[Clinical symptoms variety as a cause of late diagnosed Takayasu's arteritis]. / Róznorodnosc objawów klinicznych przyczyna póznego rozpoznania choroby Takayashu.

Takayasu's arteritis (TA) is a chronic inflammatory arteritis, preferentially affecting the major arteries such as the aorta and its main branches. Its course may be biphasic, with an early systemic phase characterised by non-specific inflammatory features and a later stage with occlusive lesion of the affected vessels. We reported 3 patients with TA, who presented very varied symptoms. These cases emphasise the importance of ultrasound image, which can help to establish the diagnosis at very early stage of vasculitis and improve prognosis.

[Studies on empathy in doctors and medical students]. / Badania nad empatia lekarzy i studentów medycyny.

Empathy is an expected attribute improving doctor-patient relationship. It also helps to understand psychological problems of patients. This paper describes a research study on empathy in physicians of different specializations. The study population included paediatricians, psychiatrists, oncologists, gynaecologists, internists, residents of family medicine and final-year-medical students. In order to evaluate empathic abilities in doctors and students two questionnaires were applied. Both estimate the level of emotional and cognitive empathy. Results indicated the highest empathic abilities in future family physicians, especially in its emotional aspect. Comparing them to internists and gynaecologists, the difference is of statistical significance. The highest level of cognitive empathy characterizes in order: paediatricians, psychiatrists and family doctors. Comparing to other specializations, internal medicine doctors and gynaecologists proved to be physicians of the lowest cognitive empathy.

Cerebral blood flow in Sjögren's syndrome using 99Tcm-HMPAO brain SPET.

Neuropsychiatric disturbances are frequent in connective tissue diseases. Little is known about the cerebral pathophysiology of Sjögren's syndrome, including cerebral blood flow disturbances. 99Tcm-HMPAO brain SPET was performed in 21 Sjögren's syndrome patients. We also studied 77 patients with systemic lupus erythematosus and 27 healthy individuals. Our results demonstrate the high rate of alterations in cerebral blood flow in Sjögren's syndrome, both psychoneurologically symptomatic and asymptomatic. Focal interhemispherical perfusion deficits were seen in 17 of 21 patients (80.9%) with Sjögren's syndrome: 13/15 symptomatic (86.6%) and 4/6 asymptomatic (66.6%). These changes were mostly localized in the prefrontal and frontal areas, occipital lobes and occipitoparietal area, and less frequently so in the temporal, parietal and central areas. Diffuse hypoperfusion of the frontal lobes (bilateral hypofrontality) was seen in 29% of patients in the Sjögren's group. An acetazolamide stress test was performed in seven patients. There was an increase in perfusion deficits in two patients, no change in two patients, and hypoperfusion decreased in three patients compared with baseline. The results indicate that most Sjögren's syndrome patients experience alterations in cerebral blood flow that are consistent with systemic lupus erythematosus, with heterogeneous reactivity to acetazolamide-induced hypercapnia. These alterations present as focal perfusion deficits and bilateral diffuse hypoperfusion of the lobes. The mechanism of cerebral blood flow alterations is unknown, although it might be the result of diffuse cerebral vasculitis.

[New diagnostic criteria for the neuropsychiatric form of systemic lupus erythematosus]. / Nowe kryteria diagnostyczne neurologiczno-psychiatrycznej postaci tocznia rumieniowatego ukladowego.

Systemic lupus erythematosus (SLE) is an autoimmunologic illness, which apart from changes in the skin, the locomotor system and the internal organs, attacks also the nervous system. The paper presents 19 neuropsychiatric symptomic syndromes which after conduction of multidisciplinary, international research were accepted by the American College of Rheumatology (ACR) as the criteria of systemic lupus erythematosus (SLE). This broadens the criteria applied since 1982, which were only considering acute symptoms and psychoses as characteristic of the neuropsychiatric form of systemic lupus erythematosus (NPSLE). In the new neurologic criteria concerning the CNS are: epileptic attacks and acute attack disorders, headaches, vascular diseases, demyelinating syndrome, aseptical meningitis, chorea, myelopathy. Psychiatric syndromes which make up the new criteria are: acute amentive state, anxiety disorders, cognitive function impairment, affective disorders, psychoses. The criteria connected to the CNS are: cranial nerve damage, mononeuropathy, damage of nerve plexus, polyneuropathy, vegetative neuropathy, myasthenia and acute inflammatory demyelinating polyneuropathy. Clinical symptoms of these syndromes were set and laboratory and visualising tests were developed, which are useful in their diagnosis. The intention of the ACR in setting new, significantly broader criteria of NPSLE, was to stress the diversity of symptoms and for a practical aspect to allow the diagnosis of NPSLE in patients having this disease, in whom the symptoms connected with the nervous system may dominate in the clinical picture, or may be before the dermatological, locomotor or internal organ symptoms.

[Asymptomatic bacteriuria in women diagnosed with systemic lupus erythematosus (SLE)]. / Bakteriomocz bezobjawowy u kobiet z rozpoznaniem tocznia rumieniowatego ukladowego (T.R.U.).

The aims of our research were: estimation of asymptomatic bacteriuria (a.b.) incidence in population of women with systemic lupus erythematodes (SLE), evaluation its clinical significance and examination of bacterial colonisation of nostrils and pharynx in SLE patients with a.b. 85 women aged 24-77 (mean 49.3) with mean SLE duration 7.8 (range 1-32) years were examined. All of them fulfilled ARA criteria for the classification of SLE. Among group of patients with a.b. were counted women who had significant bacteriuria > or = 10(4) in ml urine in two cultures. Asymptomatic bacteriuria was found in 14 cases of 85 women with SLE (16.5%). In two following urine cultures bacteria from family Enterobacteriaceae were dominated: the same types of bacteria were in 85.7%--bacteriuria persistens, in others 14.3% were observed change of bacteria--bacteriuria transistens. In 9 from 14 patients with (64.3%) a.b. very massive growth of Staphylococcus aureus in culture from vestibulae of the nose swab was, in other cultures very massive growth of physiological flora was seen. All patients with a.b. were in clinical remission of SLE and they had no clinical symptoms of infection in urinary tract in 5 months of observation. However clinical significance of asymptomatic bacteriuria and pathogenic bacteria colonisation of nostrils as a precedence to symptomatic infections needs further investigations.

Cerebral blood flow assessed by brain SPECT with 99mTc-HMPAO utilising the acetazolamide test in systemic lupus erythematosus.

BACKGROUND: Cerebrovascular diseases are one of the most important complications of systemic lupus erythematosus (SLE). The diagnostic imaging of neuropsychiatric SLE complications presents many problems. This study was undertaken to investigate cerebral blood flow char s and its reactivity to hypercapnia by means of acetazolamide test in SLE patients. METHODS: Brain SPELT studies using 99mTc-HMPAO were performed in 50 patients with SLE. Acetazolamide test was performed in 35 patients 3 days after the baseline study by means of repetitive scanning 20 min after i.v. injection of 1.0 g of acetazolamide. RESULTS: Significant interhemispheric hypoperfusion areas were shown in 76.3% of all patients, 83.8% symptomatic and 63.1 % asymptomatic. Patients with antiphospholipid syndrome showed multifocal perfusion deficits. The reaction of cerebral perfusion to acetazolamide was heterogenous and showed increase, decrease, no change or mixed reaction of baseline-study-found focal hypoperfusion. Acetazolamide test revealed hypoperfusion in two patients with normal baseline study. MRI scanning revealed cerebral lesions in 41 % of patients. CONCLUSIONS: CBF asymmetries in symptomatic and asymptomatic patients with SLE are frequent. Regional CBF alterations seem to be different in patients with and without antiphospholipid syndrome. The part of the patients with SLE shows no or paradoxically inversed reaction to acetazolamide.

[Microalbuminuria in patients with systemic lupus erythematosus]. / Mikroalbuminuria u pacjentów z rozpoznaniem ukladowego tocznia rumieniowatego (u.t.r.).

The aim of the investigation was microalbuminuria evaluation as an early symptom of renal involvement in systemic lupus erythematosus (SLE). Thirty patients aged 18 to 66 years (mean: 39,4 years) with mean duration of SLE of 6,3 years (range: 0,5 to 22 years) were examined. All of them fulfilled the preliminary criteria of the American Rheumatism Association for the classification of SLE. During the study none of patients had clinical or laboratory symptoms of nephropathy, hypertension, diabetes mellitus and heart failure. Microalbuminuria was measured by immunoturbidimetric method and the urine microalbumin concentration was expressed as the ratio microalbumin-creatinine concentration in 24 hour urine [equation: see text] Ratio I was 3,36 (+/- 2,76) in patients suffering from SLE comparing to I = 1,35 (+/- 0.89) in normal controls (p < 0.001). There was no correlation between increasing microalbuminuria and patients age and duration of disease. There was also no correlation between microalbuminuria and erythrocyte sedimentation rate or immunological activity parameters (i.e. antinuclear antibodies, anti dsDNA antibodies, levels of C3 and C4 components of complement).

[Level and dynamics of empathy in I and VI year students at the Medical Academy of Medicine in Gdansk]. / Poziom i dynamika empatii u studentów I i VI roku Wydzialu Lekarskiego Akademii Medycznej w Gdansku.

Empathy is and important element in achieving didactic goals in the field of communication skills. It is a valuable feature particularly in the family doctor practice. 353 students (210 female and 143 male) from the first and last year of medical school were survived by using the psychological questionnaire-"Emotional Empathy Scale" by A. Mehrabian and N. Epstein, evaluating emotional aspects of empathy. The findings suggest that the level of empathy is higher among women than among men from the first year. The difference is statistically significant. During six years of medical education there is a significant decrease of empathy skill in women, specially in its emotional aspect. These students represent the lack of willingness in contact with people having problems. According to these findings we decided to continue our research to check the hypothesis concerning reasons of decreasing level of empathy in medical students.

[Evaluation of diagnostic sensitivity using ARA criteria in 108 patients with systemic lupus erythematosus studied retrospectively]. / Ocena czulosci diagnostycznej kryteriów ARA w grupie 108 chorych na toczen rumieniowaty ukladowy badanych retrospektywnie.

We studied usefulness of ARA criteria for the classification of sle in 108 outpatients with diagnosis established during long term follow-up. Sensitivity of ARA criteria was 96.3% and excluding tests for anti dsDNA and anti Sm antibodies was 93.5%. That means less than 10% false negative diagnoses. When at least 2 ARA criteria are present immunological tests of high specificity should confirm the diagnosis.

[Trial evaluation of familial asymptomatic bacteriuria]. / Próba oceny rodzinnego wystepowania bakteriomoczu bezobjawowego.

Between September 1, 1987 and December 1, 1988, 57 cases of asymptomatic bacteriuria were distinguished in the group of 2,898 schoolgirls, aged between 15 and 20 years (mean 16.7 years). For screening purposes Griess'test modified by Sleigh was used. Bacteriologic tests have shown, that 12 out 57 mothers (21.05%) and 5 out of 39 sisters (12.82%) suffered from asymptomatic bacteriuria, while this pathology was diagnosed in 61 (2.10%) out of all control population, i.e. 66 girls. Incidence of the asymptomatic bacteriuria was 4.55% in the 66 mothers. The differences in the incidence of the infection between the whole population and mothers of the control group, and between sisters and mothers of girls with asymptomatic bacteriuria were statistically significant (p < .001 and p < .01, respectively). History of the urinary tract infections was significantly more frequent in girls with asymptomatic bacteriuria, their mothers and sisters than in the control group. Type of bacterial strains isolated from the urine, similar sanitary conditions in these families as well as the lack of ultrasonographically and renographically diagnosed urinary pathologies in 11 out of 13 girls whose mothers and sisters suffered from asymptomatic bacteriuria suggest that familial asymptomatic bacteriuria may have a genetic background.