Lege Artis Medicinae

[ESPRIT]

MATOS Lajos

JULY 20, 2005

Lege Artis Medicinae - 2005;15(07)

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Lege Artis Medicinae

[A NEW SURGICAL TECHNIQUE FOR THE TREATMENT OF SEVERE BRAIN EDEMA OF TRAUMATIC ORIGIN - RESULTS OF THE APPLICATION OF VASCULAR TUNNELS]

CSÓKAY András

[INTRODUCTION - Decompressive craniectomy with durotomy is a well known, although strongly disputed method of treatment in cases of brain trauma, brain swelling and during persisting danger of fatal incuneation. It is not without significance that literature mentions this method only as an option. Although the method successfully diminishes the ICP this can still result in a partial or total lesion occuring in the herniating part of the brain. The actual cause of these symptoms is found in the blockage of the veins and arteries, caused by the shear and the pressure forces between the dural edge and brain tissue. PATIENTS AND METHODS - The new surgical technique consists of the creation of a vascular tunnel around the main cortical veins and the arteries of herniated brain. 36 patients have been operated on with this method. We used historical control (28 patients treated conservatively, 20 patients treated with decompressive craniotomy). RESULTS - A retrospective comparison was performed and the results in connection with the mortality and morbidity rate was promising. CONCLUSION - With the help of our new technique we managed not only to reduce the ICP greatly but we could also avoid further vascular laesion. This is due to the fact that we can assure the circulation and veinous drainage of the herniated part of the brain. This method can be used in any severe edematous state generated by other causes.]

Lege Artis Medicinae

[SUBCLINICAL THYROID DISEASES]

FÖLDES János, WINKLER Gábor

[More and more data are indicating that subclinical thyroid diseases can not be regarded as innocuous states. It seems very likely that slight changes in the serum thyroid hormone levels, still within the normal reference range, are sensed beside the pituitary also by other tissues and organs and their function may become abnormal. Considering these problems, it would be advisable to elucidate the proper time to start treatment, whether it is beneficial or not and to determine what the risks are for the applied therapy. Though the recommended guidelines for the management of subclinical thyroid diseases are becoming more and more evident, many questions remain still unanswered. It is not advisable to start an overzelous therapy, however, a too long waiting time for the installation of treatment could also be harmful. Large prospective and randomized trials are needed to clear these questions. This seems to be an urgent task, since due to their high prevalence, subclinical thyroid dysfunction might be regarded as a public health problem.]

Lege Artis Medicinae

[In the focus: traveller’s diseases]

JELENIK Zsuzsanna, LUDWIG Endre

Lege Artis Medicinae

[SOME ETHICAL DILEMMAS OF PLACEBO-CONTROLLED STUDIES]

KOVÁCS József

[The article deals with the question where and when is it ethically acceptable in a randomized controlled clinical trial to give the investigational drug to one of the groups, while placebo to the other. First, it gives a short overview on the origin of the problem and the history of its reemergence before and after the revision of the Declaration of Helsinki 2000. It examines the various forms of placebo use, the pros and cons of its implementation, the international debate before the revision of the Declaration of Helsinki 2000 and the corrections after its acceptance. Finally it declares some principles in connection with placebo controlled clinical trials and examines when such a trial is acceptable in various psychiatric disorders.]

Lege Artis Medicinae

[MANAGEMENT OF CUTANEOUS MALIGNANT MELANOMAS]

OLÁH Judit

[Malignant melanoma, the disease originating from pigment cells of the skin, mucous membrane, eye and rarely from other tissues, shows increasing incidence in the Caucasian population. The Hungarian statistical data correspond with the data of other countries. In the early stages of malignant melanoma surgical removal of the tumor is often curative, but patients with disseminated tumors have a poor survival rate. Regrettably, in Hungary the majority of melanoma patients are diagnosed with advanced tumors, with nodal or systemic metastasis. Physicians working in other fields of medicine have a great responsibility in patient education and in early detection of susceptible pigmented lesions. Diagnosis and treatment of malignant melanoma requires an experienced dermatologist. The clinical diagnosis of melanoma is aided by several new techniques, like digital dermatoscopy. In recent years, surgical therapy of malignant melanoma has changed: today we routinely perform sentinel node biopsy. This type of surgical technique requires experience. In advanced disease the use of chemotherapy and immunotherapy requires onco-dermatological experience. Educating the public and physicians provides the basis for prevention. Survival rate is mainly dependent on the quality of primary care which determines survival rate, therefore it is essential that patients with melanomas are followed up in onco-dermatological centers.]

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