Lege Artis Medicinae

[The surgical treatment of shoulder instability]

BÁLVÁNYOSSY Péter1

OCTOBER 27, 1993

Lege Artis Medicinae - 1993;3(10)

[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.]

AFFILIATIONS

  1. Fővárosi Önkormányzat Csepeli Kórháza Traumatológiai Osztály Budapest

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Clinical application of specific antibodies in immunotherapy of transplantation]

PETRÁNYI Győző, PÁLÓCZI Katalin

[In organ and tissue transplantation practice as well as in the therapy of autoimmune, haematological, immunological and oncological diseases, the possibility for applying immunotherapy is occuring more frequently. The paper deals with all those reagents which are primarily of polyclonal or monoclonal immunglobuline origin and play a significant role in the various cell-bound immune reactions on the surface of lymphocytes. In addition to the anti-lymphocyte or/rather anti-thymocyte globuline as well as the Orthoclone (anti-CD3 monoclonal antibody) reagents well known in clinical practice, it also refers to other lymphocyte surface anti-marker monoclonal anti-bodies (anti CD4, -CD8; anti TCR, anti-LFA reagents) under clinical trial. The article reviews the possible uses of the group of immunotherapeutical reagents in the clinical practice of Kidney and bone marrow transplantation. The pharmacological mechanism, side effects, and prospects for a wider use of these reagents in the future are discussed.]

Lege Artis Medicinae

[The origin of serum catalase in healthy subjects and in some diseases]

GÓTH László

[The activity of serum catalase is highly increased in acute pancreatitis, hemolytic disorders and in some liver diseases, but there is no data on its tissue origin. The serum catalase activity was determined by a spectrophotometric assay in healthy subjects (n = 4275) as well as in increased erythropoesis (n = 424), in hemolytic diseases (hemolytic anemia = 12, megaloblastic anemia = 28, Zieve syndrome = 8, hemorrhage = 38), in acute pancreatitis, (n = 111), in liver diseases (fatty liver = 21, alcoholic hepatitis = 42, acute yellow atrophy = 18, toxic hepatitis = 15), and in liver congestion due to cardiac circulatory failure (n = 28). These diseases yielded increased serum catalase activity. This enzyme has no tissue specific isoenzymes, therefore mathematical and statistical approaches were used. The correlation between serum hemoglobin and serum catalase was analysed. The catalase release was estimated from the time activity curves of serum catalase and compared to its tissue equivalent. In healthy subjects about 60 percent of serum catalase derived from the erythrocytes and the rest from other tissues. During enhanced erythropoesis and in hemolytic diseases, similarly to hemoglobin, its source was the erythrocyte pool. In acute pancreatitis also the erythrocytes might be responsible for the increased serum catalase level. in some liver diseases as well as in liver congestion due to cardiac circulatory failure the increase of serum catalase derived from the liver cells. The diagnostic analysis of serum catalase requires the consideration of its increase as well as its origin. ]

Lege Artis Medicinae

[Prenatal follow up of a complex cardiac malformation complicated with complete AV block]

SZABÓ István, CSABAY László, NÉMET János, HAJDÚ Júlia, PAPP Zoltán

[In a congenital disorder of heart development where the complex cardiac malformation is pared with complete atrioventricular block heart rate is stabile between 50–60 beats/min. Transfer of atrial impulses through the AV node is fully blocked and the slow rhythmic heart beat is maintained by a ventricular pacemaker. In a case of such a complete cardiac malformation recognized in week 32 of gestation and the AV block complication caused stabile 57–58 beat/min bradycardia. 2-di mensional, pulsed and color Doppler ultrasonography was used to identify the disorder and to follow up the intrauterine condition of the fetus. Cardiotocography (CTG) could not generate appreciable results at such a low heart rate. During observation no centralization of fetal circulation causing intrauterine hypoxia was recorded. Updated knowledge on the pathogenesis and obs tetrical management of the fetal third degree AV block is also presented. In this case ultrasonography allowed clear-cut identification of the disorder and also ensured correct evaluation of the intrauterine status of the fetus when other diagnostic methods for evaluation were not applicable. ]

Lege Artis Medicinae

[Eurpean Concerted Action on Thrombosis and Disabilities Angioma Pectoris Study]

MATOS Lajos

[Patients with more than 50% stenosis in one or more coronary arteries had significantly higher fibrinogen levels (p<0.0001). Reduced fibrinolytic activity was also observed in patients with coronary artery stenosis, mainly due to higher levels of plasminogen activator inhibitor-1 (PAI). Decreased fibrinolytic activity was strongly associated with diabetes, elevated triglyceride levels, smoking and impaired left ventricular systolic pump function. Cholesterol levels correlated mainly with protein C and plasminogen levels.]

Lege Artis Medicinae

[Ticlopidine Aspirin Stroke Study]

MATOS Lajos

[The 3-year incidence rate of all-cause mortality and non-fatal stroke was 17% in the ticlopidine group and 19% in the aspirin group. This means that compared with aspirin, ticlopidine reduced the risk of the events studied by 12% (p = 0.048). The incidence of fatal and non-fatal stroke was 10% with ticlopidine and 13% with aspirin, a 21% reduction in risk in favour of ticlopidine (p = 0.024). As side effects, ticlopidine caused diarrhoea (20%), skin rash (14%) and reversible neutropenia (1%), whereas aspirin caused diarrhoea (10%), skin rash (5.5%), gastritis (2%), gastrointestinal ulcer (3%) and haemorrhage (1%). Total cholesterol levels increased by 9% in the ticlopidine group and 2% in the aspirin group (p < 0.01).]

All articles in the issue

Related contents

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

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.

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]