Lege Artis Medicinae

[Gastrolienalis fistula caused by acute pancreatitis]

CZAKÓ László, GÉCZI Tibor, LEINDLER László, FARKAS Gyula, TISZLAVICZ László, LONOVICS János

NOVEMBER 20, 2007

Lege Artis Medicinae - 2007;17(11)

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Lege Artis Medicinae

[NEUROVASCULAR COMPRESSION IN THE MEDULLA OBLONGATA AS A CAUSE OF RESISTANT HYPERTENSION - THOUGHTS APROPOS OF A PATIENT]

KOVÁTS László, BRETUS Angelika, CSUTAK Kinga, NAGY Gyöngyi, GASZTONYI Beáta

[INTRODUCTION - The vasomotor centre, the central regulator of the cardiovascular system, is localised in the rostral ventrolateral medulla oblongata. Irritation of this area and/or of the ninth and tenth cranial nerves (that are involved both in the afferent and efferent pathways of the baroreceptor reflex) causes sympathetic hyperactivity, which in some cases leads to severe resistant hypertension. A common underlying cause of this is pulsatile neurovascular compression, a vascular malformation rarely sought for. CASE REPORT - The authors present the case of a middle-aged woman with what had been considered “essential” hypertension. Magnetic resonance angiography showed vascular compression of the medulla oblongata and the departing left ninth and tenth cranial nerves as the cause of her hypertension. CONCLUSIONS - After a literature review the authors draw the attention to this rarely identified cause of resistant hypertension and to the difficulties of its diagnosis.]

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[The 17th Congress of the European Respiratory Society]

BALIKÓ Zoltán

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[Internal Medicine Aspects of Bowel Diseases Inflammatory Bowel Diseases – Novelties in Attitude Edited by: János Fehér and Ágota Kovács]

dr. SZÉKELY György

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[Intraabdominal sarcoma of follicular dendritic cells]

OROSZ Zsolt, HOLLÓSI Melinda, FORRAI Gábor, RAHÓTY Pál

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JAKAB Ferenc

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ONDER Burcu, KELES Yavuz Betul

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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[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

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Simultaneous subdural, subarachnoideal and intracerebral hAemorrhage after rupture of a peripheral middle cerebral artery aneurysm

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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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The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

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