Lege Artis Medicinae

[Successful treatment of a complex supraventricular arrhythmia from the 26th gestational week]

HAJDÚ Júlia1, SZABÓ István1, MACHAY Tamás1, PAPP Zoltán1, SZATHMÁRI András2, KONCZ Erzsébet2

MARCH 30, 1994

Lege Artis Medicinae - 1994;4(03)

[Intrauterin fetal arrhyth mias may cause severe problems, sometimes intrauterine or neonatal death. An atrial flutter with orthodromic reciprocating tachycardia was detected (ATL, Ultramark 9 type echocar diograph, M-mode, 2 dimension and color Doppler imaging) in a fetus at the 26th week of gestation. Antiarrhythmic transplacental drug therapy was introduced first with digoxin (0,25 mg/die) and later a digoxin-verapamil (0,5 mg/die, 80 mg/die respectively) combination thereafter. Maternal blood digoxin concentrations were 1.4 ng/ml; 1.1 ng/ml and, at last 1.76 ng/ml. The digoxin-verapamil combination converted the tachycardia in utero. The authors suggest that first choice of therapy in such cases should be digoxin at a 2.0 ng/ml maternal serum level. The treatment should be started in hospital with a daily ultrasonography follow-up. After conversion weekly controls are enough. Diagnosing the arrhythmia the 35. week of gestation termination of the pregnancy and the treatment of the newborn are suggested. ]

AFFILIATIONS

  1. Semmelweis Orvostudományi Egyetem I. sz. Szülészeti és Nőgyógyászati Klinika
  2. Országos Kardiológiai Intézet Budapest

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[Hormone replacement therapy from a gynaeco oncological point of view]

BŐSZE Péter

[In Hungary, hormone replacement therapy (HRT) has been used more extensively in the last few years. The benefits of HRT in cardio vascular diseases, osteoporosis and quality of life have been well established. Breast cancer and endometrial carcinoma have been considered as contraindications for HRT. A reappraisal of this practice is necessary since we have no evidence that HRT may adversely influence the outcome of these tumours, al though this is theoretically possible since the effect of estrogens on occult metastases is unknown. The relationship between replacement therapy and the uterine sarcomas is of particular concern. HRT is safe in patients successfully treated for carcinoma of the vulva, vagina, uterine cervix and in those with ovarian cancer. Experience suggests that estrogen can also be used safely in women treated previously for endometrial cancer. As far as breast cancer is concerned, it appers logical to discuss the risk-benefit considerations with our patients before embarking on using HRT. Consultation with a gynaecological oncologist prior to HRT in patients with endometrial and/or breast cancer is strongly recommended. ]

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[Developing a complex approach to hospice and home-care]

MOLNÁR Lajos, BÖSZÖRMÉNYI Dalma

[The home-care and hospice movement has been sporadically encountered in the hospital and care network for a long time, and we have already seen all that this paper aims to do. Across the country, hospitals and specialist outpatient departments alike are seeking ways and means of providing this care. ]

Lege Artis Medicinae

[Letters - Spontaneous pneumothorax]

KESZLER Pál, RÁCZ Egon

[Dear Editorial Team! In the 30 November 1993 issue, AC Miller and JE Harvey's "Guidelines for the management of spontaneous pneumothorax" was published as a position paper of the British Thoracic Society. It may seem an ungrateful undertaking to enter into a debate with the principles of such a venerable and long-established society.]

Lege Artis Medicinae

[The increasing threat of antibiotic resistance: implications for antibiotic prescribing in community practice]

ROBERT Sutherland

[Infectious diseases caused by bacteria have been treated successfully by antibiotic the rapy for the past half century, and a diversity of antibacterial agents with widely differing mechanisms of action has been developed by the pharmaceutical industry. However the selective pressure of antibiotic usage has inevitably led to the isolation of resistant bacteria and the rate of emergence of antibiotic resistance appears to be increasing rapidly, reducing the effectiveness of existing agents. Factors responsible for the wide dissemination of antibioticresistant bacteria in both community and hospital practice include the acquisition and spread of resistant genes by plasmids and transposons, inappropriate anti biotic usage and social factors. Mechanisms to controll the emergence of antibiotic resistance require optimal usage of antibiotics by clinicians, control programmes to improve hygiene and to reduce the transmission of resistant bacteria within and between communities, and the continued development of new antibacterial agents.]

Lege Artis Medicinae

[Highly located and intrahepatic malignant biliary stenoses treated by interventional radiological procedures]

KÓNYA András, VIGVÁRY Zoltán

[In the palliative treatment for patients with highly located and/or intrahepatic malignant biliary stenoses or obstructions interventional radiological procedures may play a significant part. In 12 patients with obstructive jaundice caused by highly located malignant stenosi(es) or obstruction(s) 23 endoprostheses were implanted. In 5 cases double endoprosthesis placement was performed to connect isolated lobes or segments of the liver. Patients' survival was 4–22 (average 8, 7) months. In 6/12 patients surviving for 4-8 months, occlusion of the endoprostheses did not occur. In the other half of the patients, in whom the disease permitted a longer life-expectancy, prosthesis occlusion led to recurrent jaundice within 3–11 months. In all but one case, in which endoscopic exchange was successful, percutaneous interventions were necessary. Successful endoprosthesis placement was carried out 3 times in one patient and once each another 5 patients following percu taneous extraction (3 times), distal displacement (twice) and endoscopic removal (twice) of the occluded endoprostheses. Authors consider percutaneous endoprosthesis placement an effective procedure in the palliative treatment of the aforementioned patients' group, both for improving their survival and quality of life. They emphasize the fact that lengthy and difficult manipulations are required for these procedures which consequently result in a considerable amount of scattered radiation exposure to those performing the procedures.]

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