Lege Artis Medicinae

[Report of the Health Insurance Supervisory Committee]

BOD Péter, KAMENCZKY István

JULY 29, 1992

Lege Artis Medicinae - 1992;2(07)

[Recent activities; Main tasks facing the EFB; Joint decision]

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Lege Artis Medicinae

[The role of prostacyclin in the function of the gastric mucosa]

BÁLINT Gábor Sándor

[The intracellular effect of exogenously admi nistered prostacyclin in the gastric mucosa seems to be a polyphasic one, namely: 1. effect on the cyclic nucleotide (CAMP, CGMP) turnover, 2. effect on the calmodulin-content, 3. DNA and RNA changes 4. influence on protein synthesis 5. new cell formation. Besides the endogenous prostacyclin exerts a natural protection against damaging noxae, thus maintaining the physiological integrity of the mucosa. ]

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[What is the cause of delay in the diagnosis of the primary sjögren's syndrome?]

ZEHER Margit, SZEGEDI Gyula

[Primary Sjögren's syndrome is the most frequent polysystemic autoimmune disease after rheumatoid arthritis. Keratoconjunctivitis sicca and xerostomia are characteristic of primary Sjögren's syndrome but the evolution of these signs may exist for years, and only one of them may be observed for a long time. Arthritis and enlargement of the parotid and submandibular glands are rarely observed as first symptom. The diagnosis of primary Sjögren's syndrome is based on the evaluation of the obligate signs. Clinical experience shows that there are many patients with undiagnosed Sjögren's disease. The authors would like to demonstrate the importance of the characteristic sings of primary Sjögren's syndrome, and the clinical and immunoserological tests which are useful in the diagnosis of the disease.]

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[Clinical principles in the diagnosis and therapy of disseminated intravascular coagulation]

SAS Géza

[Psychologically intravascular coagulation of the blood is hampered by the endothelium, the inhibitors of the coagulation system and the circulation as well. Various pathological events may the diffuse activation of the blood coagulation factors causing disseminated intravascular coagulation. The two main consequences of the DIC are ischaemia in the organs concerned and the consumption of the blood coagulation factors. The activation of the fibrinolytic system improves the former though aggravates the latter pathological events. In the prevention and therapy the effective treatment of the basic disease is of primary importance. Thorough evaluation of the clinical symptoms and the laboratory data can help in the diagnostics. Heparin can be administered only in the hypercoagulative-consumptive forms of the DIC if bleeding does not exist actually. In recent years, the administration of the anti thrombin concentrate has come into prominence because it can promote the restitution of the coagulation system without increase of bleeding. Antifibrinolytic (Gordox) therapy is advised only in cases of extreme hyperfibrinolytic activity. ]

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[Laboratory diagnosis of disseminated intravascular coagulation]

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[Disseminated intravascular coagulation (DIC) is a highly dynamic process with a broad spectrum of clinical manifestations and laboratory findings. There is no specific laboratory test for the diagnosis of DIC. For the reliable diagnosis of DIC we recommend a test-panel which can be divided into three groups: 1, The screening tests include the measurement of prothrombin time, activated partial thromboplastin time, trombin time, platelet count and detection of fibrin monomers; 2, The diagnosis of DIC can be confirmed with the help of additional assays, such as the determination of fibrin degradation products, antithrombin III or the detection of fragmentocytes in peripheral blood smear; 3, Special tests such as determination of clotting factors, reptilase time, activation peptides and thrombin-antithrombin III complexes may serve as useful tools in the differential diagnosis and in the scientific evaluation of the mechanisms of DIC. In this paper the advantages and disadvantages of different laboratory tests used in the diagnosis of DIC are also critically evaluated. ]

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[The development of the tissue banking techniques has made possible the production of wide range of differently preserved collagen based tissue grafts (skin, bone, dura mater, fascia lata). Excellent clinical results have been obtained by the application of allogeneic and xenogeneic grafts. The article summarizes the activity fields of tissue banks in the USA and in Europe. The review presents the most important aspects of tissue banking, antigenicity, sterility, preservation and storage of different grafts. ]

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

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