Lege Artis Medicinae

[Tooth extraction as a fairground amusement]

NÉMETH István

JULY 28, 1993

Lege Artis Medicinae - 1993;3(07)

[Tooth extraction is not a completely painless medical procedure today, and was even less so in the 17th century. In the Dutch painter Gerard van Honthorst's 1628 portrait on our front cover, the patient's pain-warped face is a perfect illustration of the agony endured by anyone who would undertake such a torture.]

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Lege Artis Medicinae

[Features of chronic alcoholic liver and pancreatic diseases]

NEMESÁNSZKY Elemér, DÖNGÖLŐ László

[The most common organ pathologies caused by alcohol abuse are chronic liver disorders and chronic pancreatitis. The incidence of these diseases has not yet been fully established but both are considered to be widespread in Hungary. Since there are forms which frequently occur without symptoms, clinicians might have difficulties in recognizing them. The diagnosis should be based on the results of laboratory screening tests and the findings of the physical examination. A variety of specific and functional tests should be performed. Morphologic damage of the organ can be assessed by analysing the tissuesample obtained by biopsy. In the course of the disease progression, well characterised clinical entities (syndromes) develop. Features of the most advanced stage are as follows: fibrosis of the gland causing functional insufficiency which manifests itself in marked laboratory and clinical alterations.]

Lege Artis Medicinae

[Bronchological possibilities to treat the main airway stenosis]

STRAUSZ János, BÖLCSKEI Pál

[The review summerizes the recent broncholo gical possibilities to treat the main airway stenosis. The most of the patient have inoperable central endobronchial or endotracheal tumor. However these methods are of considerable palliativ value for recanalization of the main airway and these way for amelioration of the quality of life. The three methods: the LASER phototherapy, the afterloading irradiation and the stent implantation can be available yet in Hungary. ]

Lege Artis Medicinae

[Antineutrophil cytoplasmic autoantibodies and their pathogenic and diagnostic role in different diseases]

SZŰCS Gabriella, SZEGEDI Gyula

[Antineutrophil cytoplasmic autoantibodies (ANCAs) are found in the circulation of patients with systemic vasculitic syndromes, including Wegener's granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, and other disorders within the spectrum of autoimmune diseases. ANCAs have specificity for different proteins in the cytoplasmic granules of neutrophils. Two major patterns of ANCA staining are observed by indirect immunofluorescence as say: cytoplasmic (C-ANCA) and perinuclear (P-ANCA). There is in vitro evidence that antineutrophil cytoplasmic autoantibodies are directly involved in the pathogenesis of antineutrophil cytoplasmic autoantibody-as sociated vasculitides. Antineutrophil cytoplasmic autoantibody titers may be useful in modulating treatment regimens.]

Lege Artis Medicinae

[Cutaneous symptoms and reactive arthritis in giardia lamblia infection]

RIESZ Tamás, VÁLYI-NAGY István, TEMESVÁRI Erzsébet, WINKLER Valéria, KASZÁS Ilona

[ The authors discuss reactive arthritis and cutaneous symptoms as two infrequent complications of giardiasis. The incidence of reactive arthritis and cutaneous symptoms in 569 patients with giardiasis with simultaneous characte risticbiliary and gastrointestinal manifestation was investigated. In the majority of cases, parasitic infection was detected from fresh (warm) bile or, in a smaller proportion of patients, from fresh stool. Nine patients presented with reactive arthritis, 59 with chronic urticaria, 17 with rosacea, 8 with prurigo nodularis, and 2 with erythema nodosum. In all cases, initial therapy consisted of metroni dazol (Klion), using a daily dose of 0.75-1.5 g for 10–15 days. Only those patients whose symptoms were eliminated or substantially diminished and whose duodenal aspirate and stool was devoid of the parasite one month following treatment were considered cured. Sixty seven patients remained Giardia positive after metronidazol treatment. A detailed description of the curative therapeutic combinations in the cases of 64 patients is presented in the paper. Despite repetitive and combination therapy, three patients remained Giardia positive and continued to present with the symptoms of the parasitic disease. The authors emphasize that in patients having cutaneous allergic symptoms, reactive arthritis, or erythema nodosum with simultaneous gastrointestinal symptoms (even of the gastroin testinal symptoms are mild or absent), biliary or gastrointestinal Giardia infection must be considered. ]

Lege Artis Medicinae

[Color doppler imaging of the eye and orbit]

BARTA Miklós, DANIEL A Merton , BARRY B Goldberg, ROBERTA M Sandy

[Color Doppler Imaging (CDI) has added new dimension to orbital sonography. The indications of this method are basically the vascular and neoplastic diseases of the eye and orbit. After demonstrating the scan technique and normal findings the authors present some pathologic entities, such as reversed flow in ophthalmic artery as a result of occlusion of the internal carotid artery, lack of blood flow in central retinal artery in another ocular ischemic syndrome and the blood flow within a choroidal melanoma. The authors' experience reveals that CDI with pulsed Doppler spectral analysis is a promising new technique for the evaluation of vascular structures of the normal orbit as well as ocular and orbital vascular pathology.]

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Clinical Neuroscience

[Objective measurement of manual dexterity of Parkinson patients operated with DBS]

SZÁNTÓ Ildikó, SÁNDOR Balázs, KATONA Krisztián, NAGY Máté, JUHÁSZ Annamária, BALÁS István

[The evaluation of hand dexterity is an important marker for the success of DBS (deep brain stimulation) operation in patients with Parkinson’s disease. In this study we applied a simple, semiquantitative optical dental plaque staining technique for the evaluation of the hand dexterity. Ten patient with Parkinson’s disease were involved in the study. After dental students aided tooth brushing, bacterial dental deposits (plaque) were stained then photographed, and quantified under standard conditions before and after DBS surgery. Our results showed a significant decrease in dental plaque deposits after DBS operation. This simple technique seems to be a routinely applicable marker for the evaluation of the hand dexterity. Our future plans is repeating the previous experiement on a higher number of cases.]

Lege Artis Medicinae

[Experiences using the naclof eye drop after intraocular lense implantation]

BOYTHA Zsuzsanna

[Steroid containing eye drops play essential role in the treatment following cataract extraction and intraocular lense implantation. They have a very good effect on decreasing inflammation but their side effect of increasing the intraocular pressure is well known. That's why all over the world non-steroidal antiinflammatory eye drops are examined having no influence on the intraocular tension. The clinical effect Diclophenac-Na (Naclof, Dispersa AG., Switzerland) was examined following cataract surgery with implantation in the Department of Ophthalmology of the P. m. T. Semmelweis (St. Roch) Hospital, on 50 patients. While using the eyedrop 9 symptomps were evaluated at slitlamp examinations on the base of a four points subjective scale on the 1st, 3–4th, 10–14th intraocular lense postoperative days. The efficiency of the eye drop was found to be excellent at 34 patients (68%) and good at 16 patients (32%). There were no local or systemic side effects observed. The tolerance against the preparation was excellent at 47 patients (94%) and good at 3 patients (6%). The intraocular pressure did not increase in any of the cases. According to our experiences the clinical efficiency of the Naclof eyedrop is nearly the same as that of the steroid containing drops without side effect. ]

Lege Artis Medicinae

[Pancreatology in practice: acute pancreatitis]

TAKÁCS Tamás

[Acute pancreatitis requires various diagnostic and treatment procedures. The clinical picture of acute pancreatitis is diverse, ranging from mild abdominal pain or dyspepsia to severe, lifethreatening multiorgan failure or sepsis. Most cases of pancreatitis result in a mild/edematous inflammation of the pancreas, whereas the remaining 15-20 percent results in severe necrotising pancreatitis with a mortality rate as high as 10-30 percent, although imaging diagnostics, operative endoscopy and intensive internal and surgical therapy have improved significantly in the past few years. Quick and accurate diagnosis of the disease is required for early therapeutic intervention. For example, we know that in cases of biliary acute pancreatitis an early (within 24-48 hours following the onset of symptoms) endoscopic sphincterotomy and stone extraction significantly improve the prognosis of the disaese. It is also important to introduce an adequate perfusion/rehydration therapy and a simultaneous enteral feeding introduced as soon as possible to avoid the superinfection of the pancreatic necrosis. Therefore, when reviewing the epidemiological characteristics, pathophysiology, up-to-date diagnostic and therapeutic approaches of the disease, we emphasise early interventions. We also highlight the importance of patient care and follow-up checks after an incident of acute pancreatitis.]

Lege Artis Medicinae

[Prevention of tooth decay in children]

[Dental caries is a widespread disease in our country. National epidemiological studies show that the intensity of dental caries in children and adolescents doubles every 10 years. International experience has shown that dental disease can be prevented with an appropriate complex prevention programme. Dental health professionals internationally consider the use of fluorides, the promotion of dietary habits that are less damaging to the dentition and good oral hygiene as three basic pillars of primary prevention. ]

Clinical Neuroscience

[The modifying effect a PMP22 deletion in a family with Charcot-Marie-Tooth type 1 neuropathy due to an EGR2 mutation]

REMÉNYI Viktória, INCZÉDY-FARKAS Gabriella, GÁL Anikó, BEREZNAI Benjámin, PÁL Zsuzsanna, KARCAGI Veronika, MECHLER Ferenc, MOLNÁR Mária Judit

[Background - Mutations of both the PMP22 and EGR2 genes cause Charcot-Marie-Tooth (CMT) disease type 1. Deletion of the PMP22 gene, results in hereditary neuropathy with liability to pressure palsies. More publications exist about the interaction of PMP22 duplication and other CMTcausing gene mutations. In these cases the intrafamiliar discordant phenotypes draw the attention to the possible role of modifying genes. The gene-gene interactions between the PMP22 and EGR2 genes are not well understood. Case report - We report two brothers with late onset CMT1 due to a c. 1142 G>A (Arg381His) heterozygous substitution in the EGR2 gene. Additionally, the older brother with the less severe symptoms harbored the PMP22 gene deletion also. Conclusion - The coexistence of the two genetic alterations did not aggravate the clinical symptoms. Moreover, the PMP22 deletion appeared to have a beneficial modifying effect, thus implying potential gene-gene interaction of PMP22 and EGR2. PMP22 deletion may increase Schwann cells proliferation and compensate the dominant-negative effect of the Arg381His substitution in the EGR2 gene.]