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Clinical Neuroscience

JULY 30, 2020

[The complex intensive care and rehabilitation of a quadriplegic patient using a diaphragm pacemaker]

FODOR Gábor, GARTNER Béla, KECSKÉS Gabriella

[A 21 year female polytraumatized patient was admitted to our unit after a serious motorbike accident. We carried out CT imaging, which confirmed the fracture of the C-II vertebra and compression of spinal cord. Futhermore, the diagnostic investigations detected the compound and comminuted fracture of the left humerus and femur; the sacrum and the pubic bones were broken as well. After the stabilization of the cervical vertebra, a tracheotomy and the fixation of her limbs were performed. She spent 1.5 years in our unit. Meanwhile we tried to fix all the medical problems related to tetraplegia and respiratory insufficiency. As part of this process she underwent an electrophysiological examination in Uppsala (Sweden) and a diaphragm pacemaker was implanted. Our main goal was to reach the fully available quality of life. It is worth making this case familiar in a wider range of public as it could be an excellent example for the close collaboration of medical and non-medical fields.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2017

[Post-operative external Fixation in Adult and Pediatric Hand Surgery from a Nurse’s perspective]

TÓSAKI Mónika, HAJDUNÉ NÉMETH Anna Csilla

[Performing postoperative nursing duties on hand surgical patients is a special field of nursing. Our goal is to demonstrate what special - observational and other - duties are rquired of an adult/pediatric hand surgical nurse.We also would like to broaden the knowledge of our nursing staff, because due to our shortage of workstaff we are often forced into substituting positions, and patient safety requires us to be practiced in this field. We will give an overview of the most common fixating techniques, post-operative nursing duties and most common complications.]

Clinical Neuroscience

JULY 30, 2015

[Treatment of post spondylodesis adjacent segment disease with minimally invasive, anterolateral surgery on lumbar spine: there is no need for dorsal operation?]

SCHWARCZ Attila, SZAKÁLY Péter, BÜKI András, DÓCZI Tamás

[Adjacent segment disease (ASD) occurs with a probability of 30% in the lumbar spine following spinal fusion surgery. Usually advanced degenerative changes happen cranially to the fused lumbar segment. Thus, secondary spinal instability, stenosis, spodylolisthesis, foraminal stenosis can lead to the recurrence of the pain not always amenable to conservative measures. A typical surgical solution to treat ASD consists of posterior revision surgery including decompression, change or extension of the instrumentation and fusion to the rostral level. It results in a larger operation with considerable risk of complications. We present a typical case of ASD treated surgically with a new minimally invasive way not yet performed in Hungary. We use anterolateral abdominal muscle splitting approach to reach the lumbar spine through the retroperitoneum. A discectomy is performed by retracting the psoas muscle dorsally. The intervertebral bony fusion is achieved by implanting a cage with large volume that is stuffed with autologous bone or tricalcium phosphate. A cage with large volume results in excellent annulus fibrosus tension, immediate stability and provides large surface for bony fusion. A stand-alone cage construct can be supplemented with lateral screw/rod/plate fixation. The advantage of the new technique for the treatment of ASD includes minimal blood loss, short operation time, significantly less postoperative pain and much less complication rate.]

Clinical Neuroscience

JANUARY 30, 2015

[Treatment of osteoporotic vertebral compression fracture with PMMA augmented pedicle screw fixation]

PADÁNYI Csaba, MISIK Ferenc, PAPP Zoltán, VITANOVICS Dusan, BALOGH Attila, VERES Róbert, LIPÓTH László, BANCZEROWSKI Péter

[Background - Over the last few decades many innovative operation technique were developed due to the increase of porotic vertebral fractures. These new techniques aim to reach the required stability of the vertebral column. In case of significant instability, spinal canal stenosis or neural compression, decompressive intervention may be necessary, which results in further weakening of the column of the spine, the minimal invasive percutan vertebroplasty is not an adequate method to reach the required stability, that is why insertion of complementary pedicular screws is needed. Considering the limited screw-fixing ability of the porotic bone structure, with this new technique we are able to reach the appropriate stability of cement-augmented pedicle screws by dosing cement carefully through the screws into the vertebral body. We used this technique in our Institute in case of 12 patients and followed up the required stability and the severity of complications. Methods - Fifteen vertebral compression fractures of 12 patients were treated in our Institute. Using the classification proposed by Genant et al. we found that the severity of the vertebral compression was grade 3 in case of 13, while grade 2 in case of two fractures. The average follow up time of the patients was 22 months (12-39), during this period X-ray, CT and clinical control examinations were taken. During the surgery the involved segments were localised by using X-ray and after the exploration the canulated screws were put through the pedicles of the spine and the vertebral body was filled through the transpedicular screws with bone cement. Depending on the grade of the spinal canal stenosis, we made the decompression, vertebroplasty or corpectomy of the fractured vertebral body, and the replacement of the body. Finally the concerned segments were fixed by titanium rods. Results - In all cases the stenosis of spinal canal was resolved and the bone cement injected into the corpus resulted in adequated stability of the spine. In case of six patients we observed cement extravasation without any clinical signs, and by one patient - as a serious complication - pulmonary embolism. Neurological progression or screw loosening were not detected during the follow up period. Part of the patients had residual disability after the surgery due to their older ages and the problem of their rehabilitation process. Conclusion - After the right consideration of indications, age, general health condition and the chance of successful rehabilitation, the technique appears to be safe for the patients. With the use of this surgical method, the stability of the spine can be improved compared to the preoperative condition, the spinal canal stenosis can be solved and the neural structures can be decompressed. The severity of complications can be reduced by a precise surgical technique and the careful use of the injected cement. The indication of the surgical method needs to be considered in the light of the expected outcome and the rehabilitation.]

LAM KID

DECEMBER 20, 2013

[Our predecessors were right - Closing remarks on the solubility of urate crystals in microscopic specimens]

BÉLY Miklós, KRUTSAY Miklós

[The authors studied the solubility of urate crystals in alcohol, in an 8% aqueous solution of formaldehyde and in acetone, respectively. The urate crystals were least soluble in alcohol. In comparison, the amount of urate crystals decreased in the aqueous solution of formaldehyde, which confirmed the suggestion of our predecessors that tissues suspected to contain urate crystals should be fixed in alcohol. Urate crystals dissolved in greatest amounts in acetone. Acetone is widely used by histological laboratories for dehydration of tissue blocks before embedding them in paraffin, which, in case of fixation in aqueous formaldehyde, contributes to the dissolution of urate crystals. In our earlier studies, we found that dissolution of urate crystals from haematoxylineosin stained sections is caused by the staining of nuclei in haematoxylin, therefore urate crystals are preferably demonstrated in unstained tissue sections.]

LAM KID

MARCH 30, 2013

[A dogma of histochemistry that seems to be refuted - histological detectability of urate crystals]

BÉLY Miklós, KRUTSAY Miklós

[In medical practice there are a number of “truths etched in stone” that are passed on from textbook to textbook and learned by generations before they become obsolete. This short study aims to eliminate a misbelief from the diagnosis of gout that is related to the histological detectability of urate deposits. According to the generally accepted thesis, urate crystals obtained from patients with gout are dissolved in formalin solution, therefore, tissue samples should be fixated in alcohol. The authors have found that urate crystals can be detected on conventionally mounted, native (unstained) sections, despite formalin fixation, whereas the great majority of urate crystals are dissolved during haematoxylin-eosin staining. Therefore, for the detection of urate crystals the tissue samples should be examined on native, unstained sections.]

Lege Artis Medicinae

JANUARY 20, 2013

[A popular error of histochemistry seems to be change]

BÉLY Miklós, KRUTSAY Miklós

[In medical practice there are a number of “truths etched in stone” that are passed on from textbook to textbook and learned by generations before they become obsolete. This short study aims to eliminate a misbelief from the diagnosis of gout that is related to the histological detectability of urate deposits. According to the generally accepted thesis, urate crystals obtained from patients with gout are dissolved in formalin solution, therefore, tissue samples should be fixated in alcohol. The authors have found that urate crystals can be detected on conventionally mounted, native (unstained) sections, despite formalin fixation, whereas the great majority of urate crystals are dissolved during haematoxylin-eosin staining. Therefore, for the detection of urate crystals the tissue samples should be examined on native, unstained sections.]

Clinical Neuroscience

JANUARY 30, 2012

[Rare angioproliferative tumors mimicking aggressive spinal hemangioma with epidural expansion]

KULCSÁR Zsolt, VERES Róbert, HANZÉLY Zoltán, BERENTEI Zsolt, MAROSFŐI Miklós, NYÁRY István, SZIKORA István

[Background and purpose - We present two cases of angio-proliferative tumors that were misdiagnosed and treated as typical hemangiomas with epidural expansion. Materials and methods - Two middle-aged women presented with symptoms and radiological signs characteristic for aggressive hemangioma with epidural expansion. In the first case preoperative embolization and decompressive surgery with open transpedicular vertebroplasty was performed. Within less than a year, epidural recurrence of the tumor prompted for radical excision and corpectomy. The diagnosis after the histological studies and the further clinical evolution was metastasizing leiomyomatosis. No further recurrence occured during the next 6 years. In the second case percutaneous vertebroplasty was performed and complicated by epidural polymethyl-methacrylcate (PMMA) leakage, requiring urgent decompressive surgery. Histological study of the lesion raised the possibility of myopericytoma. This was confirmed 16 months later when complete vertebrectomy was performed due to severe epidural propagation of the recurring tumor. No further recurrence occurred in next the two years. Conclusions - Rare angio-proliferative tumors, like benign metastasizing leiomyoma and myopericytoma radiologically may resemble aggressive vertebral hemangiomas of the spine. Unlike hemangiomas, such tumors require radical removal due to their likely recurrence. As imaging studies may not be able to completely exclude such pathologies, bone biopsy and thorough histopathological studies are warranted prior to the therapeutic decision.]

Lege Artis Medicinae

JANUARY 20, 2007

[OUR EXPERIENCE WITH BORTEZOMIB-BASED THERAPY OF MULTIPLE MYELOMA BASED ON THE FIRST 60 PATIENTS]

MIKALA Gábor, BÁTAI Árpád, CEGLÉDI Andrea, CSUKLY Zoltán, DOLGOS János, HALM Gabriella, JÁNOSI Judit, KAPÁS Balázs, LOVAS Nóra, LUEFF Sándor, PETŐ Mónika, REMÉNYI Péter, SIPOS Andrea, TÓTH Zsuzsanna

[INTRODUCTION - Bortezomib, a first-in-itsclass proteasome-inhibitor drug was registered in 2004 for the salvage treatment of relapsed and/or refractory multiple myeloma. We have been using this drug in our department for the treatment of myeloma patients since 2005. PATIENTS AND METHODS - In this retrospective study, treatment results (response rate, response duration, survival) as well as the complications and side effects were analysed based on 60 myeloma patients treated over a period of 18 months. The patients received at least one full cycle of non-first-line bortezomib-based (predominantly combinational) therapy. RESULTS - At least minimal laboratory and/or clinical response was observed in 47 of the 56 patients who could be analysed. Clinically meaningful (at least partial remission) response was seen in 41 of 56 patients. Immune-fixation negative complete remission was achieved in six patients. Median progression-free survival of our patient population was 13 months (10.8-14.8 months, n=49, adjusted for patients lost in the first 6 weeks and for those with less than 6 weeks of follow-up). As for overall survival, the median has not been reached, while treated patients had an 80.3% probability of survival at one year. CONCLUSIONS - Based on the treatment results of 60 myeloma patients, bortezomibbased therapy is clearly effective in relapsed and/or refractory myeloma.]

Clinical Neuroscience

JULY 20, 2010

[New surgical technique for atlanto-axial instability: C1-2 dorsal fixation with the screw-rod system]

LIPÓTH László, BANCZEROWSKI Péter, VERES Róbert

[Objective - It is still challenging to perform the operation for the instability of the C1-C2 junction because of the limited cases, unique anatomical landmarks, the potential or real injury of the neurological elements, the serious clinical state and the special technical and human background is demanding. With the aim of minimalize the risk the following method provide sufficient stability, successful and simple. Method - The authors used the dorsally implanted screwrod systems for operating 34 patient with C1-2 instability resulting clinically signs and symptoms. Depending the anatomical landmarks and the technical possibilities, the screw insertion method and the reinforced wire cable use was selected. Meaning the indication of the surgical treatment, the neurological signs, compromise of the spinal canal and pain resisting the conservative treatment was presented. Result - The C1-2 dorsally fixation was performed to 34 patients. Both sided lateral mass screw was inserted in 30 cases (88.3%). Because of the anatomical landmarks in four cases (11.7%) the one sided screwing was made by the Magerl technique. Pure bone quality detecting intraoperatively demand reinforcement with titanium cables for three cases (8.8%). Pain resulted of instability was recovered. The clinical and neurorariological follow-up present perfect result for 26 patients (76%), good result for six patients, there was respectable result for two patients. Most of the patients, 31 cases (91%) were satisfied, and three patients (9%) consider their condition acceptable. Conclusion - Performing the represened techique, the risk and the time of the operation was decreased reducing the rate of the complications. The method providing full stability resulted immediate axial painless, no outer support and early mobilization is possibile. Summarizing this technique is safe, reliable and cost effective.]