Lege Artis Medicinae

[How to proceed?]

FRENKL Róbert

APRIL 22, 2008

Lege Artis Medicinae - 2008;18(04)

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Lege Artis Medicinae

[RECENT ADVANCEMENTS IN THE DIAGNOSIS AND TREATMENT OF AGE-RELATED MACULAR DEGENERATION]

SERES András István

[Age-related macular degeneration is the leading cause of blindness in developed countries. In the last few years, new therapeutic approaches such as photodynamic therapy and intravitreal injections of vascular endothelial growth factor antagonists were introduced that do not only prevent disease progression but also give the hope of vision improvement. Of the new diagnostic methods, the use of optical coherence tomography improves diagnosis and also permits the qualitative measurement of therapeutic effects. Given the current high price of the new drugs and the need for frequent re-treatments, a significant increase in the economic burden of the disease is foreseeable.]

Lege Artis Medicinae

[Homosexuality from a Medical Perspective]

KÓRÁSZ Krisztián, KORAS Réka, SIMON Lajos

Lege Artis Medicinae

[A Must-Have Scientific Book György Jermendy (editor): Hypertension from a Diabetologist’s Perspective]

NAGY Judit

Lege Artis Medicinae

[PRIMARY TUMOURS OF UNKNOWN ORIGIN WITH CERVICAL LYMPH NODE METASTASES - A RETROSPECTIVE STUDY]

GARAI Tibor, NÉMETH Zsuzsanna, TOMPOS Tamás, ZEMPLÉN Béla

[ITRODUCTION - Primary tumours are defined unknown if, despite of the presence of histologically verified metastases, the site of origin cannot be revealed even with complex investigations. On average, 5% of patients with cervical lymph node metastases belong to this group. The incidence of cervical lymph node tumours increases with age, with more than 60% arising from malignancies in patients over 40. PATIENT AND METHODS - In this retrospective study, the authors review the history of 29 patients treated or examined in their department between January 2002 and November 2006 with the starting diagnosis of cervical lymph node metastasis from a primary tumour of unknown origin. All patients had a thorough physical examination, indirect upper respiratory tract endoscopy, and aspiration cytology. In the search for the primary tumour the use of both traditional X-ray studies and modern imaging techniques are justified. RESULTS - Of the 29 patients, five did not present after surgery, and one patient died. The location of the primary tumour could be determined in 12 of the remaining 23 patients during the follow-up period. These included the palatine tonsil in four cases, the lung in three patients, the lower pharynx in two patients, and one case each of the lingual radix, the larynx and the nasal pharynx. The histology of the metastases was mostly squamous cell carcinoma and they were located in the upper parajugular region. The investigation of the remaining patients is continued. CONCLUSION - In cases of cervical lymph node metastases that histologically turn out to be squamous cell carcinoma, the primary tumour should first be searched for in the head-and-neck region, followed by the lungs. On the other hand, high-grade nasopharyngeal carcinomas warrant the search in the Waldeyer ring. The authors emphasize the importance to keep the proper order of the diagnostic and therapeutic steps and to manage these patients in experienced institutions.]

Lege Artis Medicinae

[Does Tiotropium have an Impact on the Course of Chronic Obstructive Pulmonary Disease?]

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[A faraway land: nursing in a “small” Swedish hospital]

FUCHS Rita

[The author is currently working as a degree nurse in Örebro County, Sweden. In Sweden she has a greater degree of professional autonomy, which allows her to make use of all the theoretical knowledge and practical skills acquired at college. For performing certain tasks the doctor’s written authorisation is not required; nurses proceed in accordance with their competencies and the rules set out in the given protocol. She sets out to give an insight into the day-to-day work of nurses at her hospital, by describing the documents that are used, briefly outlining the training system, and the authority exercised by the nurses. Keywords: nurse, nursing training, nursing documentation, competency]

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[POST-CHOLECYSTECTOMY SYNDROME AND SPHINCTER OF ODDI DYSFUNCTION]

MADÁCSY László

[After cholecystectomy, recurrent biliary-like pain, alone or in association with a transient increase in liver enzymes may be the clinical manifestation of the sphincter of Oddi dysfunction (SOD). Most of the clinical information concerning SOD refers to postcholecystectomy patients who have been classified according to clinical presentation, laboratory results and endoscopic retrograde cholangio-pancreatography (ERCP) findings as: biliary type I, biliary type II, and biliary type III. The prevalence of SOD has been reported to vary from 9 to 11% in unselected patients having postcholecystectomy syndrome up to 68% in a selected group of patients without organic disorder and complaining of postcholecystectomy pain. Diagnostic work-up of postcholecystectomy patients for suspected SOD includes liver biochemistry and pancreatic enzyme levels plus negative findings of structural abnormalities. Usually this would include transabdominal ultrasound, gastroscopy and ERCP. Depending on the available resources, endoscopic ultrasound and magnetic resonance cholangiography may precede endoscopic retrograde cholangiopancreatography in specific clinical conditions. In SOD patients, the endoscopic sphincter of Oddi manometry is the gold-standard diagnostic method to evaluate the abnormal motor function of the sphincter of Oddi. Quantitative evaluation of bile transit with cholescintigraphy is valuable in the decision whether to perform sphincter of Oddi manometry or to treat. The standard treatment for SOD is sphincterotomy. In biliary type I patients, the indication for endoscopic sphincterotomy is straightforward without the need of additional investigations. Slow bile transit on cholescintigraphy in biliary type II patients is an indication to perform endoscopic sphincterotomy without sphincter of Oddi manometry. Positive Nardi or Debray evocative test in biliary type III patients is an indication to perform sphincter of Oddi manometry. Medical therapy with nitrosovasodilatators, Ca-channel blockers, theophyllin compounds, β2 receptor agonists and anticholinerg drugs can be useful in biliary type II and type III patients preceding endoscopic sphincterotomy. If medical therapy fails, one might proceed to perform ERCP and endoscopic sphincterotomy but only in patients with abnormal SO manometry results.]