Respiratory insufficiency and absent left radial pulse after hemicolectomy

A 65 year old female developed right thoracic pain, productive cough and fever four weeks after hemicolectomy because of a cancer of the sigmoid. In spite of antibiotic treatment the condition of the patient deteriorated and she was admitted to the hospital with pneumonia of an upper lobe. Chest X-ray visualized prominent proximal pulmonary arteries. Progressive respiratory failure developed and blood gas analysis revealed hypocapnic hypoxemia. The patient had to be intubated and ventilated mechanically. Later, left arm blood pressure measurements could no longer be taken and the radial pulse was missing. Thereafter, an ischemic syndrome of the right leg developed. Embolectomy from the superficial femoral artery was carried out the same day. The patient died five days later. Autopsy revealed an almost complete occlusion of the pulmonary arteries. The organization of thrombotic material indicated recurrence. Emboli were also found in the systemic circulation. A large patent foramen ovale together with signs of pulmonary arterial hypertension are indicative of paradoxical thromboembolism.     

Cognitive disorders in patients with chronic renal insufficiency

Papillomaviruses are pathogens which induce cutaneous and mucosal lesions in man and in many animal species. The characterization of these viruses was rather low, because viral infection cannot be fully reproduced in cell culture. The development of molecular biology techniques in the 1970s permitted to establish the remarkable plurality of the viruses, the tissue specificity and pecular pathogenicity linked to the type. Studies of the genome organization, the gene expression regulation and the protein characterization gave many informations leading to understand the mechanisms of viral-related carcinogenesis, especially the role of HPV16, the major risk factor for the development of squamous cervical carcinoma.     

Clinical aspects, therapy and prevention of psychotic disorders in children and adolescents with cerebral residual-organic insufficiency

By means of a follow-up study the author examined 36 patients with cerebral residual insufficiency in the age group from 10-16 years. A psychotic and nonpsychotic variants of this form of pathology was detected. A psychotic decompensation may be evoked by a nonspecific exogenous factor. The clinical picture of a decompensation is characterized by affective disturbances and symptoms of changes consciousness. The treatment programme of the acute period of an exogenous-organic psychosis should include analgetics, desensitation, neuroleptical drugs, lithium carbonate, dehydration and cardio-vascular preparations.     

Features of episodes of mental disorders in chronic renal insufficiency (clinico-morphologic study)

The authors studied the traits of psychotic attacks in 40 patients with terminal stages of chronic renal insufficiency. They were expressed in atypical delirious, delirio-amentive and amentive conditions. 8 cases were studied morphologically. The pathological process in the brain was characterized as toxico-dyshomeostatic encephalopathy. The pathogenesis of such disorders is discussed.     

Respiratory insufficiency after intraperitoneal administration of Kanamycin: failure of calcium gluconate to reverse toxic effects

A 47-year-old woman developed postanesthesia respiratory insufficiency five hours after an intramuscular injection of 0.5 gm of kanamycin and one hour and 40 minutes after peritoneal lavage with 1.0 gm of kanamycin. The respiratory insufficiency was not reversed by an intravenous infusion of 400 mg of calcium gluconate. This is the third reported instance of respiratory insufficiency after kanamycin lavage. Only one of the previously reported patients responded to intravenous infusion of calcium gluconate, despite the experimental evidence supporting its efficacy.     

The diagnosis of microcirculatory-rheological disorders and their correction in patients with the initial manifestations of insufficiency of the cerebral blood supply

An evaluation was done of the state of bulbar microcirculation and aggregability of blood platelets in 47 patients presenting with early manifestations of cerebral circulatory insufficiency. A correlation was established between the revealed disturbances in the microcirculatory bed and augmentation of aggregational activity of thrombocytes. Computation of the integrative guide, microcirculatory-rheologic index, reflecting objectively the degree of intravascular hemocirculatory disorders has been performed. Treatment with calcium antagonist corinfar, antihypoxic agent actovegin was of particular benefit for the patients when administered in combination; more than half of the parameters characterizing microcirculation, rheologic properties of blood, microcirculatory-rheologic index have all returned to normal.     

Drug interactions in human neuropathic pain pharmacotherapy

The effects of 0.3 mg/kg methylphenidate (MPH) and expectancy regarding medication on the performance and task persistence of 60 boys with attention deficit hyperactivity disorder (ADHD) were investigated. In a balanced-placebo design, boys in 4 groups (received placebo/drug crossed with told placebo/drug) completed the task in success and failure conditions. Medication improved participants' task persistence following failure. Participants' task performance was not affected by whether they thought they had received medication or placebo. Children made internal attributions for success and made external attributions for failure, regardless of medication or expectancy. These findings confirm previous reports that it is the pharmacological activity of MPH that affects ADHD children's self-evaluations and persistence. The results contradict anecdotal reports that MPH causes dysfunctional attributions and confirm previous studies showing that medication does not produce adverse effects on the causal attributions of children with ADHD.     

Pseudothrombophlebitis in neuropathic arthropathy of the shoulder

The syndrome of pseudothrombophlebitis is a well-known complication of popliteal cysts. We report the case of a patient with a neuropathic arthropathy of the shoulder in whom pseudothrombophlebitis of the upper extremity subsequently developed. To our knowledge, this is the first such case that has been reported.     

Chronic renal insufficiency: 1) adaptation of nephron function in chronic renal insufficiency and 2) progression of chronic renal insufficiency

In chronic renal insufficiency resulting from destruction of the vast majority of nephrons, the surviving nephrons adapt their functions to the conditions of vigorous haemodynamic and osmolar overloads. They acquire an appropriate behaviour to preserve the principal renal functions and to achieve the balance of inner space. In the long period of time, similarly as in healthy people. Glomerulotubular balance as well as tubuloglomerular balance distinguish the remaining nephron function, while autoregulation of perfusion pressure along the glomerulus rapidly vanishes. All three regulation mechanisms are characteristic of the nephron function under physiologic conditions. Intense work of the remaining nephrons in chronic renal failure is under the high level controls of the group of hormones, among them are rennin-angiotensin system, arginine-vasopressin and atrial natriuretic peptide playing very important and particular roles. Comparison of different published studies emerge the idea that chronically increased arginine-vasopressin levels in chronic renal failure could block the autoregulation of blood flow and hydraulic pressure in glomeruli, which together with other mediator actions give high and fluctuating tense within remaining glomeruli, during every single cardiac cycle. It is probably the main event in the further course of kidney disease progression resulting in definite damage of the overloaded nephrons. Angiotensin II is one of reliably recognised mediators of unfavourable outcome in the process of nephron adaptation in chronic renal failure. Knowing the pathophysiologic processes in the remaining functionally adapted nephrons in chronic renal insufficiency determines a more adequate therapeutic approach in these patients.