Lege Artis Medicinae

[1963 - in the "medical school" section]

JUHÁSZ László

SEPTEMBER 25, 1991

Lege Artis Medicinae - 1991;1(15)

[Now that the change of regime at our university is in full swing, and we have a new elected rector, dean and senate, I think it is not taboo, and in fact it is very interesting, to see what events we can discover in the medical school press. This collection, based on the "Medical Universities" published in the winter months of 1963, gives, if not a complete, then a typical picture of how and what was seen as important and contemporary in 1963. ]

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Lege Artis Medicinae

[On pulmonary tuberculosis]

SCHWEIGER Ottó

[The author evaluates the epidemiological conditions of pulmonary tuberculosis in Hungary. The number of new cases decreases year after year. Being the disease infectious afterall, efforts must be continued against it adapted to the new epidemiological situation. This requires the collaboration of all the medical network systems as the pulmonological one is inefficient itself. Though the disease is rare, it cannot be forgotten and in certain cases tuberculosis must be borne in mind as well.]

Lege Artis Medicinae

[The differential diagnosis of pulmonary tuberculosis]

BÖSZÖRMÉNI Miklós

[Since the number of tuberculous patients is constantly decreasing, the diagnosis of pulmonary tuberculosis is a new challenge for physicians. That produces a lifethreatening danger specially for old tuberculous patients. Primary infection – since the clinical tuber culosis of children practically disappeared in Hungary - can be established mostly on young people with general symptoms, who's tuberculin-reaction shows hyperergy. The specific etiology of pleurisy can be determined by the exclusion of other etiologies on young tuberculin-positive people, but a thoracoscopic biopsy may be needed. Tuberculous bronchadenitis is a rarity, but must be differentiated from sarcoidosis or malignant mediastinal lymph nodes. In infiltrative lung diseases, primary and se condary pneumonias (caused in first line by lung cancer) and pulmonary infarctions are much more frequent, than tbc. The most difficult is the differential diagnosis of disseminated pulmonary diseases. The author warns against the too early application of aggressive diagnostic methods (BAL and especially lung biopsy by thoracotomy). He emphasizes in these situations the advantages of an antituberculous treatment without diagnosis (especially in old patients). In coin lesions the very specific transthoracic needle biopsy should be preferated. The author refers to the new researches objecting the rapid detection of BK in the sputum of paucibacillary patients, but is meaning, that the indirect ways of diagnosis mentioned in this paper would be necessary for a long time.]

Lege Artis Medicinae

[The importance of tuberculosis in childhood]

ANDRÁSOFSZKY Barna

[Nowadays tuberculosis has already become a rare disease in childhood in Hungary but the danger of the infection is still present for the several thousand (over 3500) disease manifestations among adults. The main task of the pediatricians is prevention, however the disease should be borne in mind in case of unelucidated chronic cases. In suspicion of meningitis basilaris it is necessary to start the treatment at once. Until now the maintanence of the BCG vaccination by age groups (new-born, 11 and 18 years) was justified, but it needs further restriction due to the advance in epidemic situation.]

Lege Artis Medicinae

[Some problems and characteristics of pulmonary mycobacteriosis in hungary]

KOZMA Dezső, VINCZE Egon, DÁVID Sándor, KISHINDI Katalin, ALEXY György

[360 cases of pulmonary mycobacteriosis caused by atypical mycobacteria were observed between 1980 and 1989. M. xenopi proved to be the most frequent pathogen (in 67% of the cases) followed by M. kansasii and M. avium intracellulare. The disease was common in urban-industrial areas. The yearly incidence of disease has not been increased during the observed period. 86% of patients were male with the mean age of 55 years. Underlying diseases such as pulmonary tuberculosis and chronic obstructive lung disease were found frequently. The symptoms of the disease were uncharacteristic. Thin-wall cavities with the lack of an infiltrate appeared in 24% of the patients. Malignancy and pulmonary aspergillosis were the two more frequent concomitant diseases. The occurence of lung cancer and also other organ cancers were significant higher among these patients than in the normal population between 40–69 years of age. Findings of histopathology were indistinguishable from tuberculosis among M. kansasii cases. A relative lack of caseousiting necrosis, forced fibrosis, foreign body reaction and abortive granuloma formation appeared among M. xenopi and M. avium-intracellulare cases. ]

Lege Artis Medicinae

[An update on BCG vaccination]

NYERGES Gáborné, DRINÓCZY Mária

[Tuberculosis is still a serious and wide-spread disease affecting mainly people living under poor hygienic conditions. Double infections with HIV + M. tuberculosis, however, may worsen the epidemiological situation both in developing and highly developed countries. Since its introduction, BCG vaccine has undergone several changes regarding the production strain and other characteristics. Though, the effectivity of BCG vaccination has been often questioned, it is indisputable that the vaccine protects young children against the disease. In Hungary, lyophilised „Paris" BCG strain has been safely and successfully used for vaccinating new-borns and revaccinating children for 30 years. The tbc incidence of the population under 14 years of age has been very low. Due to the relatively high tbc incidence among adults and the unfavourable tendency in the epidemiology of tbc in the world, however, no changes in the present BCG vaccination schedule are advisable. Moreover revaccination regardless to the tuberculin status should be considered. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

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Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Lege Artis Medicinae

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