the presence of centrifugal portal flow, the degree of bilirubinemia and the presence of a markedly enlarged spleen with increased splenic blood flow. Of 27 non-cirrhotic 6 had collateral arterial flow to the liver from the superior mesenteric artery. The greatest degree of collateral arterial flow was associated with celiac stenosis in 4/6 patients. One patient had pancreatitis and an explanation was not evident in one patient.     

Screening current and future diagnosis of psychiatric disorders using the Revised Drug Use Screening Inventory

The revised Drug Use Screening Inventory (DUSI-R) is a valid and reliable self-report questionnaire used for quantifying problems that frequently precede and co-occur with substance abuse. The present investigation determined whether the DUSI-R's items can be aggregated into scales that implicate current and future psychiatric disorders. Scales were derived to screen for attention deficit, conduct, antisocial, anxiety, depression, and substance use disorders in a longitudinally tracked cohort of 328 boys. Evaluations were conducted when the boys were 12-14, 16, 19, and 22 years of age. All of the scales identified youths qualifying for current DSM-IV diagnosis with excellent accuracy. Predictive validity of the scales ranged from good to excellent. Accordingly cut-off scores were determined for each scale for use in practical settings to identify youths who require comprehensive diagnostic evaluation. Thus in addition to its utility for detecting problems that precede and correlate with substance abuse, the DUSI-R is cost-efficient for screening youths for mental disorders.     

Comparative ultrasonic Doppler blood pressure determination on the upper and lower extremities as a possibility in the early detection and course observation of peripheral arterial circulatory disorders]

The comparative measuring of blood pressure on the arm and foot artery by means of the ultrasound technique after Doppler is a method for the diagnostics of the disturbance of the peripheral arterial blood supply relevant to practice. Its advantages are in the short time of examination, the simple manipulation, the little technical expenditure and the providing of clear measuring data. The course of examination used by us is explained, the normal and borderline values got are reported. Patients with haemodynamically effective disturbances of the arterial blood supply of the vessels of the leg have on the malleolar artery a by more than 10 Torr lower blood pressure than on the brachial artery. For recognition of early changes we propose a simple loading test in form of a position test. The comparative ultrasound measuring of the blood pressure after Doppler on the upper and lower extremity is suitable for the observation of the course and should stand in the first place of the functional diagnostics of peripheral angioorganopathies.     

Cardiological diagnosis in arterial embolism]

Potential cardiac sources of arterial embolism are in particular thrombi within the left atrium or ventricle, or attached to a prosthetic valve, intracardiac tumors, and vegetations due to endocarditis. Patent foramen ovale and atrial septal defect may lead to paradoxical embolism, and spontaneous echo contrast within the heart has to be considered as a parameter of increased thromboembolic risk. In rare cases, atrial septal aneurysm, mitral valve prolapse or annulus calcification and calcified aortic stenosis has to be taken into consideration. Current method of choice for diagnosis of these abnormalities is echocardiography. When the transthoracic approach fails, transesophageal echocardiography (TEE) leads to a definite diagnosis in most cases. Precordial echocardiography allows the detection of left ventricular thrombi with a sensitivity ranging between 72 and 95%, and monoplane TEE does usually not increase these numbers. In contrast, thrombi within the left atrium and particularly in the left atrial appendage can be detected with a significantly higher detection rate when TEE is used. The same is true for spontaneous echo contrast in the left atrium, a phenomenon which is almost exclusively diagnosed by TEE, as well as for endocarditis associated vegetations that can be identified by TEE with a sensitivity higher than 90%. Patient foramen ovale is usually diagnosed by precordial contrast echocardiography combined with a Valsalva maneuver; color Doppler or contrast TEE allows to increase the detection rate. In the diagnosis of prosthetic valve attached thrombi and vegetations, TEE is clearly superior compared to the precordial examination, at least concerning prosthetic devices in mitral position. If echocardiography fails to identify a potential cardiac source of embolism, other techniques don't add significant information in most cases. Detection of a potential source of embolism, however, does not necessarily prove that the particular finding represents the true etiology of an embolic event; results of all clinical and technical examinations have to be evaluated in a critical synopsis. In addition, proper therapeutic consequences in quite a number of abnormalities considered as potential cardiac sources of embolism are not yet defined.     

Malformation of bronchopulmonary foregut with systemic and pulmonary arterial blood supply

A case of congenital malformation of the bronchopulmonary foregut with communication between the esophagus and sequestered lobe is reported in a six-month-old boy. Only 29 similar cases have been reported previously, and this case was especially unusual in that the communication was from the middle portion of the esophagus to a right apical sequestration. Another unusual feature was that the sequestered segment was supplied by four systemic arteries from the thoracic aorta, as well as by branches from the right pulmonary artery. Within the sequestration, there was shunting of blood from the systemic to pulmonary arterties with reversal of flow in the pulmonary arterial branches.     

The diagnosis of peripheral arterial embolism]

Acute embolic occlusion of a peripheral artery requires rapid and precise diagnosis in order to provide the appropriate treatment without delay. The symptoms and findings of acute arterial occlusion are characterized by "the six Ps": pain of sudden onset in the hypoperfused extremity, paleness, pulselessness, paresthesias, paralysis and, in the extreme case, prostration with the symptoms of shock. With embolization in arterial segments with only minimal residual perfusion via collaterals (for example, the femoral bifurcation), a complete ischemic syndrome is usually incurred manifesting the six Ps as delineated. If preformed collateral systems provide some perfusion distal to an arterial occlusion (for example, in the common iliac artery), there is frequently an incomplete ischemic syndrome observed which is characterized by pain, paleness and pulselessness. Peripheral arterial embolism has a predilection for the femoral bifurcation, the superficial femoral artery and the popliteal artery. In principle, however, embolization can occur in every arterial segment. The diagnosis of the acute ischemic syndrome can generally be established on the basis of the history and physical examination. Diagnostic aid can be provided by electronic segmental oscillography to demonstrate diminished or absent oscillations and with the Doppler sonographically-determined systolic arterial pressure at the ankle which, in the case of severe ischemia, is less than 50 mmHg. Arteriography provides the most accurate morphological information. Abrupt occlusion of the vessel and no collateral perfusion especially in the absence of arteriosclerotic changes are strongly indicative of embolism but not conclusive. If the clinical diagnosis is unequivocal, arteriography need not be performed prior to embolectomy with a Fogarty catheter.(ABSTRACT TRUNCATED AT 250 WORDS)     

A clinical angiographic study of the arterial blood supply to the sinus node

We studied the arterial blood supply to the sinus node area in 309 consecutive patients undergoing coronary arteriography. Seventy-nine had had a previous myocardial infarction. In two who developed temporary sinus node dysfunction, the sinus node artery arose from the distal portion of a severely stenotic left circumflex coronary artery, but in 307 of the 309 patients the sinus node arteries themselves were free of atheroma. The sinus node artery arose from the right coronary artery in 182 patients, from the proximal 3 cm in 179, near the origin of the acute marginal in one, and left of the crux in two. In 119 patients it arose from the left circumflex coronary artery, proximally in 87, and in 32 from anywhere throughout its length, running posteriorly as the posterior sinus node artery. Finally, eight patients had two sinus node arteries, one arising from the right coronary artery and one from the left circumflex.