Lege Artis Medicinae



OCTOBER 20, 2001

Lege Artis Medicinae - 2001;11(10)

[Transmyocardial laser revascularization (TMLR) is a relatively new technique for the treatment of patients with angina refractory to other medical interventions, such as CABG or PTCA. The laser drills channels through the myocardial wall into the cavity of the ventricle. While the mechanism of action is still debated, clinical data show incentive results suggesting favorable outcome for patients. In the article, the published clinical and experimental data relevant to theoretical mechanisms and clinical results are reviewed.]



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[Congress of the Hungarian Society on Thrombosis and Haemostasis Alsópáhok, September 2001]

KISS Róbert Gábor

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[ACE Inhibitor for Everyone?]


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[Epidemiology and Pathogenesis of Inflammatory Bowel Diseases]


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[The 2nd Congress of the Cardiovascular and Interventional Society, Hungary October 2001, Győr]

LÁZÁR István

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[The beneficial effects of angiotensin-converting enzyme inhibitors on biochemical and vascular markers have been proven by many experimental studies. Reduction of the angiotensin-II level has a positive effect on oxidative stress, lipid peroxidation, apoptosis, inflammatory and prothrombotic processes. Two large multicentric trials, EUROPA and HOPE, showed that perindopril and ramipril significantly reduce mortality and the risk of both fatal and non-fatal cardiovascular events in patients with atherosclerosis, thereby making them the base drugs of secondary prevention of coronary artery disease.]

Clinical Neuroscience

KTP/532 precutaneous laser decompression for lumbar disc prolapse

MARTIN T. N. Knight, SAMUEL T. Pantoja

The efficacy of percutaneous laser disc demompression with the potassium titanyl phosphate laser (KTP/PLDD) for the treatment of sciatica due to lumbar disc prolapse was evaluated in a consecutive series of 109 patients. All patients had low-back pain and leg pain with positive tension signs and had received conservative treatment for an average of 11.4 (1-28) months without relief of symptoms. Disc porlapse was confirmed by computed tomography or magnetic resonance imaging and evaluated with intraoperative discography. Patients with an uncontained disc porlapse were excluded from the study. Results at an average of 18 (12-28) months were based on the MacNab outcome criteria and on patient satisfaction after surgery. Overall success was noted in 75.2% (82/109). Failure was associated with severe lateral recess stenosis. Patients without known risk factors for a bad otucome (including severe lateral recess stenosis, back pain predominant over leg pain, previous surgery at the same disc level, unsettled compensation claim and singificant functional component) had an excellent or good result in 84% (42/50). KTP/PLDD has proven a safe and efficacious procedure for outpatient treatment of sciatica due to contained disc prolapse.

Lege Artis Medicinae

[Heart surgery among octogenerians - fiction or reality?]

SZÉKELY László, GYÖRGY Margit, JUHÁSZ Boglárka, SZABÓ J. Zoltán, SZUDI László, PAULOVICH Erzsébet, LONKAY Eszter, HORKAY Ferenc

[OBJECTIVE - Aging of the society results in important demographic changes in cardiac surgical practice. Controversy exists as to whether heart surgery in elderly patients improves their life expectancy and the severe functional restraint caused by their heart diseases. PATIENTS AND METHODS - We discuss a retrospective study of octogenarian patients who underwent cardiac surgical procedures in our institutions between 01.01.2000. and 30.06.2006. The mean age of the 105 participants was 81.5 years (80-87). 67% (70) of patients had coronary artery disease (CAD). 31% (33) of the patients had aortic valve stenosis (AVR), of whom 16 had isolated AVR and 17 had AVR combined with CAD. One patient had surgery because of mitral valve insufficiency (MVR) only, and one was treated for combined AVR and MVR. The average surgical euroscore was 9.7 (5-18) and the predictive mortalities were 18%. 9.5% of the procedures were acute, 42.9% were urgent and 47.6% were chronic surgeries. RESULTS - The average operating time was 149±23 min, duration of the aortic cross clamp was 65±11 min. OPCAB procedures were performed in 82.9% of patients treated for CAD. In the postoperative period, the occurrence of renal failure was 2.9%, blood transfusions were needed in 37.4% of patients, and neurological deficits occurred in 2.9% of patients. The incidence of perioperative myocardial infarction was 5.6%. The rate of early mortality was 4.8%, the rate of late (>30 days) mortality was 14.3%. At the last follow-up examination, 67 (79%) of the surviving 85 patients were free of cardiac symptoms, physically active and able to take care of themselves. 14 patients (17%) needed some help and only 4 patients (5%) were unable of taking care of themselves. CONCLUSIONS - The mortality of cardiac diseases can be reduced by cardiac surgeries in octagenerians. Improvement of cardiac symptoms improves the patients’ functional status and their quality of life can be similar to that of healthy people of the same age.]

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[One stage procedures in the cardiac surgery]


[ During the last 47 months 2357 extracorporeal cardiac operations have been performed at the Cardiovascular Surgical Clinic of the Semmelweis Medical University. In 37 of these cases (1.57%) the cardiac procedure has been combined with a non-cardiac one. Concomitant carotid artery endarterectomy was performed in 30 cases. Endarterectomy of the popliteal artery, reconstruction of the innominate artery, embolectomy of the popliteal artery, reconstruction of the pseudoaneurysm of the common femoral artery, cholecystectomy and two lobectomies have been performed on the rest 7 patients. There was no hospital lethality. During the majority of these one-stage procedures the cooperation of well experienced cardiac and vascular surgeons has been substantial. ]

Lege Artis Medicinae

[The clinical significance of amaurosis fugax]


[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]