Endomyocardial fibrosis in Ethiopia.
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Biomedical subjects
Publications and source records attributed to S Abate.
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Records of 134 patients treated by abdomino-perineal resection (1971-1979) were reviewed. One hundred and thirteen had curative operations. Mortality was 2.6% and morbidity was 51%. Ninety-three were evaluable and were followed for 5 to 8 years; they were evaluated for survival and pattern of recurrence. Five-year survival for Dukes' A, B, C, and D lesions was 86, 62, 31, and 0%, respectively. Thirty-seven had recurrence: Four pelvic, nine pelvic and distant, and 24 only distant lesions. The overall incidence of failures was 47%, failure rates by stage were 11% for stage A, 27% for B, 48% for C, and 70% for D. Incidence of local recurrence was significantly higher in stage C compared to stage B. Irrespective of stage, after detection of local or distant recurrence, survival did not differ. Furthermore, radiotherapy for local recurrence and chemotherapy for distant lesions did not improve survival time.
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In view of the growing number of examinations proposed and employed for the diagnosis of diseases of the thyroid, a retrospective evaluation was made of their validity in a series of 2500 patients (1500 operated). Attention was paid to scintiscanning, oncotropic indicators, echography, needle biopsy, thyrolymphography and thyroid hormones as aids to determining the nature of thyroid lesions and the planning of their treatment. Scintiscanning and needle biopsy proved of primary importance in determination of the nature of a lesion. Echography supplied additional, though not necessarily indispensable information. Oncotropic indicators and thyrolymphography do not appear to be useful. They do not provide data enabling a diagnostic problem to be solved, but can only help to increase any doubts that may exist. Determination of thyroid hormones is clearly indicated when planning the management of hot lesions (single, multiple or disseminated nodes), in cold lesions where thyroiditis is suspected, and in all cases where the clinical evidence suggests hypothyroidism. In euthyroid subjects requiring surgery with no objective signs of hypofunction, preoperative determinations appear to be unnecessary, where as post-operative values are of assistance in assessing the functional efficiency of the residual thyroid tissue. The conclusion to be drawn, therefore, is that diagnostic examinations should be employed in a more selective and discriminating manner.
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Treatment of hyperthyroidism is still debated, surgery in particular is conceived as the last step of a multidisciplinary approach. 130 patients were reviewed in a follow-up based on a double cell at fixed dates, after subtotal thyroidectomy for multinodular and diffuse toxic goiter. Clinical and laboratory tests (T3, T4, TSH) showed a rate of 9.1% of recurrent toxicity and 20.7% of hypothyroidism. These data confirm that surgery offers satisfactory results in the management of hyperthyroidism if indications are carefully followed. It is also shown that TSH has a predictive role in the screening of patients at risk of developing postoperative hypothyroidism.
An open label, non-controlled trial of six-month duration was designed to determine the safety and efficacy of auranofin in the treatment of 13 children with polyarticular JRA. Adverse reactions were observed in 5 of the 13 patients (38%) but only in one was it serious enough to discontinue treatment. None of the patients developed diarrhea or hematologic abnormalities. Therapeutic response was evaluated in the 11 patients who completed the six-month treatment. According to the final overall assessment 9 of the 11 children had improved, one remained unchanged and one worsened. After four months of treatment serum gold levels in 11 patients ranged between 28 and 59 micrograms/dl, with a mean value of 34 micrograms/dl. There was no correlation between serum gold levels and the frequency and severity of side effects.
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Zolimidine 2-(methylsulphonyl-phenyl)-imidazo-(1,2-a)pyridine produces a high percentage of healing of gastro-duodenal ulcers. The action of the drug develops through an increase of protective factors on the gastric mucosal barrier. This study has the purpose of evaluating if the action of the drug is also mediated by microvascular factors. The analysis of the values of BAO, MAO and PAO confirmed that treatment with zolimidine does not modify gastric acid secretion; the values of the Neutral Red clearance at PAO, before and after the treatment, do not show a statistically significant variation of the gastric mucosal blood flow. According to the most recent literature, the increase of the gastric mucopoietic activity is carried out by a direct cellular action.
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Personal experience with autoimmune lymphocyte thyroiditis, represented by 11 cases observed between 1972 and today, is reported. After some brief aetiopathogenetic notes on the lesions in question, the problems of diagnosing the nature of the thyropathy are stressed. After reviewing the examinations that have been proposed in the literature, it is noted that the preoperative recognition of a thyroiditis with autoimmune genesis is still problematical. The institution of a diagnostic protocol based on the systematic search for antibodies, the perchlorate test, the thyrostimulation test, ESR study, the search for alpha2 and gamma-globulins, scintigraphy with positive indicators and needle biopsy as well as on scintigraphy and thyrometabolic tests (T3-T4-TSH-TRH test) is proposed. Even when such a protocol is adopted, however, it should be mentioned that only in 18% of the personal cases was it possible to diagnose thyroiditis, in the other subjects this being merely an occasional post-operative finding. In confirming the personal therapeutic approach, which at least initially is medical, for recognized forms, it is pointed out that surgical treatment is to be preferred in certain cases because of the presence of compressive phenomena, and in others it appears capable of relieving, in follow-up, the thyroiditic process, probably as a result of the removal of the antigenic tissue.
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