Lege Artis Medicinae

[Diagnostics of HER-2]

KÁLMÁN Endre

JULY 14, 2008

Lege Artis Medicinae - 2008;18(06-07)

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Lege Artis Medicinae

[UNSOLVED THERAPY - COMPLEX TREATMENT OF BUERGER’S DISEASE]

SZOMJÁK Edit, DÉR Henrietta, KEREKES György, VERES Katalin, DEZSŐ Balázs, TAKÁCS István, TÓTH Judit, MÓZES Péter, SOLTÉSZ Pál

[INTRODUCTION - Buerger’s disease is a nonatherosclerotic, segmental, inflammatory, progressive obliterative disease of the blood vessels that most commonly affects the small and medium-sized arteries and also the veins of the lower limb. It is strongly associated with tobacco use. CASE REPORT - A 37-year-old heavy smoker forest worker presented with severe gangrenous changes on the fingers as the upper limb manifestations of Buerger’s disease, which required acral amputation. After complex medical treatment, pharmacological sympathectomy on the left side and surgical sympathectomy on the right side, bilateral conserving necrectomy, cessation of smoking and 2 cycles of cyclophosphamid, the patient's status significantly improved, his pain diminished and, although to a limited extent, he could use both hands. CONCLUSIONS - Buerger’s disease is a disorder with unclear aethiology and is difficult to diagnose. Despite of a good prognosis, a causal treatment is not yet possible, so any antithrombotic, haemorheological, vasodilator or immunosuppressive therapy that have been reported to have beneficial effect should be considered for treatment.]

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[“I Want Magic!” A Discussion with Dóra Elek, Director of the Baltazár Theatrical Group]

GYIMESI Ágnes

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[Multifocal nodular hepatic steatosis]

BAJOR Judit

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[Tiotropium treatment of patients with simultaneous chronic obstructive pulmonary disease and asthma]

BALIKÓ Zoltán

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[Stem cell therapy: A new approach to treat vascular stenosis]

BODA Zoltán

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The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

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