Lege Artis Medicinae

[Modern story with a moral]

LEHOCZKY Péter

SEPTEMBER 10, 2001

Lege Artis Medicinae - 2001;11(08-09)

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Lege Artis Medicinae

[Sentinel node biopsy in melanoma malignum]

OLÁH Judit, GYULAI Rolland, VARGA János, MOHOS Gábor, KAPITÁNY Klára, PAPOS Miklós, PÁVICS László, VARGA Erika, KOROM Irma, DOBOZY Attila

[INTRODUCTION - For many decades there has been no adequate treatment for affected regional lymph nodes in melanoma malignum. In the last couple of years with the implementation of the sentinel lymph node biopsy technique, it became possible to perform selective lymphadenectomy, i.e. to perform radical block dissection only in cases of histologically proven metastases in the sentinel lymph nodes. Since the lymphatic involvement in melanoma malignum is the most important prognostic factor, it is essential to treat lymphatic etastases as early as possible to get the best results. PATIENTS AND METHODS - In the past two years we have removed the sentinel lymph nodes together with primary tumors being 1 mm or thicker, ulcerated and regressive, based on clinical appearance in 120 melanoma cases. RESULTS - Of the 120 sentinel lymph node biopsies 58 contained metastatic cells. Beside tumor thickness, histological features of regression were found to correlate with the positivity of the sentinel nodes in thin melanoma cases. CONCLUSIONS - Sentinel lymph node biopsy is a relatively simple procedure with minimal complication rate. It allows early therapeutical block dissection and the selection of patients who require adjuvant therapy. Our clinical observations suggest that beside tumor thickness and ulceration, the clinical and histological signs of regression are important factors to consider for the indication of sentinel node biopsy.]

Lege Artis Medicinae

[Wegener’s granulomatosis: diagnostic questions]

CSISZÉR Eszter, SOLTÉSZ Ibolya, FÜZESI Katalin

[INTRODUCTION - Wegener’s granulomatosis is a disease of unknown origin classified as an immune vasculitis. The main pathologic feature is necrotising granulomatous small vessel vasculitis. Clinically the upper and/or lower airways are affected most often as well as the kidneys in the generalised form. The highly specific antineutrophil cytoplasmic antibodies have diagnostic significance beside the pathology and clinical symptoms. PATIENTS AND METHODS - We have studied the clinical and diagnostic characteristics of 15 cases diagnosed in our centre from the last 25 years. All patients had pulmonary manifestation. We analysed the organ involvement, clinical signs indicating the diagnosis, chest radiography, chances for biopsies of diagnostic significance and the difficulties of differential diagnostics. RESULTS - The diagnosis was made based on histological samples from the upper airways in three cases and from the lower airways in six cases (in four cases the bronchoscopic biopsies were diagnostic, in two patients thoracotomy was necessary). In six cases, clinical signs and typical organ manifestations were the basis of the diagnosis. CONCLUSION - This very rarely occurring disease which is difficult to recognise requires pulmonological examination due to the involvement of lungs. If this diagnosis comes to mind - based on findings of bilateral, multiplex, round pulmonal shadows with cavitation - the pulmonologist should search for other organ manifestations and involve respective specialists. Ideally, diagnosis is established by histopathology or by positive cytoplasmic antineutrophil cytoplasmic antibodies.]

Lege Artis Medicinae

[Lifesaving statins]

CSÁSZÁR Albert

Lege Artis Medicinae

[Famous medical historian - Árpád Herczeg]

KAPRONCZAY Károly

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

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[The author is a nursing ethicist, who reviews the past 18 years of this professional and draws comparisons with a status report published in 1994 by two leading bioethicists, Dr. Béla Blasszauer and Dr. Tibor Jakab. The comparison deals with the issues of the overall situation of nurses, salaries, working conditions, the system of “gratitude payments” (as a phenomenon specific to Hungary), the problems associated with conflicting instructions from doctors, nurses’ lack of autonomy, the lack of recognition, the untenable ratio of patients to nurses, the explicit and implicit divisions among nurses, the unconscionable and frequently changing statutory provisions, the problems related to providing information, the tolerance of a lack of healthcare, the absence of advocacy, and the emerging phenomenon of nurse emigration. It can be inferred from the analysis that if the professional does not succeed in autonomously taking control of its own future, it could lose the moral foundation and status that it has earned in the course of its history.]

Lege Artis Medicinae

[A new fix combination therapy in effective cardiovascular prevention]

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[A large amount of literature is available one modern antihypertensive therapy. The experiences of the past 10-20 years have changed clinical practice in many areas of medication and of prevention of complications. Therapy has been revolutionised not only by the new and newer agents but also by the introduction of combined therapy. In this paper, we discuss the use of a new fix-combination antihypertensive drug, with two components (telmisartan and amlodipine) about which excellent evidence is available. We highlight the advantages of this combination therapy in cardiovascular prevention, which is partly explained by better patient compliance due to its favourable side-effect profile.]