Lege Artis Medicinae - 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[THE ROLE OF INFECTIOUS AGENTS IN THE ETIOLOGY AND PATHOGENESIS OF ATHEROSCLEROSIS]

VÁLYI-NAGY István, PETŐ Mónika, CSÁSZÁR Albert, VIRÓK Dezső, BURIÁN Katalin, HELTAI Krisztina, GÖNCZÖL Éva

[The well-known risk factors of atherosclerosis (high level of serum cholesterol, high blood pressure, diabetes, smoking) can only be re cognized in about half of the patients. Athero sclerosis begins in childhood. In vivo and in vitro data suggest that certain pathogens, like the intracellular bacterium Chlamydia pneu moniae (member of the Chlamydia genus) and cytomegalovirus (member of the herpesvirus family) may play a role in the development of atherosclerosis. Both pathogens infect the pop- ulation in childhood. Infected patients are often symptom-free, sometimes Chlamydia pneumoniae may cause respiratory disease. Both Chlamydia pneumoniae and cytomega- lovirus can be detected in atherosclerotic plaques and patients with atherosclerosis carry pathogen-specific antibodies more frequently and in higher titers. Aortic lesions similar to human atherosclerotic plaques can be indu ced by infection with Chlamydia pneumoniae or cytomegalovirus in experimental animals. Antichlamydial treatment results in the regres sion of these lesions in the infected animals. In vitro infection of tissue culture cells of human arterial origin with Chlamydia pneumoniae or cytomegalovirus results in the induction of cel- lular changes characteristic to atherosclerosis. Strategies to prevent or treat atherosclerosis might be complemented by antimicrobial treatment if the infectious origin of the disease is further confirmed. ]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography]

MATOS Lajos

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HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Disparity in the perception of the disease in asthmatics and their pulmonologists plus resource in Hungary (HUNAIR study)]

MAGYAR Pál, GYURKOVITS Kálmán, HERJAVECZ Irén, BÖSZÖRMÉNYI Nagy György

[INTRODUCTION - Bronchial asthma is a chro­nic disease having an increasing prevalence in childhood and adulthood, affecting about 3-5% of the population in the developed countries. The AIR study in the United Kingdom compared the perception of the disease in asthmatic patients' to the view of their physicians (pulmonologists). Based on the results of AIR Study the Hungarian Board of Pulmonologists conducted a partially different survey in Hungary (H UNAIR Study). The fundamental objective of the HUNAIR Study was to address the following questions: 1. The persisting symptoms and limitations in daily activity of treated pediatric and adult asth­matic patients. 2. Comparison of the GINA classification of asthmatic patients (based on self-assessed symptom severity) and their pulmonologists. 3. Determination of the total asthma-related drug costs in different severity categories. 4. Determination of the total asthma-related cost for the society and its components (total drug costs, cost of lost workdays, cost of emergency visits, cost of specialist visits, cost of GP visits, cost of hospitalisation) in the different severity categories. 5. Potential differences in total cost between adult and pediatric asthmatic patients. PATIENTS AND METHODS - Data collection based on questionnaires was carried out from October 1998 to May 1999 and was directed by the Board of Pulmonologist. 699 adults and 375 children participated in the survey. The study was conducted in 19 adult and 8 pediatric cent­res in Hungary with the participation of 103 pulmonologists. RESULTS - Significant difference was found in the severity classification (based on GINA ) done by the physicians or the patients themselves. Substantial proportion of patients complained of more symptoms and limitations considering their own condition more severe than indicated by their physicians. Minor difference was found in the use of inhaled steroids among patients with mild, moderate and severe persistent asth­ma. An approximate "one-third " rule could be set up by the health economic evaluation: about 1/3 of the total cost was made up by lost work­ days, 1/3 by drug costs and 1/ 3 by other costs. One-third of the total drug cost was made up by controller and reliever antiasthmatics , 1/3 by emergency medicines and 1/3 by other medi­cines. Cost distribution of controller and reliever medicines: in case of adult patients 1/3 of the costs was constituted by controller medication and 2/3 (73%) by reliever medicines. That ratio was reversed in children: about 2/3 (73%) of the costs was spent on controller and '1 3 on reliever medicines. Further findings: 1. The increased health care resource utilisation correlated with the physician's perception more than the patient's self-assessment; 2. the resource utilisa­tion was twice as high in asthmatic children as in adults ; 3. the resource utilisati on was not affected by the usage of inhaled steroids during the 14 days of the study. CONCLUSIONS - lt can be concluded that in real life situations the current medical treatment of asthmatic patients is unsatisfactory (vs. in clinical trials). The cost-effectiveness of any medication can only be studied in a complex way, considering all the costs incurred in real life situations. New end-points are needed to assess the condition of asthmatics, which con­sider the limitations of patients in their daily routine activities and are not based exclusively on lung function tests.]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Modern approach to functional gastrintestinal disorders]

LONOVICS János

[Functional gastrointestinal disorders defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemichal abnormalities, are everpresent in the society and in physicians' offices. These conditions account for half of the referrals to gastroenterologists, at least in the ,,developed countries". The pathophysiological mechanisms involved in the pathogenesis of these disorders are complex. The symptoms are believed to be biologically multidetermined, abnormalities in motor activity, visceral sensation (hypersensitivity and hyperalgesia) and/or central perception are the best known pathogenetic factors. Cultural/familiar influence, psychosocial status, life stress and early life events may also play important role in the development or amplification of the symptoms. Since functional gastrointestinal disorders are interrelated in their pathophysiology and clinical expression, many patients will have overlapping clinical features. Predominant symptoms, however, may be used for classifying these disorders (functional dyspepsia, irritable bowel syndrome etc) and for the positive (symptom-based) diagnostic approach of the functional gastrointestinal disorders. A biopsychosocial model created to explain complex pathophysiology described above provides the rationale also for the use of a multidisciplinary approach in the therapy. ]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Funcitonal Dyspepsia]

SIMON László, LONOVICS János

[Functional dyspepsia is defined as a group of different epigastric symptoms without definite morphological, biochemical or infectious origin, having overlapping clinical features. The pathogenesis of the syndrome is surely multi factorial, involving the alterations of visceral perception, as well. Gastric acid hypersecretion does not play an essential role in the development of symptoms, however its pharmacological inhibition may result in symptomatic improvement. Several clinical studies have proved recently that Helicobacter pylori infection has secondary importance in the clinical history of functional dyspepsia patients, nevertheless (in the ulcer-like functional dyspepsia subgroup) eradication therapy is generally accepted as a preventive tool. The dysmotility-type subgroup of the functional dyspepsia syndrome is caused primarily by a multifactorial mixture of gastrointestinal motility disorders and altered visceral perception. The need for positiv diagnosis is emphasized by the authors. The correct doctor-patient relationship plays the most important role in the management of functional dyspepsia patients, complete with a well proven series of acid-inhibitory, prokinetics and anti-anxiety drugs.]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Irritable bowel syndrome is s representative of functional bowel diseases]

WITTMANN Tibor

[New concept for the irritable bowel syndrome (IBS) has been accepted in the medical practice based on the information obtained in the last two decades about the pathogenesis of the disease. This new pathogenetical concept stimulated the revision of the current pharmacotherapy and the development of new classes of drugs. Several mechanisms are involved in the development of typical symptoms: the role of motility disorders, visceral hypersensitivity and alterations in the peripheral and central regulatory/modulatory pathways are clearly documented. The positive diagnosis is based on the evaluation of the leading and representative symptoms of the disease (Rome Criteria I and II) and this approach is helpful to define IBS in the cliniccal practice. ]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Diagnosis and management of irritable bowel syndrome]

ÚJSZÁSZY László, TÚRY Ferenc

[The basis for the diagnosis of irritable bowel syndrome is the evaluation of the patient's symptoms. The wide-ranging use of this diagnosis (irritable bowel syndrome, IBS) in the past was equivalent to the exclusion of different organic diseases. Today's use, as a „residual diagnosis" accompanies patients with severe clinical signs, psychiatric comorbidity and older age. Based on the Rome Consensus Criteria I and II, initiating the treatment based on dominant symptoms is an important part of the diagnosis. Diagnostic differentiation depend on the dominant symptoms, providing different strategies for cases having diarrhoea, obstipation or pain dominancy. ]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[New approaches in the pharmacotherapy of irritable bowel syndrome]

WITTMANN Tibor

[New findings and data obtained in the pathophysiology of IBS had promoting role in the revision of pharmacotherapy of IBS and they were crucial to stimulate the development of new classes of drugs. Symptom-specific treatment is based on three groups of drugs: products modifying the gastrointestinal smooth muscle activity, the visceral hypersensitivity and the central modulatory processes. Only small group of products fulfill the new evaluation criteria.]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Psychological relations and the feasibility of psychoterapy in irritable bowel syndrome]

TÚRY Ferenc, ÚJSZÁSZY László

[The authors overview the recent data on the psychiatric relations of irritable bowel syndrome. The characteristic personality factors (mostly depressive and anxiety traits) must be emphasized as well as comorbidity between certain psychiatric disorders and irritable bowel syndrome, with the role of sexual abuse and stress explained. From the field of psychotherapy, the effectiveness of the cognitive-behavioural methods is analyzed most commonly. Data are available supporting the advantages of other therapeutical methods, too. ]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[ Intracoronary stents]

MANISH M. Gandhi, KEITH D. Dawkins

[Over the past five years, there has been a significant increase in the use of intracoronary stents, which are used during percutaneous transluminal angioplasty (PTCA) as an adjunct to revascularization of angina patients. In 1996, 25,000 PTCA interventions were performed in the UK, using stents in half of the patients (mean 46%, standard deviation 15-99%), a fivefold increase over the 1994 data (based on a personal report by HH. Gray).]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Excerpts from publications of Hungarian authors published in foreign journals]

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HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Gratitude money in Hungarian healthcare; Attitudes and opinions]

NAGY András László

[With less and less satisfactory funding for health care, the government is striking growing interest in gratitude money. Almost at the same time, the Minister of Health set up the so-called Thanksgiving Committee and began research - commissioned and supported by the Central European University and the State Treasury - by Tárki. Studies summarizing the results of the two programs also became known at about the same time. In our series, we browse in parallel the Commission report, which focuses on theoretical approaches, and the study, which is based on sociological facts (opinions). In addition to the similarity in content, the parallelism is justified by the fact that the researchers of Tárki (Géza Bognár and Róbert Iván Gál, supervisor János Kornai) thank Péter Balázs, the head of the working committee invited by the Minister, for his “valuable comments”. It can therefore be assumed that the two research groups knew and used each other’s results.]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Ethical aspects of the autonomy of the medical profession]

KAPOCSI Erzsébet

[The term autonomy - as one of bioethics principle - in the domestic and foreign ethics literature dealing with medicine, it primarily means the autonomy of patients. A significant change in recent decades is that the emphasis has shifted in the doctor-patient relationship, which occupies a central place in the relationship system of medical activity, and the law and ethics have also focused on the principle and autonomy of patients. In addition, a number of processes have taken place that warrant an examination of how these changes affect the other side, medical activity. The present dissertation deals with the autonomy of the medical profession (it is intended not so much as critical but rather descriptive), attempts to outline its basis based partly on professional peculiarities and partly on socio-consensus, and then - without claiming to be exhaustive - issues of medical morality are necessary or worth rethinking.]

HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Scientific Browser]

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HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Historica Medica; Women on the pharmaceutical field]

SZABÓ Katalin

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HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[Fine Art; From the sickbed to world fame]

TUROK Margit

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HUN 2000;10(04)

Lege Artis Medicinae

APRIL 01, 2000

[ Music history; The flagella]

MALINA János

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HUN 2000;10(04)