Lege Artis Medicinae

[The videoendoscopic implantation of the breast prosthesis]

SEFFER István1

MAY 25, 1994

Lege Artis Medicinae - 1994;4(05)

[The authors realized in the course of CT and MRI investigations that breast prosthesis implantation is generally performed with a very invasive technique. A reliable surgical technique is recommended, wich excludes the possibility of the usual complications, assures a successful implantation, and reduces the invasiveness of the surgery. During a one year period, 21 augmentations were performed for cosmetic reasons, 3 cases of capsular contracture were resolved, and 2 procedures utilizing a prosthesis inserted under a musculocutaneous flap of the latissimus dorsi muscle were completed with a minimally invasive technique. The essential feature of this method is that a cold light emitting spatula is utilized in the exploration and in the videoendoscopic surveying of the prepared region. The smallest incision measured 30 mm, the largest reached 47 mm. No scar tissue formation was observed. This operative technique significantly reduces the scar formation and the invasiveness of the procedure and therefore may be expected to replace the traditional implantation method. ]


  1. Kaposi Mór Megyei Kórház I. Sebészeti Osztály Kaposvár



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Lege Artis Medicinae

[Tuberculosis an immunological perspective]


[Tuberculosis is one of the most frequent infections in the world, with at least one third of the world's population carrying the pathogen. The number of active tuberculosis cases is increasing in the industrialized nations. The human immune system is unable to clear M. tuberculosis completely. The immune response in tuberculosis may be summarized as follows: M. tuberculosis is an intracellular pathogen living in the macrophages and evading the cell's effective antibacterial mechanisms. The defense against tuberculosis is a local event, resulting in a labile balance between host and parasite. Bacteria can survive in the tuberculotic granuloma and are prepared at any time to spread the organism in case of defective cell-mediated immunity. Activated macrophages play a pivotal role in the defence against Mycobacteria. The appropriate activation and cooperation of T cells is mandatory to mount a protective immune response. BCG vaccination is inefficient in protecting against adult tuberculosis but does protect newborns from disseminated tuberculosis. New vaccines or vaccination procedures are needed to develop a protective immunity against tuberculosis. ]

Lege Artis Medicinae

[Immunotherapy for tuberculosis clinical aspects of immunological research]


[Efforts toward developing an immunotherapy for tuberculosis are based upon the knowledge of delayed hypersensitivity and cellular immunity. The aim of immunotherapy is to strengthen the cellular immunity, enabling the immune system to destroy those persistent bacteria which remain alive following chemotherapy. Chemotherapy combined with an appropriate dose (10%) of dead M. vaccae significantly improved the therapeutic results of tuberculosis patients and reduced their mortality in double blind controlled studies. A beneficial effect was also observed in the treatment of chronic, multidrug resistent cases and in HIV positive tuberculosis patients. The duration of chemotherapy can be considerably shortened when concurrent immuno therapy is utilized.]

Lege Artis Medicinae

[Color and pulsed doppler velocimetry of the uterine artery in the second part of the normal pregnancy]

SZABÓ István, PAULIN Ferenc, RINGÓ János Jun, NÉMETH Lajos, CSABAY László, PAPP Zoltán

[Color Doppler imaging allows accurate identification of the main uterine arteries, which reflect the sum of the resistance of the placental bed and are therefore more likely to provide an overall picture of placental perfusion. In a cross-sectional study of 231 healthy women with singleton pregnancies at 19–40 week's gestation, color Doppler imaging was used to identify the main uterine arteries for subsequent pulsed Doppler studies. Flow velocity waveforms were obtained and indices of impedance, peak systolic blood velocity and mean blood velocity were measured. Impedance to flow decreased, whereas blood velocity increased significantly with gestation. Furthermore, impedance to flow was lower and velocity higher in the placental uterine artery (closest to the main bulk of the placenta) than in the non-placental artery. The changes in the uterine blood flow during normal pregnancy provide indirect evidence for the increase of the maternal blood supply necessary for normal intrauterine development. Definition of the reference ranges of parameters used to characterize blood flow velocity wave forms has an importance in the investigation of complicated pregnancies. ]

Lege Artis Medicinae



[On outpatient care from the perspective of the hospital outpatient clinic; The doctor's medicine; Renew or reassess; ]

Lege Artis Medicinae

[Epidemological findings of inflammatory bowel diseases in borsod county 1963-1992]

NAGY György, ÚJSZÁSZI László, JUHÁSZ László, MINIK Károly

[The epidemiologic data of inflammatory bowel diseases and the clinical aspects of ulcerative colitis and Crohn's disease were evaluated among the 800 000 inhabitants of Borsod County during three decades. Inflammatory bowel disease cases were continuously gathered from all the hospitals in the county. Patients were examined by standard diagnostic criteria. Consultative endoscopic advice, follow-up, and drugs prescription were provided on the wards. Patients' data were systematically registered and summarized. The following data were recorded: the patients' age, sex, ethnic group, urbanization; family prevalence, anatomical extension, type of course, severity of disease, and the occurance of malignant transformation. The authors registered 913 patients with inflammatory bowel disease, in the 10 hospitals of Borsod County between 1963 and 1992. 488 cases of ulcerative colitis were detected during the first twenty years, which is an incidence rate of 3.1/ 100,000 per year. The incidence during the third decade was 3.6/100,000 per year. 69 patients with Crohn's disease were examined during the first 20 years, and 78 in the third decade. The incidence of ileocolonal Crohn's disease increased from 0.43 to 1.00/100,000 per year. The authors didn't find a significant change in anatomical extension, severity or the clinical course of ulcerative colitis during the three decades. The increase of Crohn's diseases, and especially of isolated colonic types, may reflect improved diagnostic techniques. The incidence of inflammatory bowel disease increased among gypsies, but the incidence in that population was still only half of what was expected in the region. The authors found familial inflammatory bowel disease occurrence in 15 patients. Eight carcinomas were observed in the 766 ulcerative colitis patients, and 2 in the 147 Crohn's disease patients. ]

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Clinical Neuroscience

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

HORVÁTH Bence, PERÉNYI Ádám, MOLNÁR Fiona Anna, CSANÁDY Miklós, KISS József Géza, ROVÓ László

Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

Clinical Neuroscience

[Minimally invasive and O-arm assisted en bloc spinal tumor resections ]

SZABÓ Viktor, LAKOSI Ferenc, NAGY Máté, DÓCZI Tamás, BÜKI András, SCHWARCZ Attila

[The en bloc resection of spinal tumors is required in primary spine tumors and in selected cases of secondary spine tumors, where the primary disease is under control and long survival time is expected. Three cases are presented, applying O-arm assisted navigation or minimally invasive anterior approaches for en bloc tumor removal. O-arm navigation assisted osteotomies were carried out to remove a Th.V. breast tumor metastasis en bloc, intact bony part of the Th.V. vertebra was spared. Vertebral corpectomies of a patient with L.IV. chordoma and of a patient with L.V. carcinoid were also performed using minimally invasive, microscope assisted, anterior approaches to the lumbar spine. No morbidity or local recurrence were detected in the patient with breast cancer 1 year after the operation. Nevertheless, new spinal metastasis were revealed 1 year after surgery despite the appropriate oncological treatment. The patient with L.IV. chordoma is still tumor free (last follow-up: 18 month after surgery), but post operatively detected lower limb paresis and gait disturbances are persisted. The posterior healthy bony parts of the spinal column remained intact, since only anterior approaches were used for en bloc L.IV. corpectomy. No morbidity or recurrence was detected in patient with L.V. carcinoid tumor on 1 year follow-up. Both the O-arm navigation assisted surgery and the minimally invasive anterior approaches to the spine can help to reduce surgical morbidity and to spare healthy bony structures of the spine. The later could play important role to provide long term spine stability. The presented new surgical technologies can be accepted only, if they produce at least the same oncological results on longer follow-ups as conventional surgical approaches.]

Clinical Neuroscience

Evaluation of ischemic stroke patients with systemic cancer

UFUK Emre, TASKIN Gunes, IREM Pinar, FURUZAN Kokturk, ESENGUL Liman, ORHAN Yağiz

Purpose - In cancer patients, an ischemic stroke can be seen as both a direct effect of cancer and a complication of treatment. This condition can negatively affect the follow-up and treatment of these patients. For this research, we aimed to evaluate the clinical features, stroke types and etiological features of ischemic stroke patients with histories of cancer or found to have cancer during the aetiological investigation. Materials and methods - We retrospectively evaluated 100 patients (57 males, 43 females) who were hospitalized with acute stroke and determined to have the presence of cancer or a cancer history during the aetiological investigation between 2011 and 2016. All the demographic features, stroke types and localizations, National Institutes of Health Stroke Scale (NIHSS) scores, Rankin Scale scores, durations of cancer and cancer treatments were recorded. Results - The mean age of the patients was 67.07 ± 10.9 years old, the median NIHSS score was 5, and the median Rankin Scale score was 4. While 79% of patients had ischemic stroke risk factors, 21% did not. Atherosclerotic stroke was the most common stroke type (49%, n=49) and cryptogenic strokes were detected in 21% (n=21). In addition, 63% of the patients had chronic cancer (later than 6 months), 31% of the patients had recent cancer histories (less than 6 months), and 29% of the patients had metastases. Among all the malignancies, lung cancer (n=23), gastrointestinal cancer (n=20) and gynaecological-breast cancer (n=16) were the three most common. Moreover, 37% of the patients underwent chemotherapy, 29% underwent radiotherapy, and 88% of the patients had Carotid/Vertebral Doppler USG abnormalities. Conclusion - Similar to what is stated in the literature, an atherosclerotic stroke was the most common type of stroke in the cancer patients. Stroke risk factors were not detected in 21% of the patients, and in the majority of the patients, atherosclerotic changes in the carotid artery were observed in the Doppler examinations. In the aetiology and prognosis of ischemic stroke, it is important to keep in mind the existence of cancer in addition to the classical stroke risk factors.

Clinical Neuroscience

[Early experience with CyberKnife treatment in case of intra-, suprasellar hypernephroma metastasis]


[Among tumours found in the suprasellar region metastases are very rare and the most frequent primary tumours are lung and breast cancer. Data of a patient with clear cell renal carcinoma with intra-suprasellar metastasis will be discussed. As in most of the tumours in the sellar region, the first symptom was visual deterioration with visual field defect. A transsphenoidal debulking of the tumour was performed and the residual tumor was treated by CyberKnife hypofractionated stereotactic radiotherapy. Both our patient’s visual acuity and visual field impairment improved after the surgery and CyberKnife treatment. At 6-month after irradiation, MR of the sella showed a complete remission of the tumour. This was the first treatment with CyberKnife in our country in case of a tumour close to the optic chiasm. According to our best knowledge, there are 21 cases in the literature with renal cell carcinoma metastasis in the suprasellar region.]

Clinical Neuroscience

Case report of a woman with anti amphiphysin positive stiff person syndrome

MANHALTER Nóra, GYÖRFI Orsolya, BOROS Erzsébet, BOKOR Magdolna, FAZEKAS Ferenc, DÉNES Zoltán, FABÓ Dániel, KAMONDI Anita, ERÕSS Loránd

Stiff person syndrome is a rare neuroimmunological disease, characterized by severe, involuntary stiffness with superimposed painful muscle spasms, which are worsened by external stimuli. The classical form is associated with high levels of antibodies against glutamic acid decarboxylase. One of the variant forms is associated with antibodies against amphiphysin. This entity is a paraneoplastic syndrome, caused primarily by breast cancer, secondarily by lung cancer. Symptomatic therapy of anti amphiphysin positive stiff person syndrome includes treatment with benzodiazepines and baclofen (including intrathecal baclofen therapy). The effect of immunological therapies is controversial. Treatment of the underlying cancer may be very effective. In this report, we describe a 68 year old female presenting with an unusally rapidly developing anti amphiphysin positive stiff person syndrome, which was associated with breast cancer. Her painful spasms abolished after intrathecal baclofen treatment was initiated. Her condition improved spontaneously and significantly after cancer treatment, which enabled to start her complex rehabilitation and the simultaneous dose reduction of the intrathecal baclofen. The bedridden patient improved to using a rollator walker and the baclofen pump could be removed 18 monthes after breast surgery. This highlights the importance of cancer screening and treatment in anti amphiphysin positive stiff person syndrome cases.