Lege Artis Medicinae

[What is going to change?]

SINKÓ Eszter

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

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Lege Artis Medicinae

[CARCINOMATOUS MENINGITIS]

CSERNI Gábor, VÁGÓ Tibor, TÖRÖK Norbert, GAÁL Zoltán, VELKEI Tamás, SERÉNYI Péter, GÖCZŐ Katalin, TUSA Magdolna, KOVÁCS Katalin, SZŰCS Miklós

[INTRODUCTION - Carcinomatous meningitis is a serious complication of advanced stage solid tumours, which may become more common with improved survival. CASE REPORTS - A 53-year-old woman with a recent history of breast cancer (pT2pN2M0) had been treated by mastectomy and adjuvant chemotherapy and radiotherapy. She presented with weakness, diplopia and vertigo raising the possibility of vertebrobasilar ischaemia or an intracranial mass. In another patient, a 62-year-old man with hypertension, a stenotic common bile duct had been diagnosed when examined for abdominal complaints. When he presented with a high blood pressure value accompanied by intensive headache, vomiting and bilateral hearing loss, he was thought to have a hypertensive crisis. The rapidly progressive neurological symptoms and the history of breast cancer and findings suggesting pancreatic head tumour, respectively, led to the clinical diagnosis of carcinomatous meningitis in both cases, despite any evidence on CT scans or a negative MR scan, though of limited value, in the first case. This diagnosis was confirmed by the laboratory and cytological findings of the cerebrospinal fluid, and also by the post mortem examination, since both patients died within a month after the onset of the symptoms. The primary tumour in the second patient proved to be a widely metastasizing diffuse type gastric cancer. CONCLUSION - Carcinomatous meningitis has a varying but characteristic presentation which generally makes it easy to diagnose, but it can sometimes present differential diagnostic problems. What we can learn from these two cases may help in recognizing this complication.]

Lege Artis Medicinae

[Soul Medicine and Ethics József Kovács: Bioethical Issues in Psychiatry and Psychotherapy]

BÁNFALVI Attila

Lege Artis Medicinae

[INTRAVASCULAR LEIOMYOMATOSIS PRESENTING AS A RIGHT ATRIAL MASS]

MAGYAR Éva, SALAMON Ferenc, TOMCSÁNYI István

[INTRODUCTION - Intravenous leiomyoma is a peculiar, rare tumour that originates from the myomatous uterus, grows into the lumina of veins and, through the inferior vena cava, may extend to the right heart cavity. The intracardial tumour causes severe cardiovascular symptoms and may be fatal. CASE REPORT - The symptoms of the 45-yearold woman consisted of chest discomfort, dizziness, and short periods of unconsciousness, which occurred during vacuum-cleaning when she bent forward. Imaging showed a growth that filled the lumen of the vena cava and extended to the right atrium, swinging between the atrium and ventricle. The patient underwent surgery with cardiopulmonary bypass and the intracardial tumour was removed together with its extensions filling the veins. The histological examination verified intravenous leiomyomatosis. Although the patient refused the recommended hysterectomy, she is well after six years the operation. CONCLUSION - In cases of unspecific cardiac symptoms, the possibility of intravenous leiomyomatosis should be considered. The diagnosis can be set up by echocardiography, MR or CT scan. If the diagnosis is confirmed, the tumour should be surgically removed.]

Lege Artis Medicinae

[In the Shadows of Great People An Interview with Árpád Szállási by Elemér Nemesánszky]

GYIMESI Andrea

Lege Artis Medicinae

[The MR NOED study]

MATOS Lajos

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KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

Hypertension and nephrology

[Measurement and value of blood pressure variability in increasing the number of patients reaching target blood pressure goal in hypertension]

KÉKES Ede, JÁRAI Zoltán, PAKSY András, KISS István

[The authors evaluate the indexes and their usefulness of the short term (ABPM), medium and long term measurement of the blood pressure variability in the care phase of the hypertensive population in Hungary by using a one-year multicentre prospective observational study. The population was split into two parts: in the active group, telemedicine tools were used to maximize the patientphysician relationship and patient education, their own activity. In the non-active group, traditional care took place. Among these, 6725, 18-64 years and 1005, 65 + years of hypertensive patients were analysed. At the start of the study, ABPM was performed in 243 cases. 1407 diabetic hypertensive patients were compared to non-diabetic patients. They have analysed previous international and domestic experiences. In the present study, the reduction of systolic and diastolic blood pressure variability was successful and significant in the 18-64 age group during the whole patients’ care phase, but a larger systolic variability reduction in the active group was achieved. In the 65+s, the systolic variability reduction was found to be significant, but the variability indexes in the active group were also smaller. In the 65+s, the diastolic variability did not change significantly in either group. In diabetic hypertension, variability indices were only reduced to 12 months. It could be clearly demonstrated that a high-level physician patient relationship has a beneficial effect on blood pressure fluctuation in hypertensive patients.]

Lege Artis Medicinae

[ASTHMA THERAPY ACCORDING TO THE REVISED INTERNATIONAL RECOMMENDATION]

HERJAVECZ Irén, BÁNKÚTI Beáta, CSOMA Zsuzsanna

[A comprehensive workshop report entitled “A Global Strategy for Asthma Management and Prevention - Global Initiative for Asthma (GINA)” first published in 1995, has been widely adapted, translated and reproduced, and forms the basis for many national asthma guidelines. The 2006 report contains important new themes. It asserts that it is reasonable to expect that in most patients with asthma, control of the disease can be achieved and maintained, and recommends a change in approach to asthma management with asthma control, rather than asthma severity, being the focus of treatment decisions.]

Hypertension and nephrology

[Effects of ketodiet in fourth-stage chronic renal failure]

KÓSA Dezider, GELENCSÉR Éva, PALOTAI Ágota, GASZTONYI Beáta

[The well-known progressive nature of chronic renal failure can be slowed by low protein diet of various degrees. We applied standard 0.6g/kg body weight diet with supplement of essential amino acids and keto acids, 1 tablet/10 kg body weight Ketosteril was administered to 100 patient with IV. stage chronic renal failure for 31.5 months in average (10-63 month). During observational period 11% of the patients started hemodialysis program, 4 patients died. At the end of the observational period on basis of laboratory value of renal function 31% of patients had III, 50% IV, 19% V. stage chronic renal failure. We applied calculated glomerular filtration rate (ml/min/1.73 m2) for following the renal function. Average GFR value reduced from 24.9 to 23.63 ml/min/1.73 m2 (not significant). In case of female patients, we found a milder loss in renal function, average GFR was reduced from 24.8 to 24.6 ml/min/1.73 m2. We observed that women hold on the prescribed diet in greater ratio. On basis of the BMI value calculated at end of our examination no patient was undernourished. 25.8% of the patients had normal body weight, 54.3% had overweight, 17.5% was obese and 2.4% severely obese. We followed the changes in state of nourishment by serum albumin value, average serum albumin was 42.92 g/l at beginning and did not change significantly (42.81 g/l at the end of our examination). Applying keto diet is safe and efficient in slowing the progression of severe chronic renal failure and improves the state of nourishment. Good state of nourishment achieved in predialytic stage is associated with low mortality ratio and gives opportunity to lower the mortality of patients starting dialysis program.]

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[Application of minimally invasive instrumental spine surgery technique in lumbal diseases of degenerative or traumatic origin]

SCHWARCZ Attila, KASÓ Gábor, BÜKI András, DÓCZI Tamás

[Paradigm change has recently taken place in spine surgery with the application of minimally invasive techniques. Minimally invasive techniques have several advantages over the open traditional techniques: less blood loss, preservation of spine muscle integrity, shorter hospitalization, early mobilization, reduced pain levels, lower risk of infection. The presented cases cover following lumbar pathologies: segmental spinal instability, LV-SI grade II. spondylolisthesis, degenerative spondylolisthesis, spine trauma. Unilateral or bilateral mini-open technique was employed in the degenerative cases, depending on symptoms and signes. If unilateral symptoms - pathology was identified, screws and rod were implanted percutaneously on the side contralateral to the pathology. The segmental fusion between vertebral bodies was always assured by a cage and autologous bone. The presented trauma case involved combined AO type A2 and B fractures. The anterior column was strengthened with vertebral body stents filled with bone cement, the posterior column was fixed with a percutaneously implanted screw rod system. Insertion of stents in the collapsed vertebra significantly increased the vertebral body height and also improved the stability of the spine. Minimally invasive spine surgery techniques appear more advantageous over the traditional open spine surgery that necessitates for large midline approaches.]