Biomedical subjects

Z Rusavý

Publications and source records attributed to Z Rusavý.

At least 19 recordsLinked to original sources

PubMed2006

[Effects of insulin on glucose metabolism in sepsis].

The study surveys potential effects of hyperglycemia on prognosis, complications and mortality of critical patients. Normalization of glycemia seems to be an effective therapeutic approach that influences morbidity and mortality of critical patients. Although insulin therapy has many positive effects, it is rather a way how to achieve normoglycemia. Authors present their own research of the impact of plasmatic insulin levels on glucose metabolism. It seems that the ability of critical patients to utilise and store glucose is significantly decreased due to their insulin resistance. Glucose oxidation is decreased only slightly. Glucose utilisation and oxidation in sepsis can be enhanced by administration of insulin.

Blood Glucose↗

PubMed2006

[Enteral nutrition in diabetes mellitus].

In the last 15 years enteral nutrition has been getting ahead of parenteral nutrition. Enteral nutrition allows natural supply of nutrients, stimulates immunity, reduces overgrowth of intestinal microflora, reduces intestinal permeability, and has a positive effect on intestinal peristalsis. Substrates of enteral nutrition are nutritionally defined, low osmolar, and usually residual-free, do not contain lactose and gluten. A number of substances is flavoured, allowing continual drinking of the nutrition throughout the whole day. This mode of nutrition is increasingly used and referred to as sipping or drink feeding. Enteral nutrition is also suitable for diabetics, however, it is necessary to calculate with the amount of glucose contained in the nutritional solution. A suitable treatment strategy needs to be established through frequent glyceamia monitoring and calculating of consumed sugars in food and in the enteral nutrition with preferential utilisation of insulin treatment for its anabolic effect.

Diabetes Mellitus↗

PubMed2003

[Economic aspects of the diabetic foot syndrome].

UNLABELLED: The diabetic foot is one of the most expensive complications of diabetes mellitus. AIMS: To determine the direct costs of both inpatient and outpatient care of diabetic foot provided in Diabetic Centre University Hospital in Plzen. METHODS: 42 patients with diabetic ulcers (45% neuropathic, 26% ischaemic and 29% mixed) who have attended the podiatric surgery from January to June 2000 were randomly selected. SUBJECT CHARACTERISTICS: 4 patients with type 1 diabetes, 38 patients with type 2 diabetes, mean of age 63 years (37-81), mean of duration of diabetes 17 years (1-31), mean of duration of diabetic ulcers 37 months (1-168) ulcers. Patients visited Diabetic Centre 9 times (5-13). 23 hospitalizations occurred in 17 patients (40%) with mean of 14 days duration (3-42). The AP-DRG (all patients diagnosis related groups) model was used to determine the hospital direct costs. The ambulatory costs included the reimbursed care, drugs (local treatment, antibiotics and antiagregans), bandages, patient transport and home care. Antidiabetic drugs and insulin or antihypertensive drugs were not included. RESULTS: Total direct costs of diabetic foot care 42 patients were 1,440.600.-CK, 34.500.-CK (6.300.-CK-190.200.-CK)/patient in Diabetic Centre Plzen during 6 months. 37% of total costs (533.000.-CK), resp. 12.500.-CK (5.900.-CK -45.700.-CK)/patient represented ambulatory and 63% of total cost (907 600.-CK), resp. 53.700.-CK (18.000.CK-180.600.-CK)/patient hospital care.

Adult↗

PubMed2002

[Treatment of diabetic neuropathic defect at the surgery department and at the center for diabetic foot care].

UNLABELLED: The aim of the study was to evaluate the treatment of neuropathic diabetic ulcer at the surgery department and the treatment at the diabetic foot centre at dismissal time and 3 months after the dismissal. METHODS: For assessment of treatment success parameters of glucose control were used (average of daily blood glucose values, glycosylated haemoglobin--HbA1C and glycosylated protein), healing of ulcers (Wagner classification), hospitalisation time and number of amputations. 22 diabetic patients at the centre and 17 patients at the surgical department were observed in this investigation. There was no difference between the groups as for the age, glucose control (HbA1C), and severity of diabetic ulcers (Wagner 3-4). Local and antibiotic therapies were the same ones. Results as median and difference 75th and 25th percentile were evaluated by Wilcoxon test for paired data within the groups and by Man-Whitney test between both of the groups. RESULTS: In the both group the diabetic control and ulcer healing were significantly improved during hospitalisation period, 3 months after discharge deteriorate diabetic control and ulcer healing stagnated, however, only in the group treated at the surgical department. The hospitalisation time was significantly longer in the surgical group in comparison with the centre group [median 52 days (35)] vs. [median 31 days (38)], p < 0.01. Amount of transmetatarsal and higher amputations was lower at the foot centre in comparison with the surgical group (1 vs. 7). Statistical evaluation was not used for low amount of amputations. CONCLUSION: Team approach at the centre of diabetic foot is effective in the treatment of diabetic foot ulcers, significantly shortened the hospital stay, probably decrease amount of amputations. Three months after discharge the diabetic control and ulcer healing were significantly better in patients treated at the diabetic foot centre.

Aged↗

PubMed2002

[Effect of composition of enteral nutrition on energy expenditure and CO2 production during periods of average and excessive energy intake].

UNLABELLED: The objective of the presented work is to evaluate to what extent the CO2 production and O2 utilization and energy metabolism at rest (REE) are influenced by an excessive nutrient intake and to what extent by the composition of enteral nutrition. REE, CO2 production and O2 utilization were investigated in 9 patients on complete enteral nutrition by indirect calorimetry in four modifications: I--nutrition with 40% kJ fat in a ration 1.2x the energy output at rest at the onset of the trial; II--40% kJ and high energy intake (2.4x energy output at rest; III--60% kJ fat in ration of 1.2x energy output at rest; IV--60% kJ fat and energy intake 2.4x energy output at rest. At 40% (I) and 60% (III) fat content in a caloriocally adequate diet the energy output at rest, the CO2 production and O2 utilization did not differ (mean +/- SD: 1438 +/- 264.1 kcal/24 h, 179 +/- 31.6 nl/min, 209 +/- 38.1 ml/min vs. 1431 +/- 342.7, 190 +/- 54.2, 207 +/- 46.5). Comparison of modifications II and IV revealed a significant (p < 0.05) increase of CO2 production on a diet rich in carbohydrates (218 +/- 52.0 vs. 202 +/- 42.3). The energy output at rest (1674 +/- 389.6 vs. 1661 +/- 378.7), nor O2 production (240 +/- 54.5 vs. 242 +/- 55.4) changed. Overfeeding with 40% fat (II) as compared with (I) led to a rise of the energy output at rest (p < 0.05), O2 utilization (p < 0.05) and CO2 production (p < 0.01). Overfeeding with lipids (IV) led as compared with III to a rise of the energy output at rest and O2 utilization; CO2 production did not change. CONCLUSION: The composition of enteral nutrition according to the described modification does not influences the energy output at rest, O2 utilization and CO2 production under conditions of an adequate energy intake. In case of an excessive nutrient intake nutrition with 60% fat does not lead to an increase of CO2 production.

Adolescent↗

PubMed2002

[Autonomic neuropathy in diabetics, treatment possibilities].

Diabetic neuropathy is a chronic complication of diabetes. It involves non-inflammatory damage of the function and structure of peripheral nerves by metabolic vascular pathogenic processes. In case of affection of vegetative nerves (small non-myelinated C fibres) autonomic neuropathy develops. It is a relatively frequent form of neuropathy which remains for a long time without clinical symptoms and therefore is rarely diagnosed and treated. Manifestations of the affection are encountered in all organs which are supplied by vegetative nerves. The presence of this complication of diabetes is signalized by tachycardia at rest, deterioration of gastric evacuation, diabetic diarrhoea or constipation, erectile dysfunction, impaired function of the sweat glans or impaired pupillary reaction. The advanced form involves the danger of latent myocardial ischaemia, serious postural hypotension and sudden death. It increases significantly the mortality of the affected patients. Similarly as the treatment of other complication of diabetes, treatment of autonomic neuropathy is difficult. The objective of the present paper is to review contemporary therapeutic possibilities. An essential prerequisite remain efforts to achieve optimal compensation. The authors draw attention to the effect of alpha-lipoic acid which exerts a positive effect not only on subjective symptoms but also on the objective finding. The other mentioned drugs are used either only experimentally or for purely symptomatic treatment.

Diabetic Neuropathies↗

PubMed2002

Hyperinsulinemia and oxidative stress.

The aim of the study was to compare the effect of short-term hyperglycemia and short-term hyperinsulinemia on parameters of oxidative stress in Wistar rats. Twenty male rats (aged 3 months, average weight 325 g) were tested by hyperinsulinemic clamp (100 IU/l) at two different glycemia levels (6 and 12 mmol/l). Further 20 rats were used as a control group infused with normal saline (instead of insulin) and 30 % glucose simultaneously. Measured parameters of oxidative stress were malondialdehyd (MDA), reduced glutathion (GSH) and total antioxidant capacity (AOC). AOC remained unchanged during hyperglycemia and hyperinsulinemia. Malondialdehyde (as a marker of lipid peroxidation) decreased significantly (p<0.05) during the euglycemic hyperinsulinemic clamp, and increased significantly during isolated hyperglycemia without hyperinsulinemia. Reduced glutathion decreased significantly (p<0.05) during hyperglycemia without hyperinsulinemia. These results suggest that the short-term exogenous hyperinsulinemia reduced the production of reactive oxygen species (ROS) during hyperglycemia in an animal model compared with the control group.

Analysis of Variance↗

PubMed2002

[Transcutaneous oxygen tension in hyperbaric condition as a predictor of ischaemia in non-healing diabetic foot ulcers].

UNLABELLED: The aim of the study was to evaluate the contribution of basal and modify transcutaneous oxygen tension measurement (TcpO2) to diagnosis of ischaemia and indication of angiography in non-healing diabetes foot ulcers: METHOD: 69 patients with non-healing diabetic ulcers localised on 76 legs underwent angiography (DSA) and basal and modify TcpO2 measurement after 100 % O2 exposition under normo- and hyperbaric conditions. CHARACTERISTIC OF PATIENTS: mean age 66 years (42 81), diabetes duration 14.3 years (1 - 36), glycated hemoglobin 7.9 % (+/-1,35). RESULTS: Clinically important angiographic findings were obtained in 80 % (61/76) all ulcers. Basal TcpO2 < or = = 30 mm Hg was detected in 82 % diabetic ulcers with positive DSA (sensitivity - SN). The specificity (SP), positive and negative predictive value (PPV, NPV), relative risk (RR) and accuracy (A) of test were 60 %, 89 %, 47 %, 1.7 and 78 % respectively. TcpO2 with hyperbaric 100 % O2 was determined as the strongest predictor of ischaemia by statistical logistic regression. SN (91%), SP (77%), PPV (94 %), NPV (67 %, RR (2.8) and A (88 %) of test were increased (cut off 270 mmHg). CONCLUSION: TcpO2 measurement contributes to the diagnosis of ischaemia in non-healing diabetic ulcers. Modify TcpO2 increases the test value.

Adult↗

PubMed2001

[Metformin in the treatment of type 1 diabetics--a placebo controlled study].

BACKGROUND: Metformin is popular for it's complex mechanism of action in treatment of the type 2. diabetes. The effect in type 1. diabetes is studied less frequently. The aim of our open, prospective, placebo controlled study was to assess the effect of metformin in poorly controlled diabetic patients type 1 with high insulin requirements. METHODS AND RESULTS: In the group comprised of 19 type 1 diabetic patients the insulin resistance was assessed by hyperinsulinemic euglycemic clamp and indirect calorimetry at the beginning of the study (B), 3 months later when metformin in the dose of 2 x 850 mg was added to existing insulin therapy (M) and after 3 months of placebo therapy (P). In the same time-intervals the other parameters were measured. Wilcoxon test was used for statistic analysis. All results are given in arithmetic average +/- SD. Weight (78.6 +/- 17.9; 75.7 +/- 17.8; 76.8 +/- 19.1 kg), Dauly insulin dose (65.4 +/- 15.1; 54.4 +/- 11.2; 54.8 +/- 9.3 IU), HbA1c (8.8 +/- 1.8; 8.2 +/- 1.1; 10.1 +/- 2.8%). Utilisation of glucose (3.5 +/- 1.6; 4.2 +/- 1.7; 4.4 +/- 1.8 mg/kg/min), triglycerides (1.2 +/- 0.5; 1.1 +/- 0.4; 1.3 +/- 0.7 mmol/l), cholesterol (5.1 +/- 0.7; 4.9 +/- 0.7; 5.2 +/- 0.8 mmol/l). CONCLUSIONS: The combination of metformin and the intensive insulin therapy in type 1 diabetic patients led, in contrast to placebo, to the significant reduction in weight (p < 0.001), to the reduction in insulin requirements (p < 0.05), to the improved control of glycaemia (p < 0.01) and to the decrease of FFA during clamp (p < 0.01).

Adult↗

PubMed2001

[Short-term and long-term effect of metformin in type 1 diabetics].

UNLABELLED: The objective of the investigation was to evaluate the effect of metformin added to the usual insulin treatment on insulin resistance, on the dose of substituted insulin and on the compensation of type 1 diabetes. METHOD: The first part of the study lasted 3 months, it was an open prospective study. The group was formed by 22 type 1 diabetics, average age 38.9 +/- 8.93 (min. 21, max. 55), with duration of diabetes of 13.8 +/- 6.43 years (min. 4, max. 29). Insulin resistance was assessed by means of a hyperinsular euglycaemic clamp (insulinaemia 100 mlU/l) at the onset of the study (B), after three months of metformin treatment which was added to the insulin regimen in a dose of 2 x 850 mg (M). After the same intervals the other investigasted parameters were assessed (body weight, daily insulin dose, glycated haemoglobin, triacylglycerols and cholesterol). The second part of the study was implemented after three years in the same group. The check-up examination (K) was attended by 21 diabetics who were divided into two groups: those who steadily used combined treatment (X, 8 patients) or were treated only with insulin (Y, 13 patients). The authors followed up the development of metabolic parameters in groups X and Y and the differences between them. RESULTS: After three months combined treatment reduction of body weight was recorded, on average by 2.23 kg (by 2.9 %, p < 0.001) and reduction of the daily insulin dose on average by 12.7 IU (by 20 %, p < 0.001). The decline of insulin resistance and glycated haemoglobin did not reach statistical significance. The lipaemia levels did not change. After three years the positive effect of combined treatment (group X vs. Y) wss preserved only as regards maintenance of body weight (p < 0.005). CONCLUSION: After adding metformin to the insulin regimen of type 2 diabetics after three months a statistically significant drop of body weight and the daily insulin dose occurred. Glycated haemoglobin and resistzance declined insignificantly. After follow up of the combined regime three years later only a positive effect on maintensance of the reduced body weight was recorded in group X vs. Y (p < 0.05).the other parameters in both groups did not differ statistically after three years.

Adult↗

PubMed2000

[Relation between cardiovascular and gastrointestinal neuropathy in diabetics].

BACKGROUND: The presence of autonomic neuropathy impairs the quality of life (orthostatic hypotension, impotence, gastroparesis) or endangers the life of diabetics (sudden death, unawareness of hypoglycemia). The purpose of the investigation was: 1. To assess the presence of the autonomic neuropathy of the cardiovascular and the gastrointestinal systems and their mutual relationship. 2. To assess the relationship of found autonomic neuropathy and the subjective symptoms which are typical to affected particular systems (cardiovascular, gastrointestinal, genitourinary, sudomotor systems and the syndrome of unawareness of hypoglycemia). METHODS AND RESULTS: The group comprised of 25 type 1 diabetic patients (12 women and 13 men) mean age 40.5 +/- 11.6 (range 21-57 years) with a mean duration of diabetes of 17.8 +/- 7.9 (range 4-35 years), treated with intensified insulin regimens. The cardiovascular autonomic neuropathy was automatically examined by the VariaPulse TF 3 computer system. Scintigraphy was used to investigate the gastric emptying time of 99mTc labelled rice. The information about the subjective symptoms we collected from the questionnaire. For statistic analysis we used Spearmen correlations and ANOVA. RESULTS: 1. A statistically significant correlation was found between the presence of the autonomic neuropathy of cardiovascular and gastrointestinal systems (r = 0.634, p < 0.0007). 2. We didn't find any relation among the cardiovascular autonomic neuropathy and the subjective symptoms of cardiovascular system, respectively the gastrointestinal neuropathy (impair gastric emptying) and the subjective symptoms of gastrointestinal system. We found a significant correlation between cardiovascular and gastrointestinal neuropathy and erectile dysfunction (r = 0.48, p < 0.0078), (r = 0.42, p < 0.0388) and with the syndrome of hypoglycemia unawareness (r = 0.49, p < 0.0057), (r = 0.52, p < 0.0075). CONCLUSIONS: The evidence of the cardiovascular autonomic neuropathy is warning signal for the affected autonomic neuropathy in other systems which are more complicated for diagnostic. The subjective symptoms don't correlate with the presence of the visceral neuropathy.

Adult↗

PubMed2000

[Dietary habits in obese individuals before ambulatory obesity treatment].

Resting energy expenditure, using indirect calorimetry, and food habits by the food frequency questionnaire, were measured in randomly selected 200 obese people (body weight 102 +/- 23 kg, age 41 +/- 15 yrs) during their first appointment in the Centre for obesity treatment. All were educated in low calorie diet (LCD = 5 MJ) regime at the same way. After 30 months the obese people from the highest and the lowest quartile according to the percentage of weight loss (derived as a percentage of their initial body weight) were compared. There was not found any statistical difference in frequency of particular commodities intake, only higher probability of good weight reduction was confirmed in obese with higher body weight (p < 0.003) and higher resting energy expenditure (p < 0.02) on the beginning of the LCD treatment. This study has demonstrated that food habits assessed according food frequency questionnaire has not predictive value to distinguish between successful or non-successful compliance with very low calorie diet.

Adult↗

PubMed2000

[Gastric emptying in diabetics].

UNLABELLED: The authors evaluate gastric emptying in diabetic patients and follow up selected factors which may influence it. METHOD: In a group of 25 type 1 diabetics selected at random (12 women and 13 men), mean age 40.5 years +/- 11.6 SD (range 21 to 57 years) with a duration of diabetes of 17.8 +/- 7.9 years (minimum 4, maximum 35 years) with a mean value of glycosylated haemoglobin of 8.71% +/- 1.82 (minimum 7.2, maximum 12.2%) the authors assessed: the time of gastric emptying by scintigraphic follow up of the progress of solid food (rice labelled with 99mTc). 2. The correlation of gastric emptying and time factors (age, duration of diabetes) and metabolic factors (blood sugar level, glycosylated haemoglobin). 3. Relations of impaired gastric emptying and the presence of gastrointestinal symptoms. RESULTS: Only 9 patients had normal gastric emptying (36%). In 16 patients (64%) the time was pathologically altered, incl. 5 (20%) where the period was reduced, while in 11 (44%) the time was prolonged. After classifying the diabetics into three groups according to the period of gastric emptying in minutes (group I < 40, group II 40-90, group III > 90) by means of the statistical method ANOVA a significant correlation was found between the time of gastric emptying and age (p < 0.036) and the duration of diabetes (p < 0.0044). No significant relationship was found between metabolic parameters (blood glucose level, glycosylated haemoglobin) and the time of gastric emptying. The authors did not find any significant relationship between impaired gastric emptying and subjective symptoms. CONCLUSION: Impaired gastric emptying is frequently encountered in diabetics. In the authors group there was only a correlation between the time of gastric emptying and age and the duration of diabetes. The authors did not find a relationship with the blood glucose level or glycosylated haemoglobin. Impaired gastric emptying was not correlated with subjective gastrointestinal symptoms.

Adult↗

PubMed1999

[Systemic amyloidosis with renal involvement].

Amyloidosis is a summary of a group of disorders of protein metabolism characterized by infiltration of amorphous substance into the tissues. The diagnosis can rarely be made during life. It is usually manifested by defects of the renale, cardiovascular or peripheral nervous system. Heterogenicity of clinical and histological classification of amyloidosis and clinical course in comparison with autopsy findings are presented by two cases of general amyloidosis--secondary amyloidosis of the kidneys and primary amyloidosis with a fatal prognosis.

Amyloidosis↗

PubMed1998

[Energy expenditure at rest and obesity].

Adult human body has to have, because of every day fluctuating energy intake and energy needs, very precious adaptive mechanisms for maintenance of heat homeostasis in the body and nearly stable body weight and body composition, which are optimal for life and reproduction. These short term functioning adaptive mechanisms are called "empty biochemical mechanisms", where chemically bound energy is transformed to heat without work performance. These mechanisms are present on the cellular level (substrates cycles, uncoupling of respiration chain), on the interorgan metabolic level (glycolysis and gluconeogenesis between liver and adipose tissue-glucose-lactate cycle). Central nervous system controls them via many factors; the most important are catecholamines, leptin, insulin, thyroid hormones, cortisol, growth and sex hormones. Neurotransmitters and neuronal net influence energy intake and other behavior. Obesity seems to be associated with the amelioration or overcoming of possibilities of function short-term effective adaptive mechanisms.

Adaptation, Physiological↗

PubMed1998

[Health effects of weight reduction].

Although weight loss is routinely recommended for obese person, the observational literature is controversial in respect of prolongation of life longevity after body weight loss. The positive long-term outcome has been found only in intentional weight loss in obese people with obesity-related comorbidities. The main task in obesity treatment strategy is "primum non nocere". The authors analysed the short-term effect and acceptability of low calorie diet (5 MJ) on health state of 150 obese people (BMI x = 35.9 kg/m2). The acceptability of this diet was 60% only, when the rest of patients has broken this regime mostly after second appointment with their physician. The successful patients achieved 10% weight loss from initial body weight during in average 5 months (95% CI for BMI reduction = (-4.55; -3.01), as well as reduction of percentage of body fat (95% CI = -7.7; -3). During this period has been observed in consistency with experimental evidence of other authors a decrease of plasma values of triacylglycerol, LDL cholesterol in hyperlipidemic patients, but not significant increase of HDL cholesterol. During this period obese persons have taken up more physical activities and felt themselves more psychologically comfortable.

Diet, Reducing↗

PubMed1995

[Temporal relationship between food intake, administration of insulin and physical loading in type I diabetics treated with an intensified insulin regimen].

BACKGROUND: Although there is no doubt about the benefit of physical exercise in diabetic patients, risks of exercise are known in particular in type 1 diabetics. The purpose of the investigation was to assess the optimal time of exercise in relation to food intake and insulin administration in type 1 diabetics treated by intensified insulin regimens. METHODS AND RESULTS: The group comprised 31 type 1 diabetic patients without complications (21 women, 11 men) mean age 26 years, range 18-32 years with a mean duration of diabetes of 9 +/- 5.3 years and a BMI of 24.7 +/- 2.3. The patients were treated by intensified insulin regimens. In order to evaluate the blood sugar reaction they were subjected to a physical load amounting to 50% of the maximal oxygen consumption (VO2max) after exercise in the morning on fasting (state I), after administration of an insulin bolus and after breakfast (stage II) and after administration of a snack containing 20 g carbohydrate without insulin administration (stage III). The results of the blood sugar level during the 30th minute and during the fourth hour of the investigation are presented as per cent of the initial blood sugar level. Stage I ((10.1 mmol/l, SD = 5.2, 94%, SD = 54, 107%, SD = 50), stage II (9.16 mmol/l, SD = 5.1, 131%, SD = 86, 135%, SD = 97) and stage III (7.66 mmol/l, SD = 3.9, 189%, SD = 150, 153%, SD = 97). Processing of the results by Wilcoxon's test revealed a statistically significant difference of the blood sugar level after the load only between stages I and III (p < 0.01). CONCLUSIONS: In type 1 diabetics treated by intensified insulin regimens the authors did not reveal a different response of the blood sugar level to loads on fasting or after a meal and insulin. Thus it is not necessary to respect previous recommendations: to take exercise 30-60 minutes after a meal, but according to individual needs of the patients.

Adolescent↗

PubMed1995

[A vasoactive-intestinal-polypeptide producing tumor (VIPoma) as an uncommon cause of life-threatening hypokalemia].

The authors present a case of a 40-year-old female patient examined repeatedly in the course of 11 years and hospitalized on account of pain in the hypogastrium, subfebrile temperatures, watery diarrhoea, hypokaliaemic alkalosis, weakness, fatigue and loss of body weight. As to laboratory examinations hypokaliaemia, hyponatraemia, metabolic alkalosis, irregularly elevated CRP values and minor leucocytosis predominated. A weight loss of cca 8 kg along with a severe mineral deficiency and clinical symptomatology called for parenteral nutrition with a mean daily substitution of 240 mmol K and 200 mmol Na. Due to the clinical condition and non-specific results of graphic and histological examinations the possibility of a VIPoma was considered. This diagnosis was confirmed by laboratory examinations and clinically--after the onset of corticoid treatment marked improvement of the general condition occurred. Finally the authors discuss diagnostic and in particular therapeutic possibilities in this disease.

Adult↗