ABSTRACT
The analysis is given to experience in teaching clinical nephrology to subinterns at a therapeutic chair. The initial knowledge in nephrology assessed in undergraduates proved unsatisfactory. Guidelines are presented for lecturers as well as results of questioning surveys of the students. The students answers showed that individual clinical tasks appeared most difficult for them. The mean score fr home tasks was 3.1, good marks being given in 21% only. Poor knowledge was reported in resolving diagnostic questions, treatment of renal failure, treatment of the kidneys in systemic disorders of the connective tissue. The post-study test control stated considerable gain of relevant knowledge.
Subject(s)
Internship and Residency/organization & administration , Nephrology/education , Teaching/organization & administration , Internship and Residency/methods , Teaching/methods , UkraineSubject(s)
Cardiology/education , Cardiovascular Diseases/diagnosis , Digestive System Diseases/diagnosis , Gastroenterology/education , Lung Diseases/diagnosis , Physical Examination/methods , Pulmonary Medicine/education , Teaching/methods , Cardiology/methods , Clinical Clerkship , Gastroenterology/methods , Humans , Pulmonary Medicine/methods , UkraineABSTRACT
The authors revealed heart failure in 7 of 216 patients with gout. Two of them showed isolated mitral valve insufficiency and two patients aortal insufficiency while combined aortal disease, combination of mitral and aortal insufficiency and combined mitral valve disease with aortal insufficiency occurred each in 1 patient. One could not find distinct dependence between the clinical variant of the course of gout and development of a definite heart failure. Clinical and electrocardiographic signs of the revealed kinds of cardiac abnormalities are described. The morphological changes of the valves are described on the basis of 2 autopsy cases. The possible mechanism of development of podagric heart failures is discussed.
Subject(s)
Aortic Valve Insufficiency/etiology , Gout/complications , Mitral Valve Insufficiency/etiology , Adult , Aortic Valve/pathology , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/pathology , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/etiology , Aortic Valve Stenosis/pathology , Chronic Disease , Gout/pathology , Humans , Male , Middle Aged , Mitral Valve/pathology , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/pathology , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/etiology , Mitral Valve Stenosis/pathologyABSTRACT
Results of consultations carried out at a Regional Cardiological Dispensary in 193 coal miners admitted for ischemic heart disease excluded this kind of pathology in 10.9%. The authors analyze errors in diagnosis of various nosological entities of ischemic heart disease (exertion stenocardia, myocardial infarction, etc.) made in local medical institutions.
Subject(s)
Coal Mining , Coronary Disease/diagnosis , Occupational Diseases/diagnosis , Adult , Cardiac Care Facilities , Diagnostic Errors , Humans , Male , Middle Aged , Referral and Consultation , UkraineSubject(s)
Gout/diagnosis , Kidney Diseases/diagnosis , Kidney Failure, Chronic/diagnosis , Adult , Aged , Gout/complications , Humans , Hypertension/diagnosis , Hypertension/etiology , Kidney Diseases/etiology , Kidney Failure, Chronic/etiology , Middle Aged , Time Factors , Uremia/diagnosis , Uremia/etiologySubject(s)
Gout/diagnostic imaging , Kidney Diseases/diagnosis , Adult , Aged , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
Proceeding from the results of a study of 139 patients suffering from primary gout with kidney involvement the authors have defined 4 clinicomorphological types of nephropathy which differed both in their course and prognosis. The I proteinuric type was characterized by early signs of stable proteinuria, sometimes with the development of the nephrotic syndrome in which a morphological study revealed mainly glomerular changes. The II urolithic type was characterized by the appearance of renal colics at the onset of nephropathy, frequently with the passage of concrements (a morphological study revealed mainly tubular and stromal lesions). The III hypertensive type was characterized by the appearance of persistent arterial hypertension (a morphological study revealed mainly vascular and interstitial changes). The IV latent type was characterized by the absence of or a transient urinary syndrome (a morphological study showed mainly interstitial changes). The first signs of renal failure in these types of nephropathy developed, on an average, 7, 15, 11 and 12 years later, the 20-year survival was 24, 92, 68 and 100%, respectively.
Subject(s)
Gout/complications , Kidney Diseases/diagnosis , Adult , Aged , Arthritis/diagnosis , Arthritis/etiology , Chronic Disease , Colic/diagnosis , Colic/etiology , Female , Gout/diagnosis , Gout/mortality , Humans , Hypertension/diagnosis , Hypertension/etiology , Kidney Diseases/etiology , Kidney Diseases/mortality , Male , Middle Aged , Prognosis , Proteinuria/diagnosis , Proteinuria/etiologyABSTRACT
The authors observed 10 patients from 4 families with hereditarily determined gout and detected some specific features in its course. The familial disease was sex-unrelated, its first signs manifested themselves early acquiring a subsequent severe course; purine metabolic derangement was of a metabolic type, a urolithic form of nephropathy was seldom observed. A morphological picture was characterized by a glomerular lesion looking like focal segmental mesangiocapillary or mesangioproliferative glomerulonephritis with noticeable changes in the tubules, stroma and vessels causing early renal insufficiency. Pathogenetic therapy with uricodepressants made it possible to improve the course of nephropathy. The authors described a pedigree of 3 generations of a family in which gout developed in its 10 out of 17 members, in 6 with chronic renal insufficiency.
Subject(s)
Gout/genetics , Adolescent , Adult , Disease Susceptibility , Female , Gout/diagnosis , Gout/pathology , Humans , Male , Middle Aged , PedigreeSubject(s)
Gout/complications , Kidney Diseases/etiology , Adult , Female , Humans , Male , Middle AgedSubject(s)
Glomerulonephritis/diagnosis , Gout/diagnosis , Adolescent , Adult , Aged , Arthritis/diagnosis , Chronic Disease , Female , Humans , Hypertension/diagnosis , Male , Middle Aged , Nephrotic Syndrome/diagnosis , Urinary Calculi/diagnosisSubject(s)
Gout/blood , Lipids/blood , Adult , Female , Gout/complications , Humans , Hyperlipidemias/etiology , Male , Middle AgedABSTRACT
Altogether 100 patients with associated podagra and renal injury were examined and treated. Before the first admission to the clinic only 5% of the patients had received combined therapy of renal pathology on a regular basis, 33% of the patients had been given pathogenetic but not systematic therapy. 66% of the patients had not responded to the treatment, whereas 38% manifested a decrease in renal function. Sixty patients were followed up for the results of further dispensary observation during 1.5 to 5 years. These patients were distributed into 2 groups. The first one comprised 26 patients who adhered strictly to the physicians' recommendations, the second group consisted of patients who received treatment irregularly. The clinicolaboratory improvement was attained in almost 3/4 of the first group patients and in less than 1/4 of the second group patients. The best effect was attained in the treatment of the urolithiasis pattern of nephropathy, whereas the less marked in chronic interstitial nephritis. The worst results were attained in patients with glomerulonephritis.
