Lege Artis Medicinae

[Sonography of the shoulder joint]


DECEMBER 25, 1991

Lege Artis Medicinae - 1991;1(18)

[Sonography is the most simple, unexpensive and common method in the evaluation of the soft tissues surrounding the shoulder joint. 67 sonographic findings of 61 patients are discussed. Laesions of the rotator cuff, the bursa, the long head of the biceps and the deltoid muscle are demonstrated. Sonography is the first method of choice in the evaulation of the shoulder joint, though it has ist limitas well. ]


  1. Szent-Györgyi Albert Orvostudományi Egyetem Radiológiai Klinika



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Lege Artis Medicinae

[Metoprolol treatment in dialated cardiomyopathy]

DÉKÁNY Miklós, NYOLCAS Noémi, FIÓK János, VÁNDOR László, SEREG Mátyás, BALOGH Ildikó

[Authors applied metoprolol for treating heart failure in with dilated cardiomyopathy. Patients were given digitalis, diuretics as well as ACE-inhibitor and vasodilator drugs. The grade of heart failure was according to NYHA classification in the mean 2.5 class. For assessing the effect of metoprolol clinical variables and results of non-invasive tests were evaluated and compared in 3 consecutive periods: 1) before starting metoprolol, 2) 2–4 weeks after reaching its definitive dose (short-term effect), 3) 3-6 months later (medium-term effect). Early intolerance appeared in 3 patients; signi ficant progression of heart failure in 2 and hypotension causing complaints in 1. Evaluating the actually treated 17 patients clinical signs of heart failure (NYHA class) decreased, left ventricular ejection fraction improved, though not significantly in case of every considered variables, left atrial filling pressure decreased, exercise capacity did not alter, rate-pressure product decreased at rest and at low level of exercise as well. The authors stress the significance of "up-regulation" of myocardial beta-1 receptors in the reduction of myocardial toxic catecholamin effect and myocardial oxygen demand as well as in the increase of myocardial blood supply. Referring to the data of the respective literature and to their own experiences the authors suggest metoprolol treatment in cases of dilated cardiomyopathy, where previus therapy did not prove to be efficient.]

Lege Artis Medicinae

[Role of oxygen derived free radicals during myocardial reperfusion]

KÓNYA László , FEHÉR János, JUHÁSZ Nagy Sándor

[Oxygen derived free radicals are now considered to be important contributors to tissue (myocardium) injury associated with ischemia and reperfusion. Normaly the tissue concentration of these toxic intermediate products of oxygen is strietly limited, but production of oxygen free radicals overwhelming the capacity of the tissue elimination may cause serious damage. Thus reperfusion has it's own danger with the extension of the injury produced by the ischemia alone. Several experi mental studies have shown that different free radical scavengers can reduce the post-ischemic tissue injury, however, there are contradictory results and unresolved problems. Further investigation is necessary to establish the relevance of oxygen free radical mediated myocardial injury and the effective antioxidant treatment. ]

Lege Artis Medicinae



[Belfast Metoprolol Study; Helsinki Heart Study]

Lege Artis Medicinae

[Autoimmunity and the network of the antibody-forming cells: the "immunological homunculus"]

UHER Ferenc

[Frank M. Burnet's clonal selection theory declares the deletion and/or anergy of self-reactive clones to be the fundamental mechanism responsible for self tolerance. There is ample evidence, however, that all healthy individuals have lymphocytes and , natural” antibodies that recognize self structures. In the 1970s, Niels K. Jerne postulated the network theory. It is based on the idea that the idiotype, the region of an immunoglobulin that is unique because it comprises the antigen-binding portion of the molecule, can act as both antigen and antibody within the same individual. Network theory views the immune system as a single, highly interconnected system, through idiotypes, a web of V domains. Antonio Coutinho adressed this problem and divided the repertoire of the B lymphocytes into two parts. He suggested that a set of naturally activated cells and the immunoglobulins they secrete, is reflected in the autonomous immune activities of the self-related network as the central immune system. In contrast, immune responses to external antigens are essentially allonomous clonal activities of another set of resting, rapidly turning over lymphocytes that follow the predictions of the clonal selection theory, making up the peripheral part of the system. Finally, Irun R. Cohen suggested that some, perhaps all, major autoantigens are indeed dominant because each one of them is encoded in the organizational structure of the immune system. This picture was termed the immunological homunculus by its analogy to the picture of the body encoded in the central nervous system. ]

Lege Artis Medicinae

[Modern therapy of intracerebral and subarachnoidal hemorrhages]


[The frequency of the intracerebral hemorrhages among the strokes is most commonly quoted around 10 percent. The rupture of an intracranial aneurysm is often complicated with subarachnoideal hemorrhage as well as with intracerebral hematoma therefore this latter type of intraparenchymal hemorrhage may also be discussed in this topic. The modern imaging procedures (Computed to mography, Nuclear magnetic resonance) are of crucial importance in the urgent and exact diagnosis of intracranial hemorrhages. The first essential step in the diagnosis of stroke is to distinguish the ischemic lesion from the hemorrhage by means of CT. When an intra cerebral hemorrhage threatens life and the patient's condition is relatively good there must be an urgent decision considering the choice between medical therapy or surgical intervention. Although clearcut indications for surgery are now available, the clinical and computed tomographic guidelines play indi vidually an important role in the final decision. The individual judgment is always desirable in every case of intracerebral hemorrhage as well as in the surgical intrvention of intracranial aneurysm during the acute phase (two days).]

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[The author briefly reviews the static and dynamic stabilizing system and the biomechanics of the shoulder and describes his principles and techniques of the surgical treatment of instability. A modified Bankart procedure is used for recurrent anterior dislocation. Bone blocks are implanted in cases of locked posterior dislocation. Different forms of cranial instability are described as well as partial and total superior glenoidal lesions. The author discusses surgical procedures used in the treatment of these instabilities. Cranial instability leads to impingement syndrome, which results in rotator cuff lesions. These lesions increase instability and the increased impingement leads to further rotator cuff damage. This vicious cycle can be interrupted by surgical intervention.]

Lege Artis Medicinae



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[Tarsal coalitions in our adult patients]


[INTRODUCTION - Tarsal coalition is an abnormal bony, cartilaginous or fibrous union between two or three bones of the mid and hindfoot. It occurs mostly (90%) in the calcaneonavicular and talocalcaneal joints. Coalitions are usually detected in the second decade of life, but several cases are noted in children and in later adulthood. Estimated incidence is 1-2% of the total population. CASE REPORTS - Cases of unilateral tarsal coalitions (five calcaneonavicular, three talocalcaneal) in four male and three female patients are presented. The average age of the patients is 30 years. The radiologic diagnosis was based on the secondary signs seen on the lateral plain films of the feet. These signs are parallel with clinical symptoms, in contrary to the primary radiologic signs. The two types of the anomaly coexisted in a female patient. CONCLUSION - Routine lateral not-magnified pedal radiographs are valuable screening tool for tarsal coalitions.]