Lege Artis Medicinae

[NEPHROPATHY CAUSED BY PHYTOTHERAPY - LESSONS LEARNED]

KAKUK György

JUNE 20, 2005

Lege Artis Medicinae - 2005;15(06)

[Modern medical science, the ‘officially’ recognised medicine, relies on evidence based medicine, in contrast to the ancient, empirical practice that is gradually gaining ground in the population. This is now referred to as complementary alternative medicine. Alternative medicine has been present throughout the whole history of medicine and gaining popularity these days. Complementary medicine with its various branches and methodology, however, remains controversial - even in some aspects hazardous - due to the lack of scientifically valid evidence. The article deals in detail with the severe side effects of phytotherapy, with an illustration of the so-called ‘chinese herb nephropathy’, an ailment that afflicted more than 100 women on diet in Belgium. For two consecutive years these women took plant extracts labelled Stephania tetranda and Magnolia officinalis plus fenfluramin, diaethylpropion, cascara powder, acetazolamide, extracts of belladonna and meprobamate. The results: chronic renal failure, precancerous urinary tract conditions and aortic valve damage. Detailed analysis suspects the toxic substance of aristolochic acid found in one of the herbs to be the likely cause for the organ and tissue damage. These cases illustrate the need for the cautious approach towards phytotherapy and suggest that in the case of complementary medicine therapy one can not ignore the results of evidence based medicine. In this article, we critically analyse the state of modern and alternative medicine and emphasize that two separate types of medicine does not exist - only one, that has to integrate the methods of complementary medicine that are acceptable, and at the same time charlatan practice must not prevail.]

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ALTORJAY Áron, VARGA István, SÁRKÁNY Ágnes, TÓTH Sándor, MUCS Mihály, HAMVAS Balázs, PAÁL Balázs, THAN Zoltán

[INTRODUCTION - The leading role of laparoscopy in the surgical treatment of functional diseases of the gastro-esophageal junction has become indisputable. But has the time of the “classic”, open surgical interventions really gone for good? PATIENTS AND METHODS - Between January 1., 2000 and December 31., 2004 we performed hiatal reconstruction and antireflux plastics for 186 patients. 83.3% (155/186) of the operations was performed laparoscopically, while 16.7% (31/186) with the traditional approach. The average age of patients was 46.9 years, 7% of the operations was performed on children. In case of recurrent paraoesophageal hernias the surgical plan was drawn up based on the result of the barium swallow X-ray performed after endoscopic clipping of the Z-line. In case of a brachy-esophagus, we formed the neo-esophagus by performing the Collis-Nissen operation modified by us (Neodinium magnet + plastic sliding scale) from the traditional abdominal exposure. RESULTS - The indication for hiatal reconstruction and antireflux operation was sliding hernia in 68.2%, paraesophageal hernia in 17.8% and reflux disease in 14%. We observed signs of panmural esophagitis in 22%, while latent or true brachy-esophagus in 10.7%. Antireflux procedures were grouped as Nissen type operation in 82.7%, Toupet type in 9.67%, Narbona in 2.1%, Belsey-Mark IV in 1.61%, and resection type operation in 3.76%. To narrow the diaphragmatic openings, two sutures were needed in most cases (57.1%). Conversion to laparotomy was necessary in 3.2%. We observed recurrences in 3.3% after laparoscopic interventions. In case of open operations we experienced no recurrences in the studied period. The barium swallow X-ray examination performed after endoscopic clipping of the Z-line could reveal brachy-esophagus before the operation. CONCLUSION - Open surgical interventions can not fall into oblivion even in the age of laparoscopic hiatal reconstructions and antireflux plastics. Open surgical procedures are justified even in the new milennium in cases when the patient's medical history contains upper abdominal operations - due to an increased risk of injury because of adhesions -,in cases of primarily recurrent paraesophageal hernias after an unsuccessful open and/or laparoscopic reconstruction, as well as in cases of reflux with complications.]

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