Lege Artis Medicinae

[RARE CAUSES OF GASTROINTESTINAL BLEEDING]

TAHIN Balázs, TÓTH Csaba, KOVÁCS Attila, DOBOS András, DÖBRÖNTE Zoltán, NAGY Lajos, TARABÓ Zoltán, MÁRKUS Béla, GARZULY Ferenc

SEPTEMBER 20, 2005

Lege Artis Medicinae - 2005;15(08-09)

[INTRODUCTION - The efforts to eliminate the source of gastrointestinal bleeding are not always successful, especially in rare diseases. CASE REPORT - In three patients causes and sites of haemorrhages were detected only at autopsy. The first patient underwent upper gastrointestinal endoscopy as well as surgical exploration. The post-mortem examination showed multiple gastric Dieulafoy’s vascular lesion. The second patient was examined by repeated upper gastrointestinal panendoscopy, but the site of haemorrhage remained unknown. Two polyps were removed during colonoscopy. Unexpected haemorrhage caused sudden death. The aortobifemoral graft, which had been implanted two years earlier had destroyed the duodenal wall, a fistula developed and caused haemorrhage. The third patient had had a right hemicolectomy abroad because of angiodysplasia, but the bleeding episodes repeated. The cause was revealed at autopsy as angiodysplasia of the small bowel. CONCLUSION - Dieulafoy’s disease can sometimes be discovered only by repeated endoscopy but sudden death may precede diagnosis. In the presence of an aortic graft we have to keep in mind that this could be the cause of catastrophic bleeding. Therefore, the examinations should be performed immediately - endoscopy has to involve the distal part of the duodenum - and operation is urgent. Angiodysplasia of the small bowel is a rare site of angiodysplasia which requires special diagnostic procedures like capsule endoscopy. The multiplicity of the disease and the age of the patients made the diagnostic difficult.]

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[REHABILITATION OF HEARING IMPAIRMENTS WITH HEARING AIDS IN CHILDREN AND ADULTS - INDICATIONS, POSSIBILITIES, CARE]

REJTŐ Kálmán

[The early diagnosis of the different types of hearing impairments and the adequate surgical or conservative therapy have changed in the last decades. Up-to-date objective audiological methods (otoacustic emission, auditory brain stem potentials, audiotory steady state potentials) and genetic laboratory examinations help us in the diagnosis of the congenital hearing impairments. Formerly, only patients with the different diseases of the middle ear consisted into the group for surgical rehabilitation but recently this has been completed with middle ear implantation of different types as well. In cases of sensoryneural hearing impairments of severe degree cochlear implantation is now possible and in the case of severe impairments nerve VIII brain stem implantation can be performed. The high level of the technical development brought revolution in the rehabilitation with hearing aids as well. The new digital technology, the sizes of the hearing aids, good cosmetic and excellent functional results help the medicaltechnical team in the optimal fulfilment of the demands and expectations. In the process of the complex rehabilitation with hearing aids, the exact diagnosis, the fitting of the proper hearing aids with individual ear moulds, the teaching and training and the care of the patient will bring the expected result.]

Lege Artis Medicinae

[MARITAL STRESS, DEPRESSIVE SYMPTOMS AND CARDIOVASCULAR VULNERABILITY IN WOMEN]

BALOG Piroska, MÉSZÁROS Eszter

[INTRODUCTION - Marital stress and depression have proved to be independent biopsychosocial risk factors for cardiovascular disorders. At the same time their interaction increases cardiovascular vulnerability. The Stockholm Female Coronary Risk Study has shown that marital stress was statistically significantly associated with depressive symptoms, in both groups of healthy women and in patients, even after adjusting for age, educational level, menopausal status, body mass index, cigarette smoking, sedentary lifestyle and the severity of heart failure. METHODS - The aim of this study was to investigate the effect of marital stress on depressive symptoms and psychosocial vulnerability in women with coronary heart disease and in healthy women, cohabiting and currently working. Data were obtained from the Hungarostudy 2002, representing the Hungarian population over the age of 18, according to age, sex and county. RESULTS - The results have shown that an increase in marital stress contributes to an increase in psychosocial vulnerability (depression, anxiety, vital exhaustion, sleep complaints) in healthy women and in women with cardiovascular disorders as well. Higher depression has been related with higher marital stress as well. DISCUSSION - The relation between marital stress and depression seems to be independent from socio-cultural, economical differences: the same results have been found in Hungarian and Swedish women. This relation seems to be bidirectional: a bad marriage increases the prevalence rate of depressive symptoms and depression worsens marital quality. At the end we propose a conceptual framework for how marital stress and depression increases cardiovascular vulnerability in women, emphasizing circular causality.]

Lege Artis Medicinae

[“BONE” IN THE VESSELS, “FAT” IN THE BONES? - THE THEORY AND CLINICAL SIGNIFICANCE OF VASCULAR CALCIFICATION]

SPEER Gábor, LAKATOS Péter

[Pathologist have recognized arterial calcification for over a century described also by Virchow in the 19th century. Vascular calcification, an active mechanism, involves a complex, regulated process of biomineralization resembling osteogenesis. Evidence indicates that proteins controlling bone mineralization are also involved in the regulation of vascular calcification. The atherosclerotic plaque calcification can be easily detected noninvasively with radiological methods currently available and it correlates with the amount of atherosclerotic plaque. Also, it serves as a surrogate measure for atherosclerosis, allowing preclinical detection of the disease. There are several examples for the relationship between hyperlipidaemia and increased loss of bone mass. It is not surprising that the base drugs for osteoporosis also have the characteristics for lowering vascular calcification and are antiatherogenous and antilipaemic drugs. The clinical importance ot these facts is that vascular calcification is associated with higher risk of cardiovascular events. In the summary, the authors review the four histopathological types of arterial calcification and the molecules and proteins involved in these processes.]

Lege Artis Medicinae

[BIVENTRICULAR PACING - A NEW TREATMENT OPTION IN CONGESTIVE HEART FAILURE]

BŐHM Ádám

[Cardiac resynchronisation therapy with biventricular pacing is a new treatment option in patients with moderate-to-advanced heart failure and left bundle branch block. Cardiac resynchronisation therapy leads to improved haemodynamics at diminished energy cost. Beneficial effects include reverse remodelling resulting in decreased heart size and ventricular volumes, improved ejection fraction and decreased functional mitral regurgitation. The haemodynamic improvements are associated with a significantly better quality of life, improved exercise tolerance and less frequent hospitalisation. Several randomised trials have evaluated the short- and longterm effect of biventricular pacing on haemodynamics and clinical parameters and recent preliminary data suggest that cardiac resynchronisation therapy can reduce the mortality. Despite major advances of lead and pacemaker techniques, the implantation of a biventricular pacemaker is still a challenging and complex procedure. To introduce the left ventricular pacing lead into the sinus coronarius may cause difficulties. Approximately one third of the patients do not respond to the therapy, therefore better pre-implant identification of the responders are needed. For patient selection and follow- up echocardiography has a major role.]

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