Inferences of clinical diagnostic reasoning and diagnostic error.

This paper discusses clinical diagnostic reasoning in terms of a pattern of If/then/Therefore reasoning driven by data gathering and the inference of abduction, as defined in the present paper, and the inferences of retroduction, deduction, and induction as defined by philosopher Charles Sanders Peirce. The complex inferential reasoning driving clinical diagnosis often takes place subconsciously and so rapidly that its nature remains largely hidden from the diagnostician. Nevertheless, we propose that raising such reasoning to the conscious level reveals not its basic pattern and basic inferences, it also reveals where errors can and do occur and how such errors might be reduced or even eliminated.

Early Diagnosis and Treatment of Dementia Presenting as Transient Global Amnesia in a 76-Year-Old Man.

This article reports the case of a high-functioning patient who had an "event" diagnosed as probable transient global amnesia (TGA) 1 year before being diagnosed with evolving cognitive impairment. Formal psychometric testing was necessary to make this diagnosis owing to the insensitivity of simple tests in this high-functioning individual. Neuropsychological evaluation showed impairment of short-term verbal memory, compounded by observed fluctuations in attention. In light of its reported benefits for cognitive function and attention, galantamine was administered starting at 4 mg b.i.d., then increasing to 8 mg b.i.d. and finally to 12 mg b.i.d. During galantamine dose escalation, the patient experienced transient vomiting on the first day of taking 12 mg b.i.d. With reassurance, he returned to the same dose and tolerated it during long-term treatment without problems. His cognitive function has remained at an improved level for 18 months on galantamine administration.

[Ultrastructural changes in the skeletal muscles following nerve and tendon injuries in man. II. Nerve injuries]. / Az emberi vázizomzat ultrastrukturális elváltozásai ideg- és ínsérülések után II. Idegsérülések

The alterations occuring in the fine structure of the man's hand muscles after traumatic nerve injuries have been examined by the authors. In the muscle portions taken in the 6th--16th weeks after the injury considerable atrophy of the contractile components, the desorganisation of the myofilaments, and the atropy of the mitochondrium and the sarcoplasmatic reticulum have been observed. The motor end-organs are athropic or their place is indicated but by a single great vacuolum. In the motor nerve fibres the typical picture of Waller's degeneration was seen.

[The effect of surgery, performed under ischemia, on the fine structure of the hand muscles]. / A vértelenítésben végzett mütétek hatása a kézizmok finom szerkezetére

The ultrastructural picture of the intact and injured hand muscles has been examined by the authors during and after operations in tourniquet ischaemia of 12 patients, in connection with tendon and nerve reconstruction. Muscle specimina were taken partly in the beginning of the ischaemization, and partly at the end ot it, every 15--20 minutes, and the muscle specimina have been examined by means of electron microscope. It has been found that in the first 2 hours of ischaemia neither the intact muscles, nor those previously injured suffer demonstrable damage.

[Open fractures of the hand joints]. / A kézízületek nyílt törései

In the authors' opinion the optimal treatment of the open fractures of the hand articulations is the internal fixation offering the best fixation possible--this being the best antidote of the inflammatory complications and assuring the satisfactory late functional results. The splinting (stabliizing) methods known so far--as well as the preventive measures applied by the authors against inflammatory complications are discussed.

[Ultrastructural changes in human skeletal muscles following tendon and nerve injuries. I. Ultrastructural changes following tendon injuries]. / Az emberi vázizomzat ultrastrukturális elv

During reconstructive procedures performed 4-16 weeks after the tendon lesion the specimens obtained from the injured muscle have been examined by the authors. It was found that after the tendon injury inactivity atrophy develops and a condition of equilibrium could be observed at this time. The most important changes in the fine structure were seen in the contractile elements: these were atrophied, homogenized, fragmentated and ragged independently from the functional unities. The number of the mitochondria was considerably decreased, the sarcoplasmic reticulum was increased, and the difference between the originally red and white muscular fibres was indistinct. The glycogen content of the musculature was decreased, or it disappeared completely. No pathologic changes have been observed in the sarcolemma, the cell nuclei and the motor nerve end-organs.

[Accidental immobilization of the proximal joint of the index finger]. / A mutatóujj alapízületi mozgásának elakadása

In connexion with one case a rare clinical picture is described by the authors. The stoppage of movement observed in young individuals in the MP articulation of the forefinger occurs under the effect of trauma, - under normal articular conditions, - on strongly flexed finger, under the effect of powerful ulnar duction.