P. SZABÓ Réka1, PÉTER Mózes2, VARGA István3, VAJDA Gusztáv3, HARANGI Mariann1, MÁTYUS János1, BALLA József1
JULY 20, 2012
Lege Artis Medicinae - 2012;22(06-07)
[INTRODUCTION - Diagnosis and treating intestinal ischaemia in time presents a great challenge for clinicians. CASE REPORT - In a 60-year-old woman on dialysis who presented with abdominal angina, angiography revealed stenosis of the superior mesenteric artery, which was treated by implantation of a 6×29 mm Genesis stent. After a year, her symptoms reoccurred and angiography revealed restenosis, which was treated with a 7×34 mm Wallstent, while her previous acetylsalicylic acid treatment was supplemented with clopidrogel. Nevertheless, her abdominal angina reoccurred again after a year. During the next intervention - because of the in-stent restenosis - a Taxus Liberte stent was implanted. During the dual antiplatelet therapy, her abdominal complaints did not reoccur, her body weight increased and angiography did not reveal restenosis in the affected artery even after 4 years. CONCLUSIONS - A drug-eluting stent can be a good choice in case of restenosis of the superior mesenteric artery. In a stented patient, it is crucial to use an appropriately controlled, long-term, dual antiplatelet therapy.]
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[Six-to-eight years after the diagnosis of type 2 diabetes the majority of patients require insulin treatment. Premixed insulin therapy provides an insulin profile that is closer to the physiological profile than that achieved by basal insulin supplementation and, in some cases, may serve as an alternative treatment in patients for whom intensified insulin therapy is unsuitable. However, if premixed human insulins are used, nocturnal hypoglycaemia occurs relatively frequently. Furthermore, patients must keep a lag-time of 30-45 minutes between the injection of insulin and eating. In contrast, if premixed insulin analogues are used, there is no need for such lag-time and both nocturnal and severe hypoglycaemia are less frequent than with human premixed therapy. The superiority of premixed insulin analogues compared with premixed human insulin therapy has been confirmed by a number of prospective, randomised controlled trials and retrospective analyses. The author summarises the results of these studies, emphasising the beneficial effects of premixed insulin analogues in the therapy of type 2 diabetes.]
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Lege Artis Medicinae
[INTRODUCTION - The cause of idiopathic retroperitoneal fibrosis is unknown, but probably involves a chronic, nonspecific, autoimmune inflammation. This rare disease mostly affects middle-aged or elderly people, it hardly ever occurs in young people. It causes obstruction of the urinary tract, postrenal insufficiency as well as functional disorder of vital organs in the retroperitoneum and its surrounding area. The diagnosis is based on diagnostic imaging and histological examinations. Surgical treatment of the urinary obstruction is only efficient in the long-term if combined with immunomodulatory treatment. CASE REPORT - A young, 34-year-old man who presented with oedema in his legs was diagnosed with retroperitoneal fibrosis. Autoimmune serology was negative. He needed temporary nephrostomy on the right side. Treatment with steroid and colchicine was initially successful. His severe cardiomyopathy improved gradually. No regression occurred with tamoxifen, so we started to administer azathioprine with methylprednisolone. The control abdominal CT showed stagnation of the process. CONCLUSIONS - Because of the rarity of this disease, no randomised controlled trials are available regarding its treatment. The aim of treatment is to eradicate the symptoms, solve the urinary obstruction, maintain renal function and prevent progression of the disease. Improvement may be achieved by corticosteroids, cyclophosphamide, azathioprine, leflunomide, mycophenolate mofetil and tamoxifen. To our knowledge, this case is unique as no similar case with severe cardiomyopathy and idiopathic retroperitoneal fibrosis has been reported in the literature previously.]
Clinical Neuroscience
[Since the introduction of electrolytically detachable coils the endovascular treatment of intracranial aneurysms is dynamically developing. The good results with this technique led to a progressive expansion of the indications. For the treatment of complex, wide-necked and fusiform aneurysms several new devices and techniques were developed. The introduction of a new device is possible after a feasibility study. In these studies the number of cases is low. Some risk factors or possible complications occur only after the introduction of a new device to the market.]
Hungarian Radiology
[INTRODUCTION - Complications after subtotal esophageal extirpation (for eg.: insufficiency of anastomosis, stricture, etc.) and their treatment have special radiological considerations. Surgical departments and their radiologists meet early complications. But, all other radiological departments can face late complications, so the knowledge of these is important for all radiologists. PATIENT AND METHODS - 58 subtotal esophageal extirpations were performed in the last 5 years in the 1st Department of Surgery, Semmelweis University, Budapest. All postoperative radiological examinations were undertaken by the Department of Diagnostic Radiology and Oncotherapy. Most plain chest X-rays and swallowing examinations were made per-os with non ionic water soluble, low osmolarity contrast media on the 7th postoperative day. Further examinations were performed only if needed clinically. RESULTS - The complications were categorized as early and late. Early complications were aspiration, anastomosis insufficiency (31% of cases). Nine cases had self-dilating stents placed because of suture insufficiency. Further complications were noted following stenting (eg.: occlusion, dislocation of stent, closure of stent because of granulation tissues). Amongst late complications, stomach dilatation caused by pylorus-spasm (1 case), stricture of anastomosis (14 cases) and ’too-long’ esophageal stump (3 cases) were seen. CONCLUSION - Conventional radiology has a major role in diagnostics and treatment of complications of esophageal extirpation. Dynamic radiological examination and team work are required between the radiologist and surgeon. Also, it is crucial to cultivate good cooperation in cases of stent implantation, as contrary to the published literature, we find it better to have stents placed under flouroscopy rather than endoscopically.]
Hungarian Radiology
[INTRODUCTION - The congenital absence of celiac trunk and it’s subtotal stenosis are rare abnormalities and often recognised only during digital substraction angiography (DSA). This anomaly is significant when there is a need to perform local intraarterial chemoperfusion or chemoembolisation of malignant hepatic tumours. In these cases the liver is supplied with arterial blood through the superior mesenteric artery and the gastroduodenal arch. The direction of blood flow in the common hepatic artery is changed ensuring the flow to the splenic and left gastric artery. In such circumstances it is not possible to obtain local chemotherapy. CASE REPORT - Two male patients (61 and 75 years old) are reported. Both patients were candidates for chemotherapy due to hepatocellular carcinoma (HCC). In these two cases the planned therapy was impossible because of a stenosis of the celiac trunk in one, and atresia of the celiac trunk in the other. CONCLUSION - The recognition of vascular anomaly prior to endovascular intervention significantly affects the planning of the therapy.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease2.
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Lege Artis Medicinae
[We do not know that the phenotype of the coronavirus would have changed]5.
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[Teleconsultations in general practice during coronavirus epidemiological emergency]
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