Clinical aspects and therapy of Sheehan's syndrome and its special forms]

Sometimes the Sheehan-syndrome appears in form of a partial insufficiency and sometimes also with atypical symptomatology. From this result diagnostic and therapeutic consequences, the peculiarities of which are exhibited. The acute form of the course is dangerous. It makes necessary the use of a specific emergency treatment, whereby the result of the highly threatening condition depends on its consequent application. When a competent therapy is carried out the life expectancy of female patients suffering from the Sheehan-syndrome is no more to be regarded as reduced.     

Immunopathogenetic aspects of chronic hepatitis]

In a short survey aspects to the immunopathogenesis of chronic hepatitides are explained. Hereby, partly critically, humoral and cellular immunophenomena are discussed, furthermore, the author deals with genetic factors, viruses and drugs as a cause of autoimmune hepatitides. Finally a simple working hypothesis to the pathogenesis is formulated and it is tried to classify the chronic aggressive hepatitis into six sub-groups on the basis of immunological, clinical and biochemical criteria: 1. much HBAg-associated, 2. lupoid, 3. drug-induced, 4. autoimmune cholostatic mixed form, 5. much associated with Ak to endoplasmatic reticulum and 6. undefined.     

Genetic aspects in Klippel-Trenaunay syndrome]

A thorough study of the genetic aspects of Klippel-Trenaunay syndrome revealed two further cases of K.T. in the family 2 of the 86 patients questioned. In addition, 7/4,000 first degree relatives had flat angiomas. The authors suggest that these individuals are in fact "mini-Klippels". "Formes frustes" of the syndrome can be explained by variable expression of the genetic defect. In all, 7/86 families were of particular genetic interest: - two families with two individuals suffering from KTS; - five families with several individuals with flat angiomas on one or more limbs. All these findings suggest multifactorial inheritance of the syndrome. It is not possible to calculate the precise probability of inheritance of the syndrome on the basis of our figures but we consider it to be of the order of 1 to 2%.     

Leg ulcers in Werner's syndrome. Report of one case]

Werner's syndrome (adult progeria) is a rare autosomal recessive condition characterized mainly by a characteristic habitus (short stature, light body weight) scleroderma like changes of the limbs and premature aging. Chronic leg ulcers appears in about fifty per cent of the patients. These ulcers can be related to the combination of mechanical factors on atrophic subcutaneous tissue and skin of the feet and leg associated with early arteriosclerosis (20%) and diabetes mellitus (60%).     

Clinical aspects and therapy of chronic pancreatitis]

Not infrequently exact diagnosis of chronic pancreatitis is possible only after step by step observation. The results of examination, analyses and treatment should be communicated from a general practitioner to a specialist, further to a specialized centre and vice versa. Screening tests and special examinations should be conducted in definite order. A surgical treatment is desirable in approximately 40% of clinically pronounced chronic pancreatitis. The best results are obtained by close cooperation between different specialists and the patient himself.     

Various aspects of drug therapy of chronic forms of ischemic heart disease

Experience in the treatment of over 500 chronic coronary patients with various anti-anginal drugs or their combinations is summarized. Controlled (double blind) and open studies and acute pharmacologic tests demonstrated comparative efficacy of depot-nitrates, beta-blockers, oxyfedrine, cordaron, lidoflazinum, molsidamine (corvaton). The effects on exercise tolerance (bicycle ergometry) with isolated and combined use of the drugs are described. Indications for surgery are discussed.     

Anatomical viewpoint and physiopathological aspects of Wolff-Parkinson-White syndrome]

Reviewing various histological and physiopathological conditions pertinent to the WPW syndrome, attention is focused on the particular position of the HIS bundle, which is entrapped in different densities of connective tissue and in a turning point of the a.-v. conduction. In particular it may be stretched between one fixed limit at its Tawara extremity and its opposite limit which is relied upon the atrial contraction just in the ventricular presystole. This mechanical moment, together with a pathological trigger point in the HIS bundle, could assume the abnormal function of a timing factor of a.-v. conduction as well of the intraventricular one. In a summary manner two diagrams make effort to give likeness of this pathological viewpoint to an observer who is rather sceptical about the histological genuiness of many accessory bundles.     

Complicated forms of superinvasion opisthorchiasis: pathogenetic aspects

Superinvasion opisthorchiasis is characterized by host growth retardation and weight reduction, which are due to the cleptoeffect of Opisthorchis felineus; metabolic disturbances, proliferative processes, accelerated collagen biosynthesis and biodegradation in the organs reflect parasite-host interactions as components of the system. The productive reactions of visceral pathology are initiated by the parasite's metabolites located in the liver, lung, heart, and testes.     

Biopsychosocial aspects of chronic fatigue syndrome (myalgic encephalomyelitis).

Fifteen patients, with a primary complaint of chronic fatigue, were referred to a physician by their general practitioners. Psychological distress, measured by simple psychiatric rating scales was common, but specific psychiatric diagnoses, derived from a comprehensive diagnostic interview, occurred less frequently. One questionnaire (Montgomery-Asberg depression rating scale) found emotional distress in 93%, but the diagnostic instrument (Present State Examination) suggested depressive syndromes in only two patients (13%). There were significant occupational difficulties in 87%. No consistently abnormal indices of biochemical or immunological function were found, nor evidence of acute or chronic infection. Chronic fatigue syndrome (CFS) is associated with physical, psychological and social distress. The illness cannot be defined using just one of these dimensions. Such a unilateral approach has resulted in unnecessary controversy over the nature of the 'real' core of CFS. A problem-oriented approach, recognising the multi-factorial and overlapping cause and effect issues in CFS, may be of more benefit to patients.     

Natural course and medical treatment of chronic pancreatitis]

Chronic pancreatitis is a progressive disease without curative treatment. Abdominal pain is the most predominant symptom of chronic pancreatitis that initially brings most of the patients to the physician's attention. Some studies have correlated the course of pain in chronic pancreatitis in comparison with the duration of the disease, progressing exocrine and endocrine pancreatic insufficiency, and morphological changes such as pancreatic calcification and duct abnormalities. Furthermore, the course of pain has been studied after alcohol abstinence or surgery in some groups. However, there are only few well-performed and valid studies, and some of them even have produced diversing results, in part. Further controlled studies harboring a large number of patients in a multicenter setting should be considered. Therapeutic efforts on chronic pancreatitis have focused on palliative treatment of pain which is present in about 80% of cases. Endoscopic treatment of pain in chronic pancreatitis is useful and feasible in many patients. Selecting candidate for endotherapy is mandatory. Main indication of pancreatic stent insertion in chronic pancreatitis is the presence of an obvious ductal stricture. Complications of chronic pancreatitis are also indications of endoscopic intervention. Exocrine and endocrine insufficiencies should be meticulously managed to prevent complications and to maintain good quality of life.