Lege Artis Medicinae

[Shall we save?]

KIS János Tibor1

AUGUST 20, 2010

Lege Artis Medicinae - 2010;20(08)

AFFILIATIONS

  1. Budai Irgalmasrendi Kórház, Belgyógyászati Osztály

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Further articles in this publication

Lege Artis Medicinae

[A chance to concretize the teratogenic risk: healthy babies born to mother with isotretinoin treatment during pregnancy]

TIMMERMANN Gábor, KONDÉR Béla, GIDAI János, CZEIZEL Endre

[The teratogenic risk means the probability of the occurrence of congenital abnormalities in fetuses after the exposure of teratogenic agents, mainly drugs during pregnancy. The recent highresolution ultrasound scanning may help us to concretize this teratogenic risk. The Genetic, Teratogenic and Family Planning Counseling Clinic of the authors in Budapest were visited by 10,557 couples or client between 1998 and 2007. Ten pregnant women visited this Clinic due to the isotretinoin (Roaccutan) treatment during pregnancy during the 10 years study period. At present Roaccutan is the most teratogenic drug among the medicinal products in Hungary because its teratogenic risk is 25% for a characteristic pattern of congenital abnormality syndrome including a/microtia, ventriculomegaly and contruncal cardiovascular malformation. These fetal defects are detectable by the high-resolution ultrasound scanning between 18th and 20th gestational week of pregnant women. Thus this examination was recommended for the 10 pregnant women with unintended use of isotretinoin (Roaccutan ) in early pregnancy. Six pregnant women followed our advice and the repeated ultrasound scanning was not able to detect the above-mentioned characteristic defects and all the 6 newborns were healthy after birth. In conclusion the recent highresolution ultrasound examination provides a chance for the diagnosis of certain fetal defect between 18th and 20th gestational week of pregnant women. The Hungarian law allows these pregnant women to decide the termination of pregnancy until 20th (24th) gestational week after the diagnosis of severe fetal defects. However, this approach can protect the life of the major part of fetuses in pregnant women at high risk.]

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[Nasal Congestion as an Endemic]

NEMESI Zsuzsa

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[Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT trial]

BALIKÓ Zoltán

Lege Artis Medicinae

[On the safety of angiotensin-receptor blockers - A new attack on this drug class]

FARSANG Csaba

[Up until now, angiotensin-receptor blockers have been considered to be the safest cardio-, cerebro-, reno- and vasculoprotective drugs. In a previous metaanalysis, ARBs were accused of increasing the risk of myocardial infarction, but a number of metaanalyses and randomised, controlled trials have disproved this hypothesis. In a recent metaanalysis, ARBs were associated with an increased risk of tumours. The author reviews this issue, discusses the flaws of the above metaanalysis and, on the basis of the most up-to-date data in the literature, expert opinions and official statements (FDA, EMA), concludes that members of this drug class should continue to be used according to their approved indications, which is supported by their cardio-, reno-, cerebro- and vasculoprotective effects demonstrated in a number of appropriate, large-scale clinical studies.]

Lege Artis Medicinae

[Abscessus lienis?]

HAJDU Mária, KRUTSAY Miklós, CHANIS William

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Hypertension and nephrology

[Prominents in Hungarian nephrology Professor Gyula Petrányi (1912-2000). Part II]

SZALAY László

[A nation can only survive and keep its identity through its traditions. This is why the initiative to launch this series coming from professor János Radó is worthy of attention. Gyula Petrányi is an outstanding personality in 20th century internal medicine, to be more precise in nephrology and immunology, his activity being wide-ranging. The first part of the current summary of his work deals with a tribute to his personality, and his role in immunomodularity treatment in glomerulonephritis. The second part shall cover his role in spreading renal biopsy, screening and caring kidney patients, dialysis, in developing kidney patients’ care, furthermore in clinicopharmacology and renal transplantation.]

Clinical Oncology

[Intersphincteric resection for low rectal tumors]

METZGER Péter

[The technical development of rectal surgery, together with chemo- and radiotherapy, improved the effi ciency of surgical intervention as well as the patients‘ survival and quality of life. The treatment of ultra deep malignancies - 2-3 cm from linea dentata - is a real challenge for rectal surgery. Before the introduction of laparoscopy the removal of the deep tumors with conventional surgical techniques was impossible to save the tumorous rectum. The new techniques made possible the ultra deep resection, i.e. the removal even those tumors which progressed until the linea dentata. The explosive use of laparoscopy and the new waves of chemo- and radiotherapy resulted signifi cance advance contributed to an interdisciplinary therapeutic approach, which is a well adapted method in deep rectal surgery. In case of ultra deep localization of tumors - 0.5-1.0 cm to linea dentata - the neoadjuvant therapy supported the saving the anal sphicter. This new techniques contributed to the preservation of feces continentia of the patient.]

Lege Artis Medicinae

[Selective abortion in twin pregnancies discordant for congenital fetal anomaly]

PATKÓS Péter, HRUBY Ervin, PAPP Csaba, TÓTH-PÁL Ernő, PAPP Zoltán

[INTRODUCTION - In special cases of twin pregnancy where one of the fetuses is affected by severe congenital anomaly or disease confirmed with prenatal diagnostic methods and the other fetus is healthy, selective abortion has been accepted as the method of choice for twenty years to save the healthy sibling and to improve its life expectations. PATIENTS AND METHODS - The authors present their clinical experience of the past 15 years from 14 cases of selective abortion performed in twin pregnancies discordant for congenital fetal anomaly. Indication for the intervention was the anomaly of the second fetus in eleven cases and the anomaly of the first twin fetus in three cases. RESULTS - Out of eleven selective abortions performed on the second twin fetus, only one ended with the loss of the entire pregnancy. All three cases of selective abortion performed on the first twin fetus resulted in abortion of the entire twin pregnancy. All ten surviving fetuses were born living and healthy, followed by unharmed infant and childhood development. CONCLUSIONS - To offer the possibility of selective abortion to the parents seems to be indicated only in those cases of twin pregnancy where the discordant fetal disease or congenital anomaly is severe, placentation is dichorionic or at least diamniotic and where the second twin is affected.]

Clinical Neuroscience

[REMOVAL OF INTRASPINAL SPACE-OCCUPYING LESIONS THROUGH UNILATERAL PARTIAL APPROACH, THE “HEMI-SEMI LAMINECTOMY”]

BANCZEROWSKI Péter, VAJDA János, VERES Róbert

[Objective - The conventional dorsal surgical approaches used in removal of intraspinal space-occupying lesions by unroofing the spinal canal, often result the destruction of dorsal bony structures, sacrifice the interspinosus/supraspinosus ligament complexes and stripping of the paraspinal muscles causing a pathologic biomechanical milieu may lead to spinal deformities, instability. Various less invasive techniques exist to save the integrity and to prevent the instability of the spinal column and allow removal of intraspinally located space-occupying lesions at the same time. The authors discuss the experiences with unilateral partial laminectomy approach in removal of intraspinally, mainly lateral, intra- or extradurally located pathologic lesions. Methods - The unilateral partial laminectomy, in which the laminas were preserved (hemi-semi laminectomy) was performed in 86 symptomatic patients to remove space-occupying intra- or extradurally located lesions of the cervical, thoracic and lumbar spinal canal. Symptoms were local or radicular pain, motor, sensory and vegetative disturbances. Results - Adequate surgery of the lesions located within the spinal canal was achieved in all patients using this approach. The hemi-semi laminectomy was performed at one spinal level in 68 patients, two levels in 15 and three levels in 3. The affected spine was the cervical in 16, the cervico-thoracic in 6, the thoracic in 35, the thoraco-lumbar in 10 and lumbar region in 19 cases. Histological results were as follows: 32 intradural meningeomas, 27 neurinomas, 10 ependymomas, 3 arachnoid cysts, 2 cavernomas and extradurally 4 epidural haemorrhage, 5 epidural abscesses and 3 dural vascular malformations. Conclusion - The unilateral partial laminectomy (named hemi-semi laminectomy) approach for the mainly laterally located intra- or extradural lesions, confined to one side, allow to minimize resection of and injury to tissues not directly involved in the pathologic process, while affording a safe and thorough removal of space-occupying pathologies and decompression of neural structures located in a spinal canal. Two additional advantages come from this technique in cases of misjudged level or at re-operation.]

Lege Artis Medicinae

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