Gotowa bibliografia na temat „Clinical medicine – problems, exercises, etc”

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athletic training students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness as a first step towards evidence-based functional outcomes. In addition to the proper storage of and access to appropriate biomedical knowledge, an equally important component of effective clinical reasoning is the ability to select and interpret various conclusions from the mounting quantity of evidence-based medicine (EBM) sources. In assessing injury and illness, this competency is particularly reliant upon experience, skill execution, and available evidence pertaining to the diagnostic accuracy and utility of various special tests and physical examination procedures. In order to both develop and assess the ability of our students to integrate EBM into their clinical reasoning processes, we have designed exercises and evaluations that pertain to evidence-based clinical decision making during oral practical examinations in our assessment of athletic injury labs. These integrated oral practical examinations are designed to challenge our students' thinking and clinical performance by providing select key features of orthopaedic case pattern presentations and asking students to pick the most fitting diagnostic tests to fit that particular case. Students must not only match the appropriate special/functional tests, etc, to the case's key features, but also choose and explain how useful the chosen tests are for the differential diagnosis process, relative to the best diagnostic evidence. This manuscript will present a brief theoretical framework for our model and will discuss the process we use to evaluate our students' ability to properly select, perform, and explain various orthopaedic examination skills and the relevant evidence available. Specific examples of oral practical exam modules are also provided for elucidation.

Background. Osteoporosis is characterized by low bone density, affecting predominantly women, especially after menopause, and it is associated with a decrease in the quality of life. It is a known fact that a low level of physical activity represents a substantial risk for osteoporosis. Purpose. The purpose of the survey is to compare the health-related quality of life (HRQoL) of patients with osteoporosis and osteopenia before and after a physical exercise intervention. Material and method. A prospective descriptive survey on 70 women with osteoporosis and osteopenia was carried out between April 2021 and February 2023 in the ambulatory of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania. Data are collected using medical docu-ments (sociodemographic and anthropometric data, comorbidities, bone density level, osteoporosis treatment, etc), the Interna-tional Physical Activity Questionnaire (IPAQ) (physical activity level), and the Romanian version of the SF-36 (health-related quality of life). Results. The study included 70 female patients with osteoporosis (41.4%) and osteopenia (58.6%). All of the SF-36 doma-ins and the summary scales (physical and mental component scores) revealed significantly (except Social Functioning, p=0.158) higher mean values postinterventional than the baseline mean scores. The most remarkable improvements were observed in the following domains: Role limitation due to physical problems (18.5; p=0.003), Role limitation due to emotional problems (14.7; p=0.018), and General health (14.0; p<0.001). Conclusions. All dimensions of quality of life were significant improved after the exercise intervention program in the patients with osteoporosis and osteopenia.

Crataegus oxyacantha L. (syn. C. rhipidophylla Gand.) (Rosac-eae) is one of the two medicinally recognized hawthorn species in European Pharmacopeia. Standardization of the extract prepared from the berry and flowers of the plant is required according to its oligomeric procyanidins. C. oxyacantha is well-known for its use in the treatment of various heart problems particularly, including heart failure in cases of declining cardiac performance equivalent to stages I and II of the New York Heart Association classification, angina pectoris, hypertension with myocardial insufficiency, mild alterations of cardiac rhythm, and atherosclerosis. C. oxyacantha has been reported to exert several other pharmacological activities such as hypotensive, antihyperlipidemic, antihyperglycemic, anxiolytic, immunomodulatory, and antimutagenic. Oligomeric procyanidins and flavone/flavonol types of flavonoids, which are considered to be the chief groups of active substances, phenolic acids, triterpenes, fatty acids, and sterols are present in the plant. The present review aims mainly to outline cardiotonic effect of C. oxyacantha as well as its brief phytochemistry. Numerous experiments and clinical studies have underlined cardiovascular efficacy of the plant through various mechanisms including positive inotropic and negative chronotropic effects, escalation in coronary blood flow and exercise tolerance, inhibition of the enzymes such as angiotensinconverting enzyme (ACE) and phosphodiesterase, anti-inflammatory and antihyperlipidemic effects, improving status of antioxidant enzymes, etc., which support its cardioactive efficacy. The plant possesses several other bioactivities for human health usually concomitant to its rich polyphenolic content.

Lifestyle is the interest, behavior, opinion, style of living or world outlook of an individual, group, or culture; a combination of tangible factors like demographics and intangible factors like personal values and preferences.1 Recently researchers have more interest in the relationship between life style and health. Millions of people, following unhealthy lifestyle (or risk-factors), are plagued with morbidity, disability and mortality due to non-communicable, communicable diseases & nutritional disorders. Persons having unhealthy behaviors may be called as ‘at risk groups’.2 Although a healthy lifestyle has consistently been shown to decrease mortality, the population prevalence of healthy living remains low.3 The mental health of an individual can be assessed by his behavior and attitude. Common lifestyle variables influencing health include diet, exercise, sleep, smoking, alcohol consumption, substance abuse, stress management, sexual behavior, internet, recreation, etc.4 Besides, weight management, exposure to the sun, social contact, work life balance, leisure activities, screening for cancer etc. make a healthy life style. Healthy ways of living are developed through processes of socialization with parents, friends, relatives and community. However, not all life style factors are harmful. There are many life styles that promote health. For example, adequate nutrition, exercise, meditation, enough sleep etc.5 Modern or slow epidemics of non-communicable diseases (NCDs) e.g. hypertension (HTN), coronary heart disease (CHD), diabetes mellitus (DM), obesity, cancer etc. have been increasing in incidence compared to the previous century. With the increase in life expectancy, the prevalence of NCDs is on the rise. About 2 billion people are overweight in developed as well as low to middle income countries.6 Comorbidities of obesity include HTN, CHD, DM, stroke, cancers, gallbladder disease, dyslipidaemia, osteoarthritis, gout and sleep apnoea.7 Obesity is not only preventable but treatable with lifestyle modifications to forestall DM.8 Furthermore, several pathways linking obesity and CHD have been described; in particular coronary atherosclerosis, heart failure, and atrial fibrillation.9 In a study by CDC conducted in late 1970s in US, approximately 48% of all premature deaths prior to age 75 years could be traced to one’s lifestyle or health behavior choices, hence focusing on a personal responsibility model whereas another study accounts for about 63% of all deaths.10 Human behavior is a major obstacle to disease control. Changes in human behavior may prevent most of the world's major health problems & premature deaths at low cost. Public health is defined as ‘the health status of a defined group of people and the governmental actions and conditions at the local, state, and national levels to promote healthy behaviors, prevent spread of disease and injuries, protect against environmental hazards & disasters and assure the curative and rehabilitative health services. Many public health recommendations and clinical guidelines emphasize that healthy lifestyles have substantial health benefits.11 Changes in the life-style of the population by health education encompass three approaches of primary prevention as recommended by the WHO for prevention of chronic diseases. In first approach or primordial prevention, children are discouraged from adopting harmful lifestyles through individual/ mass education in countries in which many adult health problems (e.g., obesity, hypertension) have not yet appeared. Lifestyles are formed during childhood and aim is to prevent the emergence of risk factors. Second approach or population (mass) strategy is directed at the whole population, irrespective of individual risk level. A small reduction in the average blood pressure/ serum cholesterol in the community, helps in reducing the CHD prevalence. Third approach or high-risk strategy, on the other hand, aims to detect individuals at high risk by the optimum use of clinical methods and provide preventive care to them. To have an impact on the population, all the above three approaches should be implemented as they are usually complementary but the results are perceived after several decades and not immediately. Besides health education the population must have access to preventive measures.5 Lifestyle medicine program serves as a systematized approach to manage NCDS by addressing multiple risk factors through self-management skills.12 Physical activity leading to cardiorespiratory fitness is needed in all age groups, both sexes, race & ethnicities to prevent NCDs including CVDs.13 Better control of behavioral risk factors alone could prevent one-third of all acute and two-thirds of chronic disabilities. Physical activity, consumption of fresh rather than processed foods, limited use of cooking/ table salt to

Training and education in physical education lessons is a complex, multifaceted process, the effectiveness of which depends not only on what the teacher himself knows and can do, but also on how he transfers knowledge and skills to students. Pedagogical activity is a continuous solution of pedagogical problems. A special feature of the working conditions of a physical education teacher is the need to demonstrate physical exercises and insure students when they perform physical exercises, as well as to move with students during outdoor exercises, on hikes, etc. The effectiveness of a coach depends on many factors: economic, social, scientific, organizational, etc. The indicator of a coach’s effectiveness is the successful achievement of a goal with the most rational use of forces and means, which presupposes that the structure and functioning of the coach’s psyche corresponds to the structure and dynamics of his activities.

Hippocrates - Father of Medicine (ca 460-370 BC) - endorsed the cuative effects of foods; he said: "Leave your drugs in the chemist's pot if you can heal the patient with food". This review focuses on the management of cardio-metabolic diseases (CMDs) with nutraceuticals and antioxidant diets such as Allium sativum, turmeric, soybean, peptides, phytosterols, resveratrol, polyphenolic substances etc. CMDs are a cluster of conditions linked to altered fat and carbohydrate metabolism as well as macroand micro-vascular problems. CMDs cause severe pathophysiological and metabolic alterations in the body, resulting in the occurrence of chronic diseases like atherosclerosis, coronary heart disease and stroke, neurodegenerative ailments, fatty liver, kidney malfunction, hypercholesterolaemia, hyperlipidaemia, insulin resi-tance and some cancers, consequently imposing a very high economic burden on the healthcare costs. Currently used pharmacotherapies are not only expensive but also are associated with undesirable adverse events. Thus, there is an urgent need for affordable, cost-effective and alternative safe therapies for the prevention and management of CMDs. Holistic approaches targeted for health promotion and prevention of CMDs include the intake of antioxidant-rich diets, anti-inflammation wholesome foods and moderate physical activity (about 30 min/day). Such strategies will not only prevent obesity-related CMDs, type 2 diabetes mellitus (T2DM), coronary heart disease and stroke, but also will improve the quality of patient's life and consequently reduce healthcare burdens. Nutraceuticals and probiotics exhibit anti-inflammation, anti-aging, anti-obesity and anti-diabetic effects, thereby reducing the adverse health risks associated with CMDs. Antioxidants protect cell membranes and DNA from excessive free radicals, which contribute to CMD related diseases. Physical exercise along with dietary interventions helps to mitigate oxidative stress, improve blood triglyceride levels, increase HDL-cholesterol and reduce LDLcholesterol and reverse the biological markers associated with CMDs. Many studies have provided robust scientific evidence and demonstrated links between dietary interventions, nutraceuticals, probiotics, wholesome foods and physical activity for the prevention of CMDs. The major limitations in promoting nonpharmacological therapies for health and well-being benefits are a lack of public awareness and a paucity of clinical nutrition instruction for medical students on the merits of complementary methods for the prevention and management of CMDs. The goals of this review are to provide up-to-date knowledge about selected nutraceuticals, wholesome foods and physical activity in the prevention of CMDs and the underlying mechanisms associated with each intervention, which will ultimately improve patient's quality of life and assist in reducing healthcare costs globally.

Background. The main problems of the postoperative period include organ dysfunction (“surgical stress”), morbidity due to hypothermia, pain, hyper- or hypovolemia, cognitive dysfunction, sleep disturbances, immobilization, semi-starvation, constipation, thromboembolism, anemia, postoperative delirium and more. A multimodal approach to optimizing enhanced recovery after surgery (ERAS) includes improving the preoperative period, reducing stress and pain, exercise, and switching to oral nutrition. These measures accelerate recovery and reduce morbidity. Objective. To describe the measures required for ERAS. Materials and methods. Analysis of literature sources on this issue. Results and discussion. The majority of postoperative complications are associated with the so-called surgical stress involving the release of stress hormones and the start of inflammatory cascades. The stress response is triggered not only directly as a result of surgery, but also as a result of the use of regional anesthesia and other medications. Mandatory prerequisites for ERAS include procedure-specific dynamic balanced analgesia, as well as patient blood management (PBM). The latter consists of hematopoiesis optimization, minimization of bleeding and blood loss, improvement of anemia tolerability. The presence of preoperative anemia before joint replacement significantly increases the number of complications in the 30-day period (Gu A. et al., 2020). Preoperative anemia also leads to the unfavorable consequences of other interventions, which underlines the need to detect and treat it early. An optimal infusion therapy with a positive water balance (1-1.5 L) is an integral component required for ERAS. Balanced solutions should be used; opinions on the use of colloids are contradictory. Venous thrombosis remains a significant problem, as immobilization is an important pathogenetic mechanism. The question of optimal prevention of this condition has not been clarified yet. In 40-50 % of cases after major surgery and in <5 % of cases after minor interventions, the patient develops postoperative orthostatic intolerance. The mechanisms of the latter are a decrease in sympathetic stimulation against the background of increased parasympathetic stimulation; the effects of opioids and inflammation are likely to play an additional role. Preventive methods have not been definitively established, α1-agonists (midodrine) and steroid hormones are likely to be effective. Unfortunately, for most of these problems, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. The ERAS Society has created recommendations for the management of patients, undergoing a number of surgical interventions (gastrectomy, esophagectomy, cesarean section, oncogynecological surgeries, etc.). For example, recommendations for colon interventions include no premedication and bowel preparation for surgery, use of middle thoracic anesthesia/analgesia, administration of short-acting anesthetics, avoidance of sodium and fluid overload, use of short incisions, absence of drainages, use of non-opioid oral analgesics and non-steroid anti-inflammatory drugs, stimulation of intestinal motility, early removal of catheters, oral nutrition in the perioperative period, control of surgery results and adherence to treatment. Knowledge of procedure-specific literature data and recommendations, multidisciplinary cooperation, monitoring, identification and sharing of methods that have economic advantages are necessary for the ERAS improvement. Outpatient surgery and one-day surgery are becoming more and more common. In a study by N.H. Azawi et al. (2016) 92 % of patients after laparoscopic nephrectomy were discharged home within <6 hours after surgery. Repeated hospitalizations of these patients were not recorded. In a study by G. Ploussard et al. (2020) 96 % of patients after robotic radical prostatectomy were discharged home on the day of surgery; 17 % required re-hospitalization. Early physical activity is an important component of rapid recovery after surgery. There is an inverse relationship between the number of steps per day and the severity of pain after a cesarean section. Despite a large body of literature on the subject, large-scale randomized trials and definitive procedure-specific recommendations are still lacking. This justifies the need for thorough pathophysiological studies and, once completed, randomized controlled or cohort studies. The objectives of these studies should include clear clarification of the pathophysiology of postoperative organ dysfunction, the introduction of a procedure-specific and evidence-based set of perioperative measures, monitoring of purely surgical and general medical consequences of surgeries, identifying areas for improvement and finding new treatment and prevention strategies. Conclusions. 1. Multimodal approach to ERAS optimization includes improvement of the preoperative period, reduction of stress and pain, physical activity, transition to oral nutrition, etc. 2. Procedure-specific dynamic balanced analgesia, PBM, optimal infusion therapy with a positive water balance are the mandatory prerequisites for ERAS. 3. For the majority of problems of the perioperative period, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. 4. New preclinical and clinical studies are needed to form definitive guidelines for the management of patients in the perioperative period.

This review presents the problems that arise when learning Tamil and the solutions for it, which is our mother tongue, and which has been a virgin language for a long time. Solutions to problems in learning can be found through oral training and error free writing training. Oral training should be given through different and flexible exercises. The speech of the linguist should be an example to eliminate the shortcomings of unedited speech. The difference in the duration of the writing of the characters and the place of birth of a word should be clearly stated through individual training and group training. Writing training plays an important role in providing error & free writing training. Being able to write without error is made possible by clear pronunciation, oral reading, relaxed writing, checking what is written, knowing the rules of grammar etc.

We believe a holistic approach to problems in childhood and adolescence will benefit the child, adolescent, and the whole family. As a rule, children have far less to say in the family than their parents. Therefore, it is the parents who set the agenda and decide how things are done at home and in relation to the child. Most often, it is also the parents who have a problem when the child is not thriving. The child thus acts as the thermometer of the family. When children are not feeling well or are sick, the parents are not doing well either. Most problems arising from dysfunctional patterns are almost impossible for the parents to solve on their own, but with help and support from the holistically oriented physician, we believe that many problems can be discovered and solved. Not only can health problems be addressed, but also problems of poor thriving in the family in general. With the physician in the role of a coach, the family can be provided with relevant exercises that will change the patterns of dysfunction. Consciousness-based medicine also seems to be efficient with children and adolescents, who are much more sensitive to the psychosocial dimensions than adults. Five needs seem to be essential for the thriving and health of the child: attention, respect, love, acceptance (touch), and acknowledgment. The physician should be able to see if the child lacks fulfillment in one or more of these needs, and he can then demonstrate to the parents how these needs should be handled. This should be followed by simple instructions and exercises for the parents in the spirit of coaching. This approach is especially relevant when the child is chronically ill.

Background: Musculoskeletal disorders are the frequent and serious hazards of the health in the overall world. Poor guidance to the individuals with musculoskeletal disorders can cause increase in intensity of pain and can alter the disability factor Physiotherapists have a major role in dealing musculoskeletal disorders as they use their clinical expertise to access and treat patients in order to reduce and relieve the pain and treat muscle weakness, loss of stability, and limited functional disabilities Objective: To determine the physiotherapy treatment preferences for common musculoskeletal problems across Pakistan. Material and Method: In this study 5 point likert scale was used to check the treatment preferences in which some are strongly agree, agree, while on the other hand some are disagree and strongly disagree and some shows no response or neutral reactions. Results: table 1 A total of 217 physiotherapists participated in the study. Out of total 54.8% were males and 45.2% were females. Their treatment preferences for 14 common musculoskeletal disorders of upper extremity, lower extremity and spine were asked and responses were recorded in the form of 5 point Likert scale Conclusion The most preferred treatment options were cryotherapy for Ankle Sprain, pain medication for Frozen Shoulder, anti-inflammatory agents for Plantar Fasciitis, heel lifts for Achilles Tendonitis, cervical mobilization/manipulation for Neck Pain, nerve gliding exercises for Cubital Tunnel Syndrome, strengthening exercises for Golfer Elbow, manual therapy for Knee Osteoarthritis, stretching for Piriformis Syndrome, therapeutic exercises for Hip Osteoarthritis, pain medication for Tennis Elbow, electrotherapy for Carpal Tunnel Syndrome, strengthening exercises for Low Back Pain, range of motion exercises for Rotator Cuff Tendonitis, and strengthening exercises for SIJ Dysfunct.

Acquired immunodeficiency syndrome (AIDS) patients face great socio-economic problems in obtaining treatment. There is an urgent need for new, ecofriendly, safe, and inexpensive anti-HIV agents. Traditional medicinal plants are a valuable source of novel anti-HIV agents and may offer alternatives to expensive medicines in future. Various medicinal plants or plant-derived natural products have shown strong anti-HIV activity and are under various stages of clinical development in different parts of the world. Areca catechu Linn., Azadirachta indica A. Jusss., Aegle marmelos (Linn.) Correa, Argemone mexicana Linn, Hypericum indicum Linn., Terminalia chebula Retz., Plumbago indica Linn., Asparagus racemosus Willd., Curcuma longa Linn., Coleus forskohlii Andrews, Rubia cordifolia Linn. etc. reported promising anti-HIV potential. The chapter was directed towards discussion of anti-HIV activity of various medicinal plants and their natural extracts.

A biomarker is a biological finding that, in theory, predicts and serves as a stand-in for a clinically significant endpoint or intermediate outcome that is more challenging to observe. Because biomarkers are used so often in scientific and clinical research, as well as in clinical practise, it is now nearly universally acknowledged that they should be used as primary endpoints in clinical studies. This use is totally legitimate and suitable in the case of certain biomarkers that have been thoroughly defined and consistently demonstrated to accurately predict pertinent clinical outcomes across a range of treatments and demographics. However, the "validity" of biomarkers is frequently presumed when it should be tested and retested. To provide context for interpreting studies that extensively rely on such biological measures, this article will examine the current conceptual position of biomarkers as clinical and diagnostic tools and as surrogate endpoints in clinical research. [1] Clinical biomarkers are typically assessed over a shorter time than the final clinical objective, making their application simpler and less expensive. They can be utilised for pharmacodynamic and dose-response investigations as well as for illness screening, diagnosis, characterisation, and monitoring as prognostic markers for developing tailored therapeutic interventions for predicting and treating adverse drug responses. Good biomarkers should have a large signal-to-noise ratio, be quantifiable with little to no fluctuation, and change quickly and consistently in response to changes in the condition or its treatment. Biomarkers are the cornerstone of a precision approach to clinical medicine and have the potential to dramatically improve and speed up the development of new therapeutics for patients with a variety of diseases such as tumours, heart problems, etc

The chapter is devoted to some aspects of studying the construction of new ecosystems and, in particular, medical ecosystems. This topic is very relevant, in view of the fact that currently all over the world and in the Russian Federation there is a process of transition to a new model of the existence of individual systems and industries, which are beginning to include full-fledged ecosystems. Medicine was no exception. All over the world, including in our country, medical ecosystems are beginning to form, the goal of which should be to improve the quality of medical care provided, as well as improve the quality of medicine in general. The purpose of this scientific work was an attempt to analyze the awareness of medical students and doctors about medical ecosystems, as well as to identify the main problems, including those of an economic nature, that arise during the creation and construction of new medical ecosystems, according to the subjects of the study. The subjects of the study were 200 people: 100 6th year students of the Faculty of Medicine of Voronezh State Medical University. N.N. Burdenko; 100 people became representatives of practical healthcare – doctors of the Voronezh Regional Clinical Hospital No. 1. The study was based on a questionnaire developed by the authors, containing several blocks of questions relating to the gender and age of respondents, their awareness of existing ecosystems and medical ecosystems, in particular; about their attitude to the above systems and about the opportunity to become part of such a medical ecosystem. But, directly, the most important part of the presented research was the study of existing problems that arise, according to the respondents, during the formation and formation of various ecosystems, including medical ones. As well as a more detailed study of various economic problems and their ranking. The data obtained allow us to take a fresh look at the problems of building ecosystems, including medical ones, and are also of interest to representatives of many specialties and professions – for economists, for lawyers, for doctors, for higher education teachers involved, for example, in the process training medical students, etc.

Several serine protease inhibitorsof plasma inhibit the activated coagulation enzymes but only antithrombin III(AT-III)and heparin cofactor II (HC-II) are implicated in the pathogenesisof the familial thrombosis. Since thefirst publication (1965) many thrombophilic families with reduced AT-III synthesis have been investigated. These studies have proved that the disorder is associated with a high risk forvenous thrombosis and the inheritanceis autosomal dominant. The AT-III activity in the plasma of the affected patients is about 50% of the normalvalue.In recent years the heterogeneity of the inherited AT-III deficiency has been verified. The various AT-III abnormalities are not mere interestingrarities but they provide naturally occurring models for the solution of theoretical problems such as the function of AT-III molecule, the physiological significance of heparin, etc. Furthermore, the clinical manifestationof the particular variants greatly differs from symptomless abnormality tosevere thrombotic cases.In the majority of cases, reduced functional activity is accompanied with a parallel decrease of antigen concentration of AT-III. This is the characteristic feature of the quantitative or Type I ("classical")AT-III deficiency. By means of crossed immunoelectrophoresis, electro-focussing and recombinant DNA techniques the heterogeneity of this group has been established. In one subgroup (Type la) AT-III molecules are normal as regards their biochemical characteristics. In Type lb, subnormal AT-IIIquantity is accompanied with decreased heparin affinity. Differentiation of these subgroups has practical consequences: therapeutic concentrations of heparin apparently does not decrease AT-III level in the plasma of patients with Type lb AT-III deficiency.The other main form is the qualitative deficiency of AT-III (Type II) which is characterised by reduced functional activity at normal antigen concentration. In general, two populations of AT-III molecules can be detected in the blood of these patients: a normal and an abnormal one. Up till now at least 24 different abnormalities were found and designatedwith toponymes. These disorders can be classified with relatively simple laboratory methods such as functional anti-IIaXaFirstDepartment of Medicine, Postgraduate Medical University, Budapest, Hungary.arin cofactor activity, crossed immunoelectrophoresiswith and without heparin, heparin-affinity chromatography. Type na is characterised by profound structural changes of the molecule,variably: reflected in reduced inactivation of F Ha and F Xa, abnormal heparin-AT-III reaction and aberrant immunochemical structure Seven different abnormalities fall into this group (Budapest I, Tokyo, MalmÖ, Chicago, Milano, Trento and Northwick Park). The last three abnormalities are very similar.In Type lib an isolated defect of protease inactivation can be detected and an isolated disturbance of the active centre ofthe molecule is assumed.Until now 6 apparently different variants belonging to this group have been described. (Aalborg, Vicenza, Denver, Hvidovre, Charleville, Milano 2.) Type lie abnormality is characterised by an isolated defect of the heparin-AT-III reaction. In these cases a disturbance of the heparin binding site(s) is assumed. Eleven families with this type of abnormality have been recorded (Ann Arbor, Basel, Paris 1 and 2, Toyama* Tours, Padova I and 2, Algers, Fontainebleu and Budapest 2). This subgroup is heterogeneous in respect ofheparin affinity: in the majority of cases the abnormal AT-III molecules have no heparin affinity at all while in rare cases (such as Basel, Budapest 2) they have reduced affinity.TheType lie AT-III deficiency has several distinctive features compared with the other subtypesJClinically, the thromboembolic complications are rare: in 4 families thrombosis has notoccurred at all. Only one member in each of 4 other families had thrombosis. In 3 families homozygous patients suffered severe thrombosis in young age and/or in unusual localisations (intraarterial, intracardiac, etc.) butthe other heterozygous members were free of thrombotic symptoms. No increased intravascular coagulation could be detected in Type lie heterozygous cases incontrast to the "classical" AT-III deficiency.These observations suggest a different mechanism and clinical manifestation of the deficiency of progressiveserine protease inactivation and of heparin cofactor activity. In case of progressive inactivation, reduction of 50% of the activity predisposes mainly to venous thrombosis as a consequence of the hypercoagulability of theblood. The isolated reduction of heparin cofactor activity seems to bringabout thrombosis in any part of the vascular system, but only if this reduction is as severe as that of the coagulant factors in case of coagulopathies.In accordance with this finding, rare cases of HCII deficiency give rise to thrombosis in both the arteries and the veins. Heparin cofactor activities may play an important role in the antithrombotic mechanism along theendothelial surface of the whole vascular system.