Lege Artis Medicinae

[THE FACTORS BEHIND CHRONIC PELVIC PAIN]

SZENDEI György

JANUARY 20, 2005

Lege Artis Medicinae - 2005;15(01)

[There are no data available on the prevalence of chronic pelvic pain syndrome in Hungary. Even international literature provides an equivocal view of this disease. Dealing with the pelvic pain syndrome puts not only the patients in a challenging situation but the health care system as well. In many cases the etiology and the pathophysiology of the disease is not very well known. Endometriosis, pelvic inflammatory diseases and postoperative adhesions are the most frequent causes of the pelvic pain syndrome. However, irritable bowel syndrome, interstitial cystitis and the pain caused by diseases of the musculosceletal or nervous systems can also be accompanied with similar symptoms. Although the organic mechanisms of the formation and the modulation of pain are well known, the psychological factors should also be taken account. Psychotic status may generate pain on its own, or may influence the experience of the pain. In case of pelvic pain syndrome, similarly to other chronic diseases, the biopsychosocial model tries to integrate the physical, psychological and social factors of the pain.]

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[DEPRESSION IN SOMATIC ILLNESSES - THE NEED FOR CONSULTATION-LIAISON PSYCHIATRY]

VINCZE Gábor, TÚRY Ferenc, MURÁNYI István, KOVÁCS József

[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]

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[CARCINOID TUMORS]

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[Carcinoid tumors are rare neoplasms: they are traditionally divided into three subgroups (foregut, midgut and hindgut tumors). Despite their neuroendocrine cell origin and the similarities in their histological structure, the molecular background, pathogenesis, clinical features, diagnostic and therapeutic procedures, as well as the prognosis of carcinoid tumors located at different sites may be highly variable. Although sensitive biochemical markers (serum chromogranin A concentration, urinary 5- hydroxyindoleacetic acid excretion) and localization methods (somatostatin receptor scintigraphy, positron emission tomography) are available, a considerable number of patients are only diagnosed at the late stages of the disease. When surgical cure is not obtainable such as in cases with advanced metastatic disease, surgical procedures to reduce tumoral tissue should be still considered. At present, the most effective drugs for the symptomatic treatment of carcinoid tumors are somatostatin analogues (octreotide, lanreotide). In addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and rarely, tumor regression is produced. Radioisotope-labelled somatostatin analogues are presently under clinical evaluation, which may offer new therapeutic means for patients with carcinoid tumors.]

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Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.