Lege Artis Medicinae

[A CASE OF PRIMARY HEPATIC AMYLOIDOSIS PRESENTING WITH GASTRIC BLEEDING]

STOGICZA Ágnes, GRABER Hedvig, SKALICZKI József, NÁDOR Katalin, MAGYAR Tamás

JUNE 22, 2004

Lege Artis Medicinae - 2004;14(06)

[INTRODUCTION - Amyloidosis - at an early stage - has no typical clinical findings, but severe weight loss, hepatomegaly and elevated serum alkaline phosphatase level can be clues to the diagnosis. CASE REPORT - We report a 66-year-old woman presenting at our unit with massive gastrointestinal bleeding. Gastroscopy was performed and a haemorragic ulcer was found. Before admission she had lost 20 kg-s in 6 months. The patient had hepatomegaly and markedly elevated serum alkaline phosphatase level. These findings suggested the presence of malignancy, but ultrasound, CT and MR examinations did not support this hypothesis. After liver biopsy the diagnosis of amyloidosis was proven. She had rapid downhill clinical course of gastric bleeding from an ulcer resulting in death. CONCLUSIONS - So far, no specific treatment exists for amyloidosis, but there have been promising results reported about liver transplantation and autologous stem-cell transplantation.]

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Lege Artis Medicinae

[REFRACTIVE SURGERY IN THE XXIST CENTURY - SURGICAL CORRECTION OF REFRACTIVE ERRORS]

NAGY Zoltán Zsolt, SZABÓ Viktória, SÜVEGES Ildikó

[Refractive surgical procedures have become more and more popular worldwide. The ultimate aim of these procedures is to change the refractive power of the cornea in order to achieve good uncorrected visual acuity and to get rid of the optical correction need. In this article, the history of refractive surgery, the most important characteristcs and types of the excimer lasers, the most up-to-date refractive surgical techniques and alternative refractive procedures are presented. The lower and upper limits of surgical correction, the newest diagnostic and technical development, i.e. the possibilities of wavefront technology are also discussed.]

Lege Artis Medicinae

[MEDICAL ANTHROPOLOGICAL APPROACH TO CHILDREN'S SURMISES ON SMOKING]

BAK Judit, PIKÓ Bettina

[INTRODUCTION - The aim of our study was to explore school children'’s surmises on smoking. The following questions were in the focus of our analysis: what concepts children have about smoking and smoking-related diseases before adolescence? Have they already tried smoking? METHODS - The study was conducted among 3rd, 4th and 5th year school children (N=128) in two towns of Békés County, namely in Békés and Köröstarcsa. The sample consisted of 57% males and 43% females. Regarding sampling we followed international studies with similar aims where samples of 9-11-year-old average children were thought to be ideal for such study purpose using the draw-and-write technique. RESULTS - Most respondents from the study have not tried smoking yet. On the other hand, there are great number of adults who smoke in children’s environments, in many times, both parents do. Despite these facts, children’s attitudes toward smoking is rather negative. Children'’ s opinions reflect many negative aspects of smoking: the health-damaging effect, the financial aspects, the negative effects for social and physical environment. CONCLUSIONS - Similar to previous international studies, children of our sample possess correct and comprehensive knowledge of the smoking-related health problems. Findings of our study provides a support to the need of a smoking prevention program for children in the age of their negative opinions of smoking and well before the peer group effect is getting significant.]

Lege Artis Medicinae

[On teaching, with personal overtones]

BODA Domokos

Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

Lege Artis Medicinae

[NEW METHODS FOR NON-INVASIVE ASSESSMENT OF AIRWAY DISEASES]

HORVÁTH Ildikó

[In chronic obstructive airway diseases there are several unsolved questions regarding the early diagnosis, monitoring treatment, simple detection of exacerbations and the questions of differential diagnosis. These problems indicate the need for the development of new diagnostic methods and their application in clinical practice. This need is further emphasized by the fact that in most chronic airway diseases, including asthma and chronic obstructive pulmonary disease inflammation has a central role in the pathomechanism and its suppression is the main aim of treatment, but so far, we do not have adequate method for the assessment of inflammation intensity in clinical practice. In recent decades non-invasive sampling techniques directly from the airways have made a progress in respiratory research and at present some of them are available for clinical use. Among these techniques sputum induction, measurement of exhaled biomarkers including exhaled nitric oxide and mediators in exhaled breath condensate samples are used increasingly. The present review summarises our current knowledge on these methods and the most important findings obtained by their applications.]

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[A case of gastrointestinal stromal tumor of the small intestine causing gastrointestinal bleeding]

TAMÁS Krisztina, KIRÁLY Ágnes, KALMÁR Katalin, WENINGER Csaba, TORNÓCZKY Tamás

[INTRODUCTION - The neoplastic disease of the small intestine - especially the gastrointestinal stromal tumor - is a rare disease, its diagnostics is not an easy task. CASE REPORT - The authors examined a 71-year-old female patient who presented hematemesis and melena. A small intestine tumor was detected by endoscopy and abdominal computed tomography as the source of gastrointestinal bleeding. Histology proved gastrointestinal stromal tumor. The characteristics of the tumor were reviewed based on the literature. CONCLUSION - Radiological imaging plays a significant role in the diagnosis of gastrointestinal stromal tumors.]

Lege Artis Medicinae

[Prediction of rebleeding and its importance in the treatment of upper gastrointestinal bleedings originating from peptic ulcers]

ONDREJKA Pál

[Nearly 50% of upper gastrointestinal bleedings originate from peptic ulcers. While the number of scheduled operations carried out due to peptic ulcers is decreased to nearly zero in the past decade, the number operations due to the complications of peptic ulcers remained unchanged. Bleeding from peptic ulcers usually stops spontaneously in a remarkable part of the cases, but in many times rebleeding is anticipated. These patients present several problems which are difficult to treat, and patients in need of emergency surgery are usually from this group. This is the main reason why the identification of those patients with high risk for rebleeding is important. With the help of the modified "Baylor Bleeding Score" rebleeding can be predicted. In the case of high risk for rebleeding, an early elective operation can avoid a latter urgent operation, which has markedly higher mortality and morbidity. In peptic ulcer bleeding, endoscopic treatment modalities have the priority. Most preferred method is the injection of different haemostatic drugs, with thermal methods and haemoclips being also accepted. Among surgical treatments, ”aggressive” resection operations are preferable. Additional "conservative" medical treatment with proton pump inhibitors is also recommended.]

Lege Artis Medicinae

[DIVERTICULOSIS, DIVERTICULITIS - SYMPTOMS, DIAGNOSTICS AND TREATMENT]

NÉMETH Anna Mária, ENDER Ferenc, BANAI János

[Diverticulosis of the colon is frequent in developed countries. Decreased intake of dietary fibre have been implicated as an important pathogenetic factor. Most of the affected patients are asymptomatic but 10-20% of them have abdominal problems. Clinical manifestations range from simple, non-complicated form (abdominal pain, distension, constipation, urgency etc.) to severe complications (diverticulitis, abscess, peritonitis, perforation, haemorrhage etc.) The diagnosis and therapy of different forms of diverticular disease can be very simple but in several cases differential diagnostical problems and therapeutical difficulties may arise. The gold standard for establishment of uncomplicated diverticulosis is the barium enema or colonoscopy. In case of complicated forms non-invasive methods (US, CT scan, CT-colonography, MRI) have to be preferred. These examinations have no risk for perforation and extraintestinal pathology (air, fluid, abscess) can be detected. Colonoscopy or angiography are the methods of choice in case of haematochesia. The choice of therapy is based on clinical presentation, symptoms and pathology. Fibre supplementation is recommended for patients with diverticulosis without symptoms. In case of noncomplicated symptomatic diverticular disease fiber supplementation or cyclic administration of broad spectrum, poorly absorbable antibiotic can be effective in the prevention of inflammatory episodes and complications. If some of the severe or recurrent complications can not be treated conservatively, surgery is necessary. Prevention of diverticulosis and diverticular disease has to be emphasized. While fibre supplementation in the diet is recommended, other efficacious preventive strategies remain to be identified.]

Lege Artis Medicinae

[Antiplatelet therapy with acetylsalicylic acid - Cardiovascular indications and haemorrhagic complications]

KISS Nóra, KISS Róbert Gábor

[Acetylsalicylic acid effectively blocks the activation of platelets, and becomes a basic element of antithrombotic therapy of patients with high cardiovascular risk. Decrease of platelet reactivity is due to the irreversible inhibition of COX- 1 isoenzime in platelets during treatment. Choosing the right dose is still not an easy task. Bleeding side effects are frequently seen in patients treated with this drug worldwide. Clinical benefit does not improves with escalated doses (300 mg), however the risk of haemorrhagic events increases. Therefore acetylsalicylic acid dose should be reduced to the effective minimal dose (75-150 mg daily) after the acute phase of atherothrombosis in order to prevent side effects. Effect of acetylsalicylic acid differs individually, it might be important screening out those patients who respond less to the drug. Resistance is still an evolving field, proper methodology is to be determined. Right indications of acetylsalicylic acid needs balance between reaching clinical benefit and avoiding side effects. The Hungarian Cardiovascular Therapeutic Consensus Conference 2009 suggested acetylsalicylic acid in primary prevention for those males only, who have overt cardiovascular risk, and SCORE result is more than 10%, with no gastrointestinal haemorrhage in medical history, and with a well-controlled hypertension. Lifelong aspirin prevention should be used after all diagnosed cardiovascular atherothrombotic event as a cornerstone of secondary prevention with low dose (75-150 mg daily) in both genders.]