Lege Artis Medicinae

[Fine Art Column]

MATIS Ferenc

SEPTEMBER 30, 1992

Lege Artis Medicinae - 1992;2(09)

[The work of Béla Horváth]

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Lege Artis Medicinae

[Echocardiography in the management of acute myocardial infarction]

LENGYEL Mária

[The author presents a detailed review of the role of echocardiography (echo) in the management of acute myocardial infarction (AMI). The echo diagnosis of AMI is based on segmental wall thinning and akinesia with a 90% accuracy. Echo has made a major impact on the immediate diagnosis of mechanical complications in the hemodynamically compromised patient with AMI. These mechanical complications which include myocardial rupture of the free wall or the septum or the papillary muscle, may be successfully treated by prompt surgical intervention. Echo diagnosis has an important role in the management of other complications of the acute, subacute and chronic phases of infarction as well, such as pericardial effusion, left ventricular thrombus, left ventricular aneurysm and pseudoaneurysm. Therapeutic strategies are thoroughly affected by systolic and diastolic function assessed by echo. Echo has a basic role in the algorithm of postinfarction anticoagulant treatment. Besides rest echo, early stress echo has a definite prognostic value in predicting multivessel disease and identifying viable myocardium which requires revascularisation procedures. The indications for echo in the acute phase and before discharge are summarized according to recent American recommendations. ]

Lege Artis Medicinae

[Clinical and immunological aspects of polymyositis and dermatomyositis]

DANKÓ Katalin, ZILAHI Zsolt, SZEGEDI Gyula

[Polymyositis and dermatomyositis are autoimmune diseases characterized by muscle weakness, tenderness, occasionally pain, and ultimately atrophy and fibrosis of the muscles. The extraskeletal manifestations, particularly the cardiopulmonary, oropharyngeal, gastrointestinal involvement, are described. Studies of autoantibodies and cellular immune function support a central role for disordered immunity in the pathogenesis. The myositis-specific autoantibodies, expecially those directed at certain enzymes important in protein synthesis are found in a clinically distinct subset of patients. ]

Lege Artis Medicinae

[Right ventricular infarction]

KISS Gabriella

[Right ventricular infarction (RVI) may occure as isolated or, more often, associated with left ventricular – inferior or occasionally anterior - infarction. The diagnosis of RVI is based first of all on the characteristic clinical symptoms, on the ECG pattern and on the results of 2D-echo-cardiography. The exact localisation of the infarction has vital significance in the therapy of the acute phase. The mortality can be substantially decreased with adequate therapeutic measures even in severe cases. The prospective prognosis of RVI is more favourable than that of left ventricular infarcti on. The author presents the most important diagnostic and therapeutic features related to RVI. ]

Lege Artis Medicinae

[Role of platelet function in the pathogenesis of alzheimer's disease]

HASITZ Mária, LIPCSEY Attila, RÁCZ Zoltán

[Dementias, especially those of Alzheimer type represent very serious types of disease in the elderly. Amounting evidence suggests that Alzheimer's disease is reflected in the platelets of the patients. Our results and the data of scientific literature have been summarized. In vitro parameters of platelet shape and aggregation were compared. Platelet shape, characterized by aggregometer oscillation amplitude, and the initial rate of 50 uM ADP-induced aggregation have been recommended for supporting the diagnosis of Alzheimer's disease or Alzheimer-type senile dementia. Our results and those of others revealed that the function of the Alzheimer platelet is influenced by two effects: the plasma medium and the genetic background resulting in the change of the platelets. The results suggest that both effects are involved in the vitro functions detected.]

Lege Artis Medicinae

[The role of ultrasound in the diagnosis of septic hip prosthesis loosening]

FÖLDES Károly, BÁLINT Péter, GAÁL Marianna, KISS Csaba, BÁLINT Géza

[The aim of the authors is the application of non-invasive ultrasound examination to the detection of complications after hip joint arthroplasty. Their recent work has been a trial to explore the kind of diagnostic assistance of ultrasound in case of suspected endoprosthetic infection. 39 patiens have been examined after hip joint arthroplasty. Out of this sample there was a suspected clinical infection in 20 cases. The rest 19 patients had no complaints and made the control group. Out of the patients with complaints effusion was detected around the neck of the prosthesis by means of US in 7 cases. Out of these in 10 cases reoperation in 6 cases US guided joint aspiration verified our US results. The authors made conclusion that as to patients having complaints of pain after hip joint arthroplasty very useful assistance in avoiding infection may be given by quided ultra sound aspiration.]

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[The en bloc resection of spinal tumors is required in primary spine tumors and in selected cases of secondary spine tumors, where the primary disease is under control and long survival time is expected. Three cases are presented, applying O-arm assisted navigation or minimally invasive anterior approaches for en bloc tumor removal. O-arm navigation assisted osteotomies were carried out to remove a Th.V. breast tumor metastasis en bloc, intact bony part of the Th.V. vertebra was spared. Vertebral corpectomies of a patient with L.IV. chordoma and of a patient with L.V. carcinoid were also performed using minimally invasive, microscope assisted, anterior approaches to the lumbar spine. No morbidity or local recurrence were detected in the patient with breast cancer 1 year after the operation. Nevertheless, new spinal metastasis were revealed 1 year after surgery despite the appropriate oncological treatment. The patient with L.IV. chordoma is still tumor free (last follow-up: 18 month after surgery), but post operatively detected lower limb paresis and gait disturbances are persisted. The posterior healthy bony parts of the spinal column remained intact, since only anterior approaches were used for en bloc L.IV. corpectomy. No morbidity or recurrence was detected in patient with L.V. carcinoid tumor on 1 year follow-up. Both the O-arm navigation assisted surgery and the minimally invasive anterior approaches to the spine can help to reduce surgical morbidity and to spare healthy bony structures of the spine. The later could play important role to provide long term spine stability. The presented new surgical technologies can be accepted only, if they produce at least the same oncological results on longer follow-ups as conventional surgical approaches.]

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Surveillance and management of patients with tuberous sclerosis complex

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CANOMAD syndrome with respiratory failure

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CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.