Epidemiological,clinical and prognostic indices in IgA nephropathy

Summary: IgAN is the commonest primary glomerulonephritis in all parts of the world; the different incidence reported in different geographical areas is mainly due to different biopsy policies, even though genetic factors, still unclarified, may be acting. Progression to ESRF occurs in IgAN at a variable rate (average renal survival at 10 years is 80–87%), and many studies, reviewed in this paper, have sought to identify clinical and histological features which are predictive of the outcome. A functional impairment at presentation and a severe proteinuria are the most powerful clinical indicators of unfavourable prognosis, while both glomerular and interstitial sclerosis are the most reliable histological indicators. The fact that these prognostic indicators are not always reliable in predicting the outcome for a single patient, probably due to the pathophysiology of the progressive damage in this disease, is stressed.     

Valvular heart disease

Summary Although valvular stenosis may be evaluated adequately by measuring transvalvular pressure gradients with Doppler echocardiography and cardiac catheterization, these methods have failed to provide reliable and accurate quantification of valvular regurgitation. In recent years the development of magnetic resonance imaging has broadened the diagnostic spectrum in cardiology, since it allows assessment of ventricular volumes without geometrical assumptions and the non-invasive quantification of blood flow within the heart and great vessels. The purpose of this overview is to evaluate “established” diagnostic tools and to show the capabilities of magnetic resonance imaging in the assessment of valvular heart disease. Eingegangen am 18. Dezember 1996 Angenommen am 19. Dezember 1996     

The quality of acute stroke units on a nation-wide level: the Austrian Stroke Registry for acute stroke units

Concepts for stroke units that cover the acute phase vary. Therefore, the network of acute stroke units that is being set up in Austria in a uniform way is of general interest. This nationwide network has been established in accordance to evidence-based recommendations and prespecified criteria for available resources. The location for such a unit follows a maximum of 90-min isochrones (transport time) to the hospital. The quality of the network is currently documented and the results are reported. A nationwide stroke registry was prospectively performed on 15 stroke units that were already functional in this network. The aim was to document the quality performance of Austrian stroke units, focusing on rapid admissions, ready availability of investigations and therapies performed. Outcome measures were Barthel scale, Rankin score and percentages of complications. Between August 1998 and December 2000, 2,313 patients with ischemic stroke or with primary intracerebral hemorrhage admitted to an Austrian stroke unit within 24 h after onset of symptoms were prospectively included. Forty-three percent of the patients had a moderate or severe stroke. Fifty-seven percent of all patients were admitted to the stroke unit within 3 h after the onset of symptoms. Twenty-seven percent of these patients were brought in by ambulance accompanied by an emergency physician. Two percent of patients were admitted by helicopter. Fifty-four percent of patients had their first brain imaging within 30 min after admission, another 26% within 3 h. Intravenous thrombolysis was performed in 4.1% of patients. The overall stroke-unit mortality was about 6.8% and mortality at 3 months was 12.9%. The outcome at 3 months showed a modified Rankin Scale score of 0 or 1 in 47% of patients, denoting none or mild impairment. This network of acute stroke units is highly efficient in terms of rapid admissions, short intrahospital delays, as well as rapid use of readily available investigations. Stroke units seem to be well accepted by the general public and the medical community because our data show that all types of strokes are treated in Austrian stroke units, including severe strokes. The total number of concurrently treated acute strokes in other institutions across Austria is not known and no formal comparison with other systems of hospitalized care was undertaken, therefore further research is necessary.     

中药治疗Mondor’s病34例临床分析

Mondor's病又名胸腹壁浅静脉血栓性静脉炎,是一种少见病,目前尚无特效治疗方法。1982年～1990年我院门诊采用中药“静脉炎”片治疗22例,20 d内治愈者占95.5％;对照组12例,20 d内无1例痊愈。     

Periodontal diseases in HIV-infected patients

Abstract Periodontal diseases may be the first clinical sign of human immunodeficiency virus (HIV)-infection. Since the immunosuppression and subsequent susceptibility may alter the responses of the oral tissues as well as the microflora, both periodontal treatment and result of therapy may be modified. The periodontal diseases in HIV-seropositive patients include common as well as less conventional forms of gingivitis and periodontitis, and bacteria, mycotic and viral infections are seen. Neoplasias may also involve the periodontium; most common are Kaposi's sarcoma and non-Hodgkin's lymphoma. Recent studies of unselected groups of patients indicate that periodontal health in at least some groups of HIV-seropositive patients is better than previously reported.     

Quantitative Analysis of the Tomographic Technetium－99m MIBI （~（99m）Tc－MIBI） Myocardial Bullseye Display： Application to Diag

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Pallidotomy in Parkinson's disease improves single-joint, repetitive, ballistic movements, but fails to modify multijoint, repetitive, gestural movements.

We studied 12 non-demented PD patients in on state before and 3 months after posteroventral pallidotomy (PVP), in order to evaluate the effects of surgery upon an unconstrained, multijoint skilled movement as well as a single joint, repetitive, ballistic movement. A Selspot II System was used for three-dimensional data acquisition, processing and reconstruction of limb trajectories. Specific wrist kinematic features of spatial accuracy (linearity and planarity), temporal attributes (acceleration and velocity), spatiotemporal relationships (velocity-curvature coupling), and joint kinematic variables (relationships between wrist and elbow velocities and relative arm angle amplitudes) for each cycle of movement were graphically and numerically analysed. QMC was applied to single joint, repetitive, ballistic movements. QMC significantly improved after PVP (P < 0.0006). However, wrist as well as joint kinematic variables of the gestural movements failed to change significantly after PVP. The lack of improvement of the kinematic abnormalities of the gestural movement in PD patients would indicate that they are unrelated to the basic motor deficit; most likely they are the result of a disruption of a complex of sensorimotor integration processes due to abnormal parieto-frontal basal ganglia interaction.     

Neurologic outcome after heart transplantation in Chagas' disease

Objective - To evaluate the neurologic morbidity after orthotopic heart transplantation (OHT), we examined consecutive Chagas' (Ch) and non-Chagas' (NCh) patients, before and after surgery. Material and methods - We undertook neurological and neuropsychological evaluations in Ch and NCh patients with end-stage cardiac failure, from September 1993 to September 1995. Results - Of 10 Ch patients (mean age=33.6 years; 7 male; mean follow-up=10.8 months) and 13 NCh patients (mean age=50.9 years; 12 male; mean follow-up=15 months) 3 died (rejection and sepsis) without neurologic symptoms. Neurologic complications occurred in 4 Ch and 5 NCh patients. Two Ch patients had skin and myocardial Chagas' reactivation successfully treated, without CNS involvement. NPS performance and return to work rates were similar in both groups. Conclusions - Although Ch patients are potentially at a higher risk of Trypanosoma cruzi reactivation, in addition to all known neurologic complications of OHT, early neurologic complications detected in this sample were similar in Ch and NCh patients and could not be specifically related to Chagas' disease.     

肾脏疾病患者治疗前后血浆内皮素水平动态变化及其意义

目的 为了探讨肾脏疾病患者血浆内皮素水平与肾脏疾病病情程度的关系,为肾脏疾病治疗效果的评价提供依据.方法 采用放射免疫分析(RIA)观察了77例肾脏疾病患者治疗前后血浆内皮素水平的动态变化,并与60例正常对照组比较.结果 正常对照组血浆内皮素浓度为43.1±15.2ng/L,肾脏疾病患者治疗前血浆内皮素水平为161±83.8ng/L,治疗后为97.4±52.7ng/L,均高于正常对照组(P值均<0.001).肾脏疾病治疗后内皮素水平明显下降(P<0.001),与BUN,Cr水平的下降具有一定的相关性(相关系过分别为0.54,0.55).结论血浆内皮素水平随着肾脏疾病严重程度的增加而升高,血浆内皮素水平可作为肾脏疾病治疗效果评定的指标之一     

Diagnostic imaging of spinal cord lesions

Magnetic resonance imaging (MRI) has greatly facilitated morphologic evaluation of spinal cord lesions. Eleven cases representative of inflammatory, demyelinating, neoplastic and vascular diseases, are presented which illustrate and summarize important abnormal features in spinal cord imaging, particularly MR findings. Recently, specialised techniques such as MR angiography, fat-inhibiting methods, dynamic MRI and functional imaging have been developed. These methods have facilitated not only lesion diagnosis but also qualitative assessment, and are being used to analyze pathophysiology. Comprehensive diagnoses based on such modalities may be important in determining indications for surgery or defining the extent of surgery or the intensity of other treatments.