[Acute hepatitis caused by herpes simplex virus 1]
PATYI Márta1, SEJBEN István2, VÁGÓ Tibor2, CSERNI Gábor2, KISS Antal Zsolt3, KISS József Zoltán3
MAY 20, 2011
Lege Artis Medicinae - 2011;21(05)
PATYI Márta1, SEJBEN István2, VÁGÓ Tibor2, CSERNI Gábor2, KISS Antal Zsolt3, KISS József Zoltán3
MAY 20, 2011
Lege Artis Medicinae - 2011;21(05)
[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[The author presents the recommendations of international guidelines in the modern diagnosis and treatment of low back pain. Regarding diagnosis, it is very important to differentiate between “specific” and “aspecific” or “nonspecific” low back pain. The term “specific low back pain” includes all diseases and pathologies with well-defined aetiology and pathological process, including bacterial spondylitis, rheumatic spondylarthropathies, primary or secondary tumours, malignancies, myelon- or cauda equine compression, paresis, metabolic base diseases, pathological or nonpathological fractures are suspected. The presence of so called “red flags” indicate“specific” low back pain. This type of low back pain requires quick and precise diagnosis and specific treatment. All other kinds of low back pain, even those with very painful radiculopathy, and without paresis, cauda- or myelon compression can be considered as aspecific, even if caused by a herniated disc, because there is no absolute indication of discectomy. In case of aspecific low back pain, there is no need of any diagnostic imaging methods, because they would not influence treatment. The main points of treatment are to keep the patient active, quick mobilisation with appropriate analgesia and antiinflammatory treatment following no more than 2-3 days of bed rest, and return to work as soon as possible, with easier work conditions if needed. The longer the patient is on sick leave, the higher the risk he or she will never return to work. If initial active treatment is not is effective enough, the patient's case should be reassessed in 3-6 weeks. If a herniated disc is suspected, the necessary imaging methods should be performed, and the patient should be operated if necessary. With this method, chronic, disabling low back pain can be avoided in many cases. The danger of developing chronic low back pain are indicated by the so called “yellow flags”: dissatisfaction with work, allowance claim, insufficient and even false ideas about the causes and consequences of low back pain, fear, anxiety, depression. These problems can be alleviated by the positive athmosphere of the workplace, appropriate patient education, activity, anxiolytic and antidepressant drugs, activity and regular exercise.]
LAM Extra for General Practicioners
[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]
Hungarian Radiology
[INTRODUCTION - Sarcoidosis is a relatively common multisystemic disorder. Chest involvement is most frequent, but any organ can be involved. In case of abdominal lesions the suspicion of sarcoidosis rarely arises. CASE REPORT - A 53-year old female patient with a history of crural pain unresponsive to medications and weight loss of unknown origin was sent to the internist. Hypercalcemia and bone pain suggested multiple myeloma, however, this diagnosis could not be confirmed. Chest X-ray examination was negative. Splenomegaly and multiple hypodens splenic and hepatic lesions were detected by ultrasound and abdominal computed tomography. Finally, ultrasound guided biopsy of the liver proved stage II sarcoidosis. Steroid therapy was initiated and the splenic and hepatic lesions seen with ultrasound and CT scan disappeared. CONCLUSION - Sarcoidosis is usually suspected following chest X-ray or during chest CT examination. Nevertheless, our case demonstrates that multiple lesions in the spleen or liver may indicate sarcoidosis even in the absence of thoracic lesions. Biopsy taken from the lesions can lead to adequate diagnosis.]
Clinical Neuroscience
After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.
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Clinical Neuroscience
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