A probable case of chronic occupational thallium poisoning in a glass factory

The sliding door flap raised on the surface of the vermilion to the oral mucosa has been used for reconstruction of soft-tissue defects of the lower lip. The blood supply to this flap comes from the bilateral inferior labial artery. Utilizing both sides of the arteries, bilateral flaps allow for safe and easy transfer of the vermilion tissue to partial defects of the red lip. These flaps have been used in cases of lower lip defects with complete survival. The sliding door flap has increased mobility by at least 1 cm more than by the other style of flap reported by Goldstein. Moreover, this flap contributes to excellent cosmetic results. Our technique and clinical experiences are presented.     

Lag signs in the diagnosis of rotator cuff rupture

We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign (IRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions.     

Skin tests in the diagnosis of eruptions caused by betalactams

The assumption that the amount of rainfall in the summer months influences the frequency of TBE is based on the fact that the determining factor for the existence, development and activity of Ixodes ricinus is relative air humidity (RH) and the finding that low RH negatively influences dynamics of infection and infection rate of I. ricinus with TBE virus. A higher incidence of TBE then develops due to the coincidence of increased activity of ticks and recreational activity of humans after an intense prolonged rainfall. This presumption was verified by comparing the dynamics of rainfall as an indicator of RH in the tick environment with concomitant seasonal fluctuations of TBE incidence in humans. The total monthly rainfall in two regions of the Czech Republic was compared with data on the incidence of TBE in each respective region and period. Furthermore, in the district of Ceské Bud?jovice, typical by high prevalence of this disease, a detailed follow-up was carried out by decades. The comparisons were made between April and October from 1993 to 1995. The values of both variables were related to their long-term averages estimated within each particular period and region. Monthly data were analyzed for the Central Bohemian Region and the South Bohemian Region, both with a high incidence of TBE. The July above-average incidence of TBE was preceded by an above-average rainfall in June. If there was a below-average rainfall, there was a below-average incidence of TBE afterwards. Whenever, there was an above-average rainfall in August then there was an above average incidence of TBE in September, in the opposite case, no September peak of TBE occurred. The follow-up at ten-day intervals shows that any above-average rainfall was followed by an increased incidence of TBE, in every other ten-day period or two. This time shift is due to the incubation period, and partly also to the scattered attacks by ticks during the period of increased RH. The relationship found could be useful for the short-term prognosis of TBE incidence as well as for individual prevention of this serious infection by taking special care when going outdoors after heavy rain.     

The reliability of cysto-urethrographic signs in the diagnosis of detrusor instability in children

OBJECTIVE: To assess whether the signs associated with detrusor instability (DI), as assessed by video-urodynamic studies, can be evaluated by conventional voiding cysto-urethrography (VCUG). PATIENTS AND METHODS: Fifty-nine children who underwent cystometry and VCUG were reviewed and divided into two groups; group 1 comprised 51 neurologically normal children who had DI (47 girls and four boys, mean age 7.9 years, range 4-14), with no malformations or previous surgery. Most had mixed symptoms, including urinary tract infections (44) and nocturnal enuresis with daytime symptoms (20); group 2 (control) comprised eight children (seven girls, mean age 9.7 years, range 6-15) with a stable bladder and the same clinical presentation. The interval between VCUG and cystometry ranged from 1 day to 5 months (mean 47 days) and was similar in both groups. Signs considered suspicious of DI were sought in the findings of VCUG. RESULTS: In group 1, VCUG was normal or showed no specific signs (only vesico-ureteric reflux or vaginal voiding) in 25 (49%) of patients, whereas 26 (51%) had some signs suspicious of DI. Suspicious signs were urethral ballooning (in 11), bladder trabeculation or a constricting ring (eight), a 'spinning-top' urethra (three), urethral notching (two) and Mercier's bar (one). In group 2, five patients had no abnormal findings on VCUG and three had suspicious signs. The positive predictive value of VCUG was high (0.89) but the diagnostic yield of suspicious signs was low, because the sensitivity (0.5), specificity (0.62) and overall accuracy (0.52) were low. CONCLUSION: Radiological signs suspicious of DI cannot be regarded as such in conventional VCUG, as although they were detected in half the patients with DI, they also occurred in three of eight children with a stable bladder.     

An overview of the laboratory diagnosis of lead poisoning

Four tests for the evaluation of lead poisoning are reviewed from both the clinical and methodological aspects. Whole blood or erythrocyte lead measurements appear to provide the best means of assessing the bodily burden of lead with electrothermal and Delves cup flame atomic absorption spectorphotometric techniques providing accurate and precise results. Urine lead is less reliable as a screening test for lead poisoning but is excellent for monitoring the course of ethylenediamine tetraacetic acid (EDTA) therapy. Atomic absorption methods for urine are made difficult by the variable matrix of urine but satisfactory electrothermal and flame procedures have been described. Erythrocyte delta-aminolevulinic acid dehydratase activity is a very sensitive index of lead exposure,--perhaps too sensitive. Analytical procedures for measuring this enzyme are subject to errors and many complicating factors such as lack of stability of the specimen limit the usefulness of the test. Urine delta-aminolevulinic acid is of questionable value as a screening procedure and also is subject to analytical problems.     

The importance of clinical symptoms and signs in the diagnosis of community-acquired pneumonia

PURPOSE: 118 Patients with suspected obstruction of the biliary tract of pancreatic duct were examined to evaluate the accuracy of MR cholangiopancreatography (MRCP) in comparison with diagnostic findings in endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Using a 0.5-Tesla MR imaging system (FLEXART, Toshiba) and a QD body-coil, a recently developed heavily T2-weighted fast acquisition spin echo sequence (FASE) was applied. In this FASE sequence two significant features are implemented. A fast spin-echo (SE) sequence allows a large number of echos and conjugate K-space filling speeds up data acquisition. Thus, the acquisition time of single-shot breath-hold images takes only 3 seconds, which makes MRCP a feasible technique even in elderly or suffering patients. There is no need for time-consuming postprocessing procedures. RESULTS: In all MRCP examinations images of satisfactory quality were obtained. In cases of obstruction of the biliary or pancreatic duct, locations and lengths of stenoses were correctly demonstrated. Gallstones within the gallbladder or in the extrahepatic bile ducts were also properly visualised in MRCP. Stenoses caused by non-depicted pancreatic carcinoma, gallbladder carcinoma, or segmental pancreatitis were reliably shown. CONCLUSION: Even if MRCP will not replace ERCP, a number of clinical applications for non-invasive MRCP examination arise: primary diagnosis in patients with obstructive jaundice, obstruction of the biliary or pancreatic duct, if ERCP is not possible due to anatomic reason and in patients scheduled for laparoscopic cholecystectomy.     

Role of the laboratory in the diagnosis and treatment of lead poisoning]

In an experimental canine model, topical application of phenylephrine hydrochloride (Neo-Synephrine) to the urethral mucosa was demonstrated to cause a rise of intraurethral pressure which persisted for over 2 h without any rise of arterial pressure. There was no intraurethral pressure change after the topical application of phentolamine (Regitine) or phenoxybenzamine (Dibenzyline). No effect was observed on the intraurethral pressure following isoprenaline (Isuprel) application, but a marked fall in arterial pressure was observed.     

Methods of early diagnosis and prevention of occupational mercury poisoning

Five intraventricular injections of phytopreparations lohein and abisib in a dose of 0.2 or 0.5 ml stimulated dose-dependently the development of a T-dependent and T-independent immune responses in rats kept on the usual diet, and increased or normalized the development of these processes in rats kept on a atherogenic diet. The drugs lessened lipid peroxidation and the biochemical syndromes of hepatocyte affection in animals given an atherogenic diet. The immunomodulating effect of phytopreparations is mediated by cytokines of adherent and nonadherent splenic cells, the biochemical effects only by cytokines of adherent splenocytes.     

火焰原子吸收光谱法测定粗铟中铊

粗铟样品中低含量铊的测定一般采用国家标准分析法 :甲基绿 -乙酸异戊酯萃取分光光度法。该方法操作繁冗 ,流程长 ,且有挥发性的有机溶剂乙酸异戊酯 ,危害分析人员健康。本文用原子吸收光谱法直接测定粗铟中低含量铊 ,测定结果与国家标准法一致 ,且操作简单、快速、选择性好 ,不使用有机试剂 ,改善了工作环境 ,节省了试剂。1　实验部分1 1　仪器和试剂WFX - 1C型原子吸收分光光度计。硝酸 (优级纯 ) :1 + 1 ;铊标准储备溶液 :1mg/mL ,称取 1 30 34g于1 0 5℃烘干的硝酸亚铊 (TlNO3,优级纯 )于 2 5 0mL烧杯中 ,加 1 5 0mL水溶解 ,移入 …     

Comparison of persistent thallium perfusion defects by quantitative washout analysis with thallium reinjection in patients with coronary artery disease

Thallium reinjection can improve the detection of severely ischemic viable myocardium in patients with coronary artery disease. However, a disadvantage of this method is that it requires the acquisition of 3 separate sets of images and the administration of an additional dose of the radiotracer. Alternatively, quantitative analysis of the regional myocardial washout of thallium-201 can be easily obtained from the conventional postexercise and redistribution images without additional imaging time or radiation exposure to the patient. To determine whether this method can predict the results of thallium reinjection, this study analyzed thallium-201 images of 31 patients who had persistent perfusion defects in qualitative exercise/delayed redistribution single-photon emission computed tomographic thallium studies and who underwent thallium reinjection. The quantitative mean radioactive counts of each myocardial segment that had a persistent perfusion defect in the initial and delayed redistribution on 4-hour short-axis tomographic slices were measured to derive a delayed/initial ratio, and these values were compared with the results of thallium reinjection. The delayed/initial ratio was 1.06 +/- 0.22 in 39 segments that improved, versus 0.58 +/- 0.18 in 43 segments without improvement after reinjection (p < 0.001). Thirty-eight of the 39 segments that improved had a ratio of > or = 0.75, versus only 3 of the 43 segments that showed no improvement (sensitivity, 98%; specificity, 91%). The correlation between the delayed/initial ratio and reinjection results was equally high at any segment location or severity. It is concluded that quantitative regional thallium washout analysis predicts the results of thallium reinjection in segments with persistent thallium defects.(ABSTRACT TRUNCATED AT 250 WORDS)     

Are the results of thallium scintigraphy and coronary angiography equivalent? An evaluation of thallium scintigraphies performed at Vestfold Central Hospital

The value of exercise-redistribution thallium-201 perfusion scintigraphy (SPECT; single photon emission computed tomography) in the diagnosis of coronary artery disease was evaluated in 23 patients (one patient tested twice) who were subsequently submitted to coronary angiography. Reversible perfusion defects indicating myocardial ischemia were found in 22 patients, of whom 18 had angiographically significant coronary artery stenoses. Two patients had negative thallium scans, one had a normal angiogram and one had single vessel disease. Thus 18 of 19 patients with angiographically verified coronary heart disease had a positive thallium scan. The majority of patients with left main stenosis and triple vessel disease had scintigraphic evidence of double or triple vessel disease. The scintigraphic method identified the correct anatomical localization in 73% of the angiographically verified coronary artery stenoses. In conclusion, a positive exercise-redistribution thallium scan had a high predictive value in the diagnosis of coronary artery disease, whereas its value in estimating the number and localization of stenoses was more limited.     

Skin problems in the traveler

Skin lesions are common in travelers and include a mix of mundane dermatologic problems and rare diseases acquired only in remote or tropical regions. The morphology, distribution, and progression of the lesions are useful in assessing possible causes. Early in the evaluation it is important to determine whether the patient might have a process that is rapidly progressive, treatable, or transmissible. In addition to routine laboratory studies, biopsy and serologic tests are often necessary to confirm a specific diagnosis.     

The use of exhaled carbon monoxide for the diagnosis of carbon monoxide poisoning. A case report

Antigliadin antibodies (AGA) mark celiac disease, but AGA are also encountered in IgA-nephritis, psoriasis, sickle-cell anemia, hepatic disorders, juvenile rheumatoid arthritis, autoimmune thyroidism and in persons who occupationally contact great amounts of wheat. AGA IgA and/or IgG were registered in 19 of 60 subjects (51 adults and 9 children) with various immunomediated diseases without symptoms of celiac disease: in 4 cases of chronic active hepatitis, in 2 of 4 cases of chronic persistent hepatitis, in 4 of 16 cases of rheumatoid arthritis, in 3 of 19 cases of IgA-deficiency, in 1 of 8 cases of SLE, in 2 cases of postvaccine reaction, in all the single cases of juvenile rheumatoid arthritis, focal scleroderma, macroglobulinemia. IgA only occurred in in 6 patients, IgG- in 6 patients, both IgA and IgG in 7 patients. The most pronounced positive reaction to AGA was recorded in 8-year-old girl with juvenile rheumatoid arthritis. The emergence of AGA in immunomediated diseases may be attributed to the response to food protein in pathological conditions and is often unrelated closely with celiac disease.