Problems of compensation of the insulin-dependent form of diabetes mellitus

The decompensation of the insulin-dependent type of diabetes mellitus under domestic conditions results from a low level of education of patients and their family members with regard to therapy of this disease, a formalistic attitude to doctor's recommendations and the absence of a regular control over a course of disease. Some patients and often physicians believe that the most effective measure for improving carbohydrate metabolism is to raise a dose of insulin which leads to the development of a syndrome of chronic overdosage and a more severe course of diabetes mellitus. The instruction of such patients with respect to the main therapeutic principles of this disease and their active participation in therapeutic measures and control over a course of disease will make it possible to raise the level of compensation in diabetes mellitus patients.     

Efficacy of angioplasty of native coarctations of the aorta of the big infant and of the adult with systematic endoprosthesis implantation

The angioplasty of native coarcatations of the aorta remains a controversial treatment due to recurrences and the potential risk of aneurysm or of descending aorta dissection during catheterization. The interest of a systematic implantation of an endoprothesis is poorly documented. We report our experience in a small series of 3 patients aged from 7, 28 to 52 years at the moment of the angioplasty of their native aortic coarctation. In all the three cases it corresponded to a "membranous" type, localized a the level of the isthmus without hypoplasia of the aortic arch. All presented a refractory hypertension. One patient presented an intermittent claudication related to a low perfusion of lower limbs. The angioplasty was performed with BIB balloon, associated at the same time with the implantation of a Palmaz P308 stent in two cases and Genesis PG2910P in the last patient. The efficacy was immediate in all the 3 cases with stopping antihypertensive drugs at the very day of the procedure. The immediate results were complicated by a bilateral hematoma of the scarpa in a context of excessive anticoagulation in one patient requiring blood tranfusion. After a follow-up of one, 12 and 21 months, all the 3 patients are asymptomatic without any significant residual hypertension. The control scan of the infant confirmed the absence of re-coarctation. In conclusion, the angioplasty followed by systematic implantation of an endoprosthesis is a safe and effective technique for treating simple forms of native coarctations of the aortic isthmus. It can be proposed as a first line treatment for big infants and adults affected by localized types.     

Abdominal placement of tube thoracostomy due to lack of recognition of paralysis of hemidiaphragm.

Tube thoracostomy is an invasive procedure that carries a risk of complications. We report a patient with liver cirrhosis, ascites and large left-sided pleural effusion, in whom a trocar type chest tube was inserted at the seventh left intercostal space in the midaxillary line. Chest roentgenogram revealed that the drainage tube was placed into the abdominal cavity because of a misrecognized elevation of the left hemidiaphragm. This case demonstrates that the placement of a tube thoracostomy requires caution in the identification of possible abnormalities which can lead to dangerous complications.     

The fundamentals of association of natural foci of zoonoses

Reports on the role of hydrological conditions in the functioning of parasitic systems are analyzed. The authors point out that a range of issues including different aspects of combination phenomena is discussed there. They suggest that a concept of combination shall be replaced by a concept of association of parasitic systems and their relevant natural foci of zoonoses, which is of a larger scope. The fundamentals of the formation and functioning of associated parasitic systems and natural foci of zoonoses are discussed. These include the hydrological conditions of floodplain-river regions, the multiparasitic capacity of hosts and vectors, the multihost pattern of causative agents, and a diversity of mechanisms of their transmission. The transmission mechanism without which movement of causative agents and the existence of parasitic systems and foci are impossible is shown to be a global combining onset of parasitic systems. The hydrological conditions of floodplain-river regions act as the universal mechanism of transmission of pathogens. The dynamics of the mechanism determines the functioning of all other mechanisms of transmission.     

Rehabilitation of children after total correction of tetralogy of Fallot

Nine children who had undergone total correction of tetralogy of Fallot were studied with the purpose of observing the physical changes that might be produced by a period of rehabilitation in hospital and comparing these results with those of a control group having the same pathology but which had not followed a protocol for physical activity. Precise criteria were used in the selection of the patients. Careful clinical examinations and exercise tests were conducted before and after the programme, in particular maximal stress testing on the bicycle ergometer and submaximal exercise on the treadmill. The sessions were held three times weekly in a gymnasium over three months, gradually increasing the duration of each session to a maximum of one hour. During the session, heart rate was monitored with a Sport-tester 3000 so as not to exceed 60%, then 70%, of the maximal heart rate recorded during the stress test. Testing at the end of the programme demonstrated an improvement in tolerance under maximal stress in 7 of the 9 patients. As for submaximal performance, 8 out of 9 children covered a greater distance using the same parameters as for initial testing. At the end of the programme, the children all showed increased independence and initiative and more self-confidence in establishing social relations. The programme has proven to be a comprehensive method for safely improving physical fitness in these patients and represents an important starting point for a better future.     

A Case of Endometriosis of the Appendix

A 51-year-old woman visited our clinic her chief complaint being right hypogastric discomfort. An abdominal ultrasonography revealed a circular, cystic mass in the right hypogastric region. A colorectal radiography disclosed a semi-globular shadow defect at the end of the cecum and did not visualize the appendix. A colorectal endoscopy revealed a submucosal tumor accompanied by a central dimple which seemed to represent the ostium appendicis vermiformis. Based on a preoperative diagnosis of submucosal tumor, the patient underwent a partial resection of the cecum. A histopathological examination of tissue removed led to a diagnosis of endometriosis of the appendix. In Japan, 7 cases of endometriosis of the appendix have been reported to date. In those cases, endometriosis of the appendix was detected as a lesion accompanying endometriosis of some other site or during laparotomy was based on a diagnosis of acute appendicitis. Unlike these cases, the patient presented here had been diagnosed by a preoperative colorectal radiography and endoscopy as having a submucosal tumor of the appendix.     

Structure of one of the neuropeptides of the egg-laying hormone precursor of Lymnaea

The neurosecretory caudo-dorsal of the freshwater pulmonate snail Lymnaea stagnalis, a peptidergic system controlling egg laying and egg-laying behavior, produce several neuropeptides. One of these peptides, calfluxin, causes the influx of Ca2+ into the albumen gland, a female sex gland of the snail. In the present study calfluxin was purified and the amino acid composition was determined. The ratio of the amino acids appeared to be very close to that of one of the predicted peptides present on the egg-laying hormone precursor of Lymnaea. This peptide was synthesized and shows a clear biological activity in the bioassay. Furthermore, it shows a chromatographic behavior similar to that of the natural peptide. Based on these evidences it is concluded that the sequence of calfluxin is: Arg-Val-Asp-Ser-Ala-Asp-Glu-Ser-Asn-Asp-Asp-Gly-Phe-Asp. Calfluxin shows a remarkable homology with the sequence of one of the predicted peptides on the egg-laying hormone precursor of the marine opisthobranch Aplysia californica.     

Note on degree of convergence of sequences of rational functions of prescribed type

This note studies the degree of convergence of various sequences of rational functions of given types which are of best approximation to a given function analytic on a given point set and meromorphic on a larger set. The sequences are conveniently represented by the analog of the Padé table.     

A case of adenosquamous carcinoma of the papilla of Vater]

Adenosquamous carcinoma of the papilla of Vater is a rare tumor and only a few cases have been reported so far. Here, we report a case of adenosquamous carcinoma in a 76-year-old male who presented with jaundice and right upper quadrant abdominal pain. Ultrasonography and enhanced abdominal CT scans showed dilated common bile duct (CBD) and intrahepatic bile duct (IHD) with a suspicious obstructing mass in distal CBD. On endoscopy, obstructing and ulcerated mass was noted on the papilla of Vater. Histopathological inspection of the biopsied specimens from mass showed adenosquamous cell carcinoma of the papilla of Vater. Since the patient refused operation, we inserted a self-expandable metallic stent in distal CBD. This is the first case report on adenosquamous carcinoma of the papilla of Vater in Korea.     

Utilization of prenatal care services: influence of perceived morbidity and of social networks of support

Differences in prenatal help seeking patterns were found in a sample of women of a household survey (9,139) that showed a high prenatal care coverage. The personal factors associated with the help seeking behavior were: the nature and individual perception of the symptoms and the existence of social support networks. Symptoms that make woman suspect of risk, produced a high demand of medical consultation (between 75 and 100%). Bothersome symptoms produced a medium utilization associated with its prevalence. Emotional symptoms produced a low demand of medical consultation (between 18 and 27%). Pregnant women who obtained support from their social networks consulted the doctor 3.3 times as much as those who didn't have a social network. The reinforcement of women's interaction with their natural social network is recommended as one of the basic components of prenatal care.     

Report of a Case of Mucoepidermoid Carcinoma of the Esophagus

Abstract: We report a very rare case of mucoepidermoid carcinoma (MEC) of the esophagus. The patient was a 47-year-old man with a tumor of the submucosal type, associated with erosion on its top in the mid-esophagus, detected by esophagoscopy. The lesion was stained with 3% iodine solution, but the site of the erosion was not. Endoscopic ultrasonography revealed a hypo-echogenic tumor located mainly in the submucosal layer, preserving the muscle coat intact. Distal esophagectomy with esophago-gastrostomy was performed via the retrosternal route. Microscopic study revealed the lesion to be compatible with a mucoepidermoid cancer (O-l sep type, sm massive invasion, Iy2, v0, n3 (+) based on the classification of the Japanese Society of Esophageal Diseases). The diagnosis of MEC is very difficult, because this lesion grows and develops like a submucosal tumor. Considering this feature of MEC, endoscopic ultrasonography must be carried out for small submucosal tumors of the esophagus in order to detect MEC. Clarification of the endoscopic ultrasonographic characteristics of MEC is eagerly awaited.     

A collision tumor composed of cancers of the bile duct and ampulla of Vater--immunohistochemical analysis of a rare entity of double cancer

Collision cancer of the bile duct and the papilla of Vater is an extremely rare entity. This is the first report of a case of bile duct collision cancer. A 75-year-old man presented with jaundice. Computed tomography showed isodensity masses in the middle bile duct and the papilla of Vater. Magnetic resonance cholangiopancreatography showed a tuberous filling defect in the middle bile duct. Gastroduodenal endoscopy showed a tumor with ulceration at the papilla of Vater. The patient was diagnosed with cancers of the middle bile duct and the papilla of Vater, and a pylorus-preserving pancreatoduodenectomy was performed. On pathological examination, the tumor in the middle bile duct showed a well differentiated carcinoma that had spread to the proximal bile duct, whereas the tumor in the papilla of Vater showed a papillo-tubular carcinoma with a marked production of mucin, suggesting an intestinal type of ampullary cancer. These tumors were directly communicated by microscopic findings. Therefore, the immunohistochemical characteristics were analyzed, using several antibodies, to determine whether the origins of the 2 cancers were different or not. As a result, it was concluded that this was a case of collision cancer of the middle bile duct and the papilla of Vater.     

Technology of Manufacturing of ZC Cylindrical Worm

Cylindrical worms are generally machined by the hobbing method using rotary tools, and they are formed in the finishing pass at the full profile height. In this case, the profile of the tool-action surface determines the profile of the machined surface, and for technological reasons, a rectilinear (less frequently circular) axial profile of the tool-action surface is generally assumed. In the currently known technology, machining takes place on special machine tools, and on tools that are specially prepared for a specific outline. The research objective of the article is to present the possibility of creating a helical surface with a circular concave profile on a CNC lathe with a universal tool: a ball-end mill cutter. In the case of the proposed processing method, the surface of the worm is shaped with a spherical-end mill cutter in many passes, and its shape depends on the setting of the tool. This machining method must be performed on CNC machines, and the tool is not geometrically related to the shape of the machined profile. The paper presents the mathematical apparatus for generating a concave helical surface. Based on the calculations, the worm was processed with a spherical-end mill on a CLX350 V4 DMG MORI turning machining center. The surface-quality analysis was carried out on a contact profilographometer, while the dimensional accuracy was verified on a coordinate-measuring machine, and the maximum tolerance field of the measurement was 13 μm. On the basis of the measurements made, the accuracy of the worm outline is consistent with the theoretical assumptions. Using the presented method of machining, we can shape helical surfaces with an assumed profile in the axial section on a CNC machine tool with the use of universal tools.     

A case of cystadenocarcinoma of the liver

A case of cystadenocarcinoma of the liver is reported. The patient was a 73-year-old woman in whom a tumor was detected in the lateral segment of the liver during a health examination. Ultrasonograms and computed tomograms showed a multilocular cystic mass. Magnetic resonance imaging (MRI) showed a multilocular lowintensity mass, including a high-intensity portion and a portal branch compressed by the tumor. MRI with gadolinium showed an enhanced cyst wall. The cystic part of the tumor became smaller and the solid part became larger over a 1-month period, indicating that the tumor was malignant. Subsegmentectomy (S₃) was performed and cystadenocarcinoma with cystadenoma was diagnosed by histopathological examination. Identification of changes in the appearance of a tumor should be helpful for the differential diagnosis of cystadenoma and cystadenocarcinoma.     

Use of inderal for the treatment of different forms of arterial hypertension]

Results are presented on the treatment with Inderal of 57 patients with essential hypertension and symptomatic renal hypertension in whom the changes in central and renal haemodynamics were carefully traced. In all the patients with renal hypertension (chronic pyelonephritis, chronic glomerulonephritis) the function of the kidneys was adequate. Inderal when used in a daily dose of 120--160 mg produces a hypotensive effect in patients with stage IB and IIA essential hypertension with unstable symptomatic renal hypertension who have a predominantly hyperkinetic type of the circulation. In such cases the haemodynamic changes manifest themselves in a considerable reduction of the cardiac output at the expense of a slower pulse rate and decreased stroke volume; the total peripheral resistance was moderately elevated. In patients with stage IIB of essential hypertension and in those with persistent and severe symptomatic renal hypertension the hypotensive effect of Inderal given in a daily dose of 480 mg and sometimes even higher was accompanied by a statistically significant decrease in the total peripheral resistance and a moderate reduction of the cardiac output and cardiac index at the expense of a slower pulse rate.     

Local treatment of carcinoma of the rectum

Conclusions Local treatment of carcinomain situ of the rectum is the procedure of choice. It is also preferable when there is a focal malignant change in a polyp with a pedicle that is not invaded by the cancer, and when a sessile carcinoma of low grade is less than 2 cm. in diameter. These indications may be extended in some cases when the general condition of the patient precludes a radical surgical procedure, when the patient, because of a poor mental condition, would not be able to manage the colostomy himself, and when a colostomy is refused. When a carcinoma of the rectum is inoperable, or when there is distant metastasis, local treatment may provide gratifying palliation. Read at the Canberra meeting of the Royal Australasian College of Surgeons. Canberra, Australia, November 28, 1964.     

Microanalysis of Worn Surfaces of Selected Rotating Parts of an Internal Combustion Engine

The present paper analyzes the damage of surfaces at spots of frictional contact, namely, the friction nodes on a camshaft and the connecting rod pins of a crankshaft. The resulting wear of the monitored friction nodes reduces the technical life of the machines, which can lead to the decommissioning of the machine. Wear was assessed by measuring roughness and microhardness and by observing the microstructures of the materials. The results of the experiments show that the rotating parts displayed visible wear on the cams, as well as on the connecting rod pins. The experiments revealed that wear was caused by the heating of the material to a high temperature during the operation of the machine and that there was a gradual cooling and tempering of the material, which led to a reduction in the microhardness of the monitored object. Lower microhardness values can be a cause of greater wear of the monitored objects. When comparing the microhardness of the used and the new camshaft, the hardened layer of the new camshaft from secondary production has a significantly smaller thickness compared to worn cams, which leads to the finding of a different material quality compared to the original parts from primary production. This fact indicates that the wear of a new camshaft as a spare part can contribute to the shortening of the technical life of friction nodes.     

The complete spectrum of pentalogy of Cantrell in one of a set of dizygotic twins: A case report of a rare congenital anomaly

Rationale:Pentalogy of Cantrell (POC) is an extremely rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births. Its complete form includes a midline epigastric abdominal wall defect, defects affecting the lower sternum, anterior diaphragm, diaphragmatic pericardium, and various intracardiac defects.Patient concerns:We report a case of complete POC affecting only the first-born of a set of premature dizygotic twins.Diagnosis:A giant omphalocele with an eviscerated liver and bowel on prenatal, obstetric ultrasonography at 24 gestational weeks was observed. At birth, physical examination confirmed a massive (10 × 8 cm) epigastric omphalocele in which a significant part of the liver was seen. A postnatal echocardiogram revealed the presence of an ostium secundum atrial septal defect, perimembranous ventricular septal defect, and moderate pulmonary stenosis. X-ray showed an abnormal intrathoracic positioned stomach, which was confirmed with a plain x-ray of the upper intestinal tract with hydrosoluble contrast. Computed tomography (CT) scan revealed the sternum''s absence and a close connection between the pericardial sac and the stomach wall.Interventions:The patient underwent surgical intervention at 18 days of age.Outcomes:Despite adequate and appropriate postoperative treatment, the baby rapidly deteriorated and died 72 hours after surgery.Lessons:POC is a complex, high-mortality syndrome whose management requires a multidisciplinary approach and meticulous planning. Despite all efforts, POC carries a poor prognosis, particularly in patients affected by its complete form.     

Analysis of the specificity of physostigmine stimulation of adrenocorticotropin in man

Five normal men were given infusions of saline and three doses (6, 12, and 18 micrograms/kg) of physostigmine, a centrally acting anticholinesterase, after pretreatment with glycopyrrolate, a peripheral cholinergic antagonist. There was no increase in basal ACTH or cortisol concentrations in any of the subjects after saline or the two smaller doses of physostigmine. However, each subject had a marked increase in ACTH and cortisol levels after the largest dose of physostigmine. These changes were preceded in each subject by the occurrence of noxious side effects and were accompanied by a rise in PRL levels in four of the subjects. Four subjects who received physostigmine (12 micrograms/kg) without glycopyrrolate pretreatment also experienced noxious side effects; these symptoms were followed by elevations in ACTH, cortisol, and PRL levels. These findings suggest that physostigmine stimulates ACTH and cortisol secretion through a stress-mediated effect rather than through a specific cholinergic mechanism. Consequently, physostigmine is not a reliable tool for investigating the cholinergic regulation of ACTH and cortisol.     

人体寄生虫学教学改革效果分析

对郑州大学医学院教学改革组和对照组学生进行问卷调查及试卷分析,了解人体寄生虫学教学改革措施的实施效果。教改组学生对教学的满意度和评价均高于对照组学生,其成绩亦优于对照组(t=3.072,P<0.05)。积极探索并实践教学改革新模式可充分调动学生的主观能动性,有利于提高教学质量和效果。