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Lege Artis Medicinae - 2000;10(02)
Content
Lege Artis Medicinae
FEBRUARY 01, 2000
[Perinatal postasphyxial brain damage and its obstetric prevention]
[The author provides an overview of the definition and aethiopathogenesis of fetal hypoxia and asphyxia, including possible forms of post asphyxial damages of mature fetuses as well as the incidence and neurological consequences of cerebralpalsy. Among from the screening methods of fetal hypoxia the special importance of colour-Doppler and pulse-Doppler technique (flowmetry), cardiotocography (CTG), non-stress test, biophysical profile examinations, amnioscopy and fetal pulsoxymetry are emphasized. In the prevention of fetal asphyxia the significance of preconceptional and prenatal care, the importance of maternal diseases, pathological conditions of the fetus and the umbilical cord, as well as the influence of factors during labour and delivery are also emphasized. The practice of the authors is supported by the recommendation of British obstetricians, when making a fetal scalp pH examination in case of pathological CTG findings, or performing a prophylactic cesarean section if the pH examination is not available. Since the number of postasphyxial damage in mature newborn infants is still high in Hungary, it is concluded, that an increase is required in the rate of cesarean sections when fetal asphyxia is present. ]
Lege Artis Medicinae
FEBRUARY 01, 2000
[Practical questions of perinatal thyroidology]
[Characteristic features of maternal, fetal and neonatal thyroid functions are discussed. The role of maternal thyroid hormone transfer in fetal development is emphasised with the interpretation of the association between maternal and fetal thyroid functions. Thyroid disorders and dysfunctions during neonatal period are summarised and the influence of maternal thyroid disease to neonatal thyroid function is demonstrated. The role of iodine deficiency and importance of optimal iodine intake during pregnancy are also emphasised. Congenital hypothyroidism and thyroid dysfunctions of premature infants are shortly presented. The importance of prenatal care, screening for congenital hypothyroidism and thyroid function checks in premature infants are also pointed out. ]
Lege Artis Medicinae
FEBRUARY 01, 2000
[Evaluating endocrine laboratory findings]
[The clinical value of hormonal laboratory findings is determined by many more factors than of the conventional (non-endocrine) parameters. The increased complexity is partly due to the physiological and pathophysiological properties of hormonal biomolecules as well as to the characteristic differences in the analytical methods. Correct interpretation of the endocrine results requires the consideration of potential preanalytical errors and the collection and handling of samples done more carefully. Because of the low physiological concentrations of hormones, only microanalytical methods can be used. Endocrine parameters in clinical laboratories are usually measured with immunoassay methods these days. Due to the assay characteristics of these methods (e.g. cross-reactivity of the antibodies, specificity, technology-dependent differences in sensitivity), numerical values appearing on the laboratory reports – particularly if not accompanied with additional information - may be incorrectly interpreted by the clinicians. Therefore, plausibility control should be an integral part of the post-analytical tasks of a laboratory. The authors evaluate these specialties based on their own analytical and clinical experience as well as on literature data. It is concluded that correct endocrine laboratory report should contain not only data on reference values, but also the confidentiality limits of the given endocrine test. Subnormal values, provided they are of clinical relevance, should be evaluated together with the variation coefficient and the functional sensitivity, measured specifically in this lower range. The frequently asked question, whether a difference in endocrine results is due to biological factors determined by a disease, or to analytical problems, is particularly important when using dynamic tests. ]
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
[A case of juvenile haemochromatosis presenting adrenocortical insufficinecy ]
[Juvenile haemochromatosis is a rare autosomally inherited disorder of iron metabolism causing severe iron overload in young adults. The organs mostly affected are liver, spleen, pancreas, heart and the skin similarly to the genetically also determined adult form. CASE REPORT - Contrary to most juvenile haemochromatosis cases characterised by secondary hypogonadotropic hypogonadism, this patient presented with adrenocortical insufficiency. Involvement of the heart was present on diagnosis while liver showed normal architecture without increased iron content. Genetic analysis revealed that the patient did not carry the C282Y mutation, while the H63D mutation was present in heterozygous form. With hormone supply and regular vena sections the patient is free of complaints. CONCLUSION – This case demonstrates that severe iron overload can occur early in adult life without the presence of HFE gene mutations suggesting a putative gene defect responsible for juvenile haemochromatosis. ]
Lege Artis Medicinae
FEBRUARY 01, 2000
[Standardizing the results of Diabcare Hungary; A method for comparison and quality Improvement]
[INTRODUCTION – DiabCare, the monitoring system of the WHO/IDF-Euro was developed for continuous quality improvement of diabetes care based on a structured and standardized diabetes dataset. PATIENTS AND METHODS - Data from 5 DiabCare Hungary centers with different patient populations were adjusted for demographic parameters and compared to the 2403 records of the national dataset collected between 1995–97. RESULTS - More than half of the investigated patients were >56 years old (centers analyzed in detail: 20–83%), one third of them had an age 36-55 years (17-52%), 45% were male (27-63%). The prevalence of type 1 DM was 29% (0–80%). Almost one third of the patients had a diabetes duration >15 years (14-58%). Eyes were examined in 79% (28-98%), retinopathy was found in 29% (28–81%, minimal change after standardization). Risk factor identification was above 80% in all centers (except in center 3: 16-94%). Rate of patients with risk factors: HbAlc >8%: 43%; triglycerides >2mmol/l: 33% (in center 5 lower, 17%; after standardization 37%), blood pressure (>160/95 Hgmm), smoking and alcohol consumption together 15%. Albuminuria was examined in 55% (25–89%), with microalbuminuria present in 24% (0-38%). The frequency of self-monitoring and of severe hypoglycemia (49 and 5%) paralleled the relative weight of type1 DM patients during standardization. CONCLUSION - It is concluded that centralized evaluation and anonymous comparison of crude and adjusted data might be helpful in assessing and improving the quality of diabetes care. ]
Lege Artis Medicinae
FEBRUARY 01, 2000
[Non-surgical treatment of menorrhagia]
[This summary attempts to approach the diagnostic problems and therapeutic options of menorrhagia in a rational way. In preparing it, I used two professional opinions published in 1998 (8, 9), the material of a consensus conference published in 1995 (10), and the database of the Cochrane library.]
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
Lege Artis Medicinae
FEBRUARY 01, 2000
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