[Crimes and offenses in the prodromal period of mental diseases].
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The medical examination of persons who have no medical complaints is a procedure that has different purposes than the traditional diagnostic examination. These include not only the detection of incipient disease but the evaluation of the adjustment of the individual to his environment and an assessment of his personal hygiene. It should be concluded by a discussion of what has been found, and by positive, persuasive advice and education which will lead to better health. Interest in such work and competence for it are not found in every physician. Physicians who do not want to acquire such competences should recognize the fact and refer such work to others who are prepared to cope with it. Inept, incomplete health examinations disappoint the patient and make the physician uncomfortable; thorough, constructive examination and counseling is satisfying and profitable to both.
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The mechanisms of acute myocardial infarction depend on the site of myocardial infarction (MI). In anterior MI, the main factor is a large area of injury; in inferior MI, of importance is dysfunction of the papillary muscles and multiple lesions of the coronary artery in addition to the above factor. The site, the area of injury and the status of the coronary bed influence the rate, character and prognostic value of early load test criteria and contractile function of the left ventricle. In anterior MI, elevation of the ST segment is the most frequent criterion; in inferior MI, its depression. Their combination with other criteria for test discontinuation point to multiple lesions of the coronary artery. In patients with anterior MI, the ejection fraction of the left ventricle amounting to 40%, inadequate growth of AP, anginous pain and the T dominant elevation of the ST segment are unfavourable predictors, allowing the patients to be differentiated in accordance with the risk of postinfarction complications.
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The author analysed files of 101 patients suffered from chronic radiation sickness due to chronic occupational mainly external radiation (dose of 98 to 947 cGy). Through represented clinical diagnoses, the author studied age of primary diagnosis of ischemic heart disease, cerebrovascular diseases in general and of individual entities, arterial hypertension, relationships between age at the diagnosis and total radiation dose, dose rate. The article presents comparative data on dose loads, time of various cardiovascular diseases diagnosis in accordance with circulatory disorders during chronic radiation sickness.
Under observation there were 29 casualties with severe combined trauma complicated by acute heart failure (AGF) caused by a direct injury of the heart, without severely disturbed consciousness and valuable blood loss. In 65% of the patients the trauma was severe, in 35%--extremely severe. Higher ST wave was registered in ECG of 40% of the patients in standard leads, in 30% there was no wave R in chest leads. Disturbed rhythm was noted 2-2.5 times more often than in other kinds of injuries. Ventricular extrasystoles, paroxysmal ciliary arrhythmia, atrioventricular and ideoventricular rhythm were determined since the first day after trauma. The results of the investigation have shown that the primary injury of the myocardium was followed by a decreased heart work. Circulatory insufficiency of blood circulation was developed. The impaired systemic hemodynamics led to inadequate delivery of oxygen to the tissues and of oxygen consumption, to the development of tissue hypoxia and respiratory disorders closely connected with it. The circulation disturbances caused also a suppression of detoxication mechanisms of organism, the development of disseminated intravascular coagulation and endotoxicosis.
The authors have made an analysis of the frequency and character of intravascular microthrombi found in the capillaries and venules of the inner organs on the basis of results of 20 autopsies of adult patients with DIC having the burned body surface from 25 to 90%. The patients were treated and died in the Russian Burn Center. In the 18 dead out of 20 patients different kinds of microthrombi were revealed. The greatest number of microthrombi were found in the brain, the fewest--in the kidneys.
The influence of piracetam on the level of inorganic and phospholipid phosphorus in blood of ischemic stroke patients was evaluated. In healthy patients piracetam (2G, i.v.) diminished the concentration of inorganic phosphorus and essentially lowered the content of ion connected with phospholipids. In stroke patients inorganic phosphorus was primarily enhanced and organic lowered. Treatment with piracetam lowered the concentration of both inorganic and phospholipid phosphorus in blood.