Difficulties in the electrocardiographic diagnosis of a previous posterior myocardial infarct

A retrospective study was carried out of 39 cases of posterior m.i. from 8 months to 6 years after acute episode. In each case the diagnostic reliability of the standard derivations of a series of parameters was evaluated (duration of Q D3 and Q aVF, Q.100/R ratio in aVF, R/S ratio in V1 and R V1/R V6) and of the following accessory derivations: De Maria, III P of Pescador (classical and in two personal modifications), dorsal and sternal derivations. It is concluded that in many cases, standard derivations do not enable previous posterior m.i. to be diagnosed. The De Maria and III P of Pescador derivations (with the proposed personal modifications) are advisable. In isolated cases, the sternal derivation may also be very useful.     

Difficulties in the diagnosis and treatment of uterine malformations

The authors shows detailed classification of Buttram and Gibbons for the Muller uterine anomalies. According this classification the anomalies are classified in 6 different groups based on the stage of insufficiency in the normal development. Many theoretical arguments have been made on the different malformations in groups. The stress has been put on the clinical view and the choice of a surgery behavior. Some special cases are described which caused difficulties with the diagnosis and the treatment. The anomalies in the different groups are illustrated in different figures.     

Value of the Di Maria leads in the electrocardiographic diagnosis of posterior myocardial infarct

Authors retain, on the basis of their experiences, that right chest leads proposed by Di Maria for the infer-posterior and postero-basic myocardium wall study can overall be useful in those cases which had posterior myocardial infarction and where standard leads did not show variations or showed untrustworthy variations. Therefore Authors also supported by vectorcardiographic findings, recommend the routine use of Di Maria leads.     

Stepwise diagnosis of intestinal hemorrhage

Endoscopy is the method of choice in diagnosing gastrointestinal bleeding. In case of acute and severe bleeding a bleeding-source in the upper gastrointestinal tract has to be excluded with priority. The efficiency of endoscopy would be enhanced by endoscopic Doppler ultrasound. A diagnostic gap in the region of small bowel possibly will be closed by recently developed push-enteroscopy. Angiography and scintigraphy with labeled autologous erythrocytes are reserved to bleeding of still unknown source. Enteroclysis and double contrast barium enema are necessary only in very rare cases.     

The stepchild of intestinal diagnosis. Evaluation of radiologic methods in the diagnosis of leiomyoma of the small intestine

PURPOSE: Various radiological methods to diagnose small bowel neoplasms and problems of differential diagnosis specially considering leiomyomas are discussed. PATIENTS AND METHODS: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography. Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. RESULTS: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed. The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. CONCLUSION: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly.     

Breath tests in intestinal diseases and functional gastrointestinal diagnosis

Among the numerous breath tests described for gastroenterological applications, breath hydrogen (H2) tests have emerged during the past two decades as a most sensitive, reliable and feasible method for detecting carbohydrate malabsorption and maldigestion (e. g. lactose maldigestion). Hence they are regarded time honored standards of contemporary gastroenterological function tests. For the diagnosis of the small bowel bacterial overgrowth syndrome the glucose H2 breath test is a feasible tool with moderate sensitivity (approximately 65%), which, however, is not higher with alternative breath test (e. g. the 1 g 14C-D-xylose breath test). Measuring mouth-to-caecum-transit time by the breath H2 response after lactulose is more of scientific interest than clinically informative. Breath tests making use of 14C labeled substrates (usually 5 to 10 microCi) bear a rather low calculated radiation hazard and are thus in routine use in some countries, e. g. in Scandinavia, but they are abandoned in others. At least, however, radioactive 14C breath tests are (partially) dispensible, as these restrictions do not apply for the stable isotope 13C breath tests which are nonradioactive and thus devoid of any radiation hazard. For the purpose of gastroenterological function testing the 13C urea breath test for the detection of Helicobacter pylori infection, quantitative studies of gastric emptying with 13C-acetate or 13C-octanoate and quantitative liver function tests have gained diagnostic use while 13C-breath tests assessing intestinal absorption or exocrine pancreatic function have been found less effective than the respective alternatives, or too expensive. Both, H2-breath tests and 13CO2-breath tests are clinically important, diagnostic methods with well delineated indications in gastroenterology.     

Myocardial infarct in the puerperium

Two women of 34 and 31 years suffered an acute myocardial infarction in the puerperium. One of them had many risk factors for atherosclerosis: hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, hypertension, obesity, nicotine abuse and a positive family history for cardiovascular disease. She had an occluded right coronary artery and was successfully treated with percutaneous transluminal coronary angioplasty. The other patient had an acute myocardial infarction after her first delivery. She was known with hypercholesterolaemia, obesity and nicotine abuse. During her latest pregnancy she was treated with acetylsalicylic acid. Again she developed an acute myocardial infarction in the puerperium, probably due to coronary dissection. Although the incidence of acute myocardial infarction is low in the peripartal period (less than 1 in 10,000) the diagnosis should be considered when a woman presents with chest pain or dyspnoea.