Lege Artis Medicinae

[Color and pulsed doppler velocimetry of the uterine artery in the second part of the normal pregnancy]

SZABÓ István1, PAULIN Ferenc1, RINGÓ János Jun1, NÉMETH Lajos1, CSABAY László1, PAPP Zoltán1

MAY 25, 1994

Lege Artis Medicinae - 1994;4(05)

[Color Doppler imaging allows accurate identification of the main uterine arteries, which reflect the sum of the resistance of the placental bed and are therefore more likely to provide an overall picture of placental perfusion. In a cross-sectional study of 231 healthy women with singleton pregnancies at 19–40 week's gestation, color Doppler imaging was used to identify the main uterine arteries for subsequent pulsed Doppler studies. Flow velocity waveforms were obtained and indices of impedance, peak systolic blood velocity and mean blood velocity were measured. Impedance to flow decreased, whereas blood velocity increased significantly with gestation. Furthermore, impedance to flow was lower and velocity higher in the placental uterine artery (closest to the main bulk of the placenta) than in the non-placental artery. The changes in the uterine blood flow during normal pregnancy provide indirect evidence for the increase of the maternal blood supply necessary for normal intrauterine development. Definition of the reference ranges of parameters used to characterize blood flow velocity wave forms has an importance in the investigation of complicated pregnancies. ]


  1. Semmelweis Orvostudományi Egyetem I. sz. Szülészeti és Nőgyógyászati Klinika Budapest



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Lege Artis Medicinae

[Tuberculosis an immunological perspective]


[Tuberculosis is one of the most frequent infections in the world, with at least one third of the world's population carrying the pathogen. The number of active tuberculosis cases is increasing in the industrialized nations. The human immune system is unable to clear M. tuberculosis completely. The immune response in tuberculosis may be summarized as follows: M. tuberculosis is an intracellular pathogen living in the macrophages and evading the cell's effective antibacterial mechanisms. The defense against tuberculosis is a local event, resulting in a labile balance between host and parasite. Bacteria can survive in the tuberculotic granuloma and are prepared at any time to spread the organism in case of defective cell-mediated immunity. Activated macrophages play a pivotal role in the defence against Mycobacteria. The appropriate activation and cooperation of T cells is mandatory to mount a protective immune response. BCG vaccination is inefficient in protecting against adult tuberculosis but does protect newborns from disseminated tuberculosis. New vaccines or vaccination procedures are needed to develop a protective immunity against tuberculosis. ]

Lege Artis Medicinae

[Immunotherapy for tuberculosis clinical aspects of immunological research]


[Efforts toward developing an immunotherapy for tuberculosis are based upon the knowledge of delayed hypersensitivity and cellular immunity. The aim of immunotherapy is to strengthen the cellular immunity, enabling the immune system to destroy those persistent bacteria which remain alive following chemotherapy. Chemotherapy combined with an appropriate dose (10%) of dead M. vaccae significantly improved the therapeutic results of tuberculosis patients and reduced their mortality in double blind controlled studies. A beneficial effect was also observed in the treatment of chronic, multidrug resistent cases and in HIV positive tuberculosis patients. The duration of chemotherapy can be considerably shortened when concurrent immuno therapy is utilized.]

Lege Artis Medicinae



[On outpatient care from the perspective of the hospital outpatient clinic; The doctor's medicine; Renew or reassess; ]

Lege Artis Medicinae

[Epidemological findings of inflammatory bowel diseases in borsod county 1963-1992]

NAGY György, ÚJSZÁSZI László, JUHÁSZ László, MINIK Károly

[The epidemiologic data of inflammatory bowel diseases and the clinical aspects of ulcerative colitis and Crohn's disease were evaluated among the 800 000 inhabitants of Borsod County during three decades. Inflammatory bowel disease cases were continuously gathered from all the hospitals in the county. Patients were examined by standard diagnostic criteria. Consultative endoscopic advice, follow-up, and drugs prescription were provided on the wards. Patients' data were systematically registered and summarized. The following data were recorded: the patients' age, sex, ethnic group, urbanization; family prevalence, anatomical extension, type of course, severity of disease, and the occurance of malignant transformation. The authors registered 913 patients with inflammatory bowel disease, in the 10 hospitals of Borsod County between 1963 and 1992. 488 cases of ulcerative colitis were detected during the first twenty years, which is an incidence rate of 3.1/ 100,000 per year. The incidence during the third decade was 3.6/100,000 per year. 69 patients with Crohn's disease were examined during the first 20 years, and 78 in the third decade. The incidence of ileocolonal Crohn's disease increased from 0.43 to 1.00/100,000 per year. The authors didn't find a significant change in anatomical extension, severity or the clinical course of ulcerative colitis during the three decades. The increase of Crohn's diseases, and especially of isolated colonic types, may reflect improved diagnostic techniques. The incidence of inflammatory bowel disease increased among gypsies, but the incidence in that population was still only half of what was expected in the region. The authors found familial inflammatory bowel disease occurrence in 15 patients. Eight carcinomas were observed in the 766 ulcerative colitis patients, and 2 in the 147 Crohn's disease patients. ]

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[Experience with endobronchially localised benign tumors]

PÁPAI Zsolt, SZIMA Barna, KISS Katalin, KIS Sándor, STRAUSZ János

[The authors studied histologically verified, benign endobronchial tumours. Twenty seven tumours were discovered in our department in a 3 year period and 3 of them were surgically removed. From the group of 24 tumours unresectable for tehcnical or clinical reasons, 21 were endoscopically removed. During the follow-up tumour recurrence has not been observed. Most of the clinical symptoms improved significantly following tumour resection. These findings suggest that in well-defined cases, benign endobronchial tumours should be resected bronchologically. ]

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Lege Artis Medicinae

[Transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The authors performed serial examinations using a transvaginal transducer with color Doppler facilities in normal and pathologic early pregnancies in order to examine the circulatory changes in the female genital tract and developing embryo. This is a preliminary study demonstrating the application of TVCD and summarizing the main circulatory characteristics in early pregnancy as a part of a detailed program investigating circulation in the first trimester of pregnancy. Parallel with the implantation as a result of trophoblast induction the branches of the uterine arteries can be visualized by TVCD, and characteristic ilus velocity waveform can be identified in each portion of this network. No diastolic flow can be detected in the embryonic arteries until 12–14 weeks of gestation. The fetal heart rate shows a characteristic change between the 5th and the 14th week of gestation. Examination of the circulatory changes in pathologic early pregnancies helps to establish an exact clinical diagnosis and to choose the proper treatment. The recent advent of the transvaginal probe with color Doppler imaging has permitted accurate studies of the circulatory changes in the female reproductive organs to be performed and provided more information about physiologic and pathologic processes in early pregnancy than all the non-invasive systems developed previously. ]

Lege Artis Medicinae

[Investigation of uterine circulation by transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The circulatory changes and the characteristics of blood flow in certain uterine vessels can be detected by transvaginal color Doppler in early pregnancy. The uterine circulation of 53 patients with normal intrauterine pregnancies at 4–14 weeks of gestation and 104 non pregnant patients were investigated. The main uterine artery, arcuated and spiral arteries were demonstrated by color Doppler in all patients in early pregnancy and characteristic flow velocity waveforms were obtained in 94% of the cases. The impedance to flow in the main uterine artery was significantly lower and the mean velocity was significantly higher in early pregnancy than in non pregnant patients. The indices of impedance to flow decreased with gestation in the uterine branches and there was a progressive fall in these indices from the uterine artery to the spiral arteries. Mean blood velocity in the uterine artery increased with gestation. The hemodynamical changes which are proportional to gestation age give an indirect evidence of the adequate maternal blood supply for the growing embryo.]

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.