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Lege Artis Medicinae - 2000;10(05)
Content
Lege Artis Medicinae
MAY 01, 2000
[Aspirin therapy in diabetes mellitus]
[Patients with diabetes mellitus have an increased risk of cardiovascular events and this risk is often present in the prediabetic phase of the type 2 diabetes. Diabetic patients have altered platelet function, including increased production of thombox ane resulting in increased platelet aggregation. This effect is reversed by aspirin within few days after beginning treatment with 75 mg aspirin daily. These findings of primary and secondary prevention trials in men and women with dia betes mellitus support the view that low-dose aspirin therapy should be used as secondary prevention when not contraindicated, and it should also be used as primary prevention in patients who are at high risk for cardiovascular events. ]
Lege Artis Medicinae
MAY 01, 2000
[The role of apoptosis in human diseases]
[Apoptosis and mitosis control the homeostasis of various cell populations. Several diseases are characterised by too much or to small amount of apoptosis. Carcinogenesis itself is connected with a decrease in apoptotic activity and malignant neoplasms are also known to show low apoptotic index. However, each type of malignant tumors should be viewed as a distinct entity, regarding the capacity for the induction of apoptosis especially. The role of apoptosis in the pathogenesis and progression of autoimmune, infectious, neurodegenerative diseases and alterations in the liver, kidney, lung and heart is also discussed, with special emphasis on therapeutic possibilities influencing the imbalance of apoptosis. ]
Lege Artis Medicinae
MAY 01, 2000
[Gout]
[In spite of our increasing knowledge about the pathomechanism, clinical classification and therapy of gout as well as the improving care of gouty patients, many problems of the field are unsettled. Among others, the atypical character of female gout, its more frequent occurrence in elderly women, the often aggressive character of the cyclosporin-induced gout belongs to the unanswered questions. Understanding the role of crystals covered by proteins (mostly IgG) in the induction of inflammation was of great importance, however, the changing character of inflammation caused by intraarticular MNU-crystal deposition is still a challenging problem. It is well known, that not all gouty patients are middle aged males, the number of young, drug-resistant gouty males having extensive tophi is increasing. Although the relationship between hyperuricemia and gout was clarified in many respect, it would be important to understand why chronic hyperuricemia is not associated regularly with gout and why gout can develop in patients without high serum uric acid levels. We learned finally, that early diagnosis and adequate treatment of gouty attacks and the therapy resulting in the decrease of high level of serum uric acid are prerequisites for slowing down the progres sion of the gout and for the prevention of its complications. ]
Lege Artis Medicinae
MAY 01, 2000
[Reiter-syndrome]
[The Reiter-syndrome is the complex of sterile arthritis, urethritis and conjunctivitis and involvement of other organs (skin, mucosal membranes, cardiac conducting system) following bacterial enteric or urogenital infec tion. Systemic signs can also occur with polyarthritis. This syndrome belongs to the reactive arthritis group. In each year there are 30 40 new cases among 100 000 citizens. The disease can occur at any age, but most of the patients are 20-40 years old. It is the patient's genetic background and the type of invading microbes that play a leading role in the pathomechanism of the disease. The exact pathomechanism is yet unknown, therefore our treatment is symptomatic. It is advised to immobilize the involved joint and aspirate the excess fluid and to take non-steroidal antiinflammatory drugs. The patient's medical history is most important to diagnose the disease, because laboratory tests may show signs of inflammation, the serology can only prove antecedent infection, viable organism can not be cultured from the involved organs and the imaging procedures and histology shows non-specific inflammation only. The importance of diagnostic procedures is to exclude the presence of other diseases. Other causes of monarticular inflammation (infection, crystal induced arthritis, sarcoid arthritis) and rheumatic fever should be excluded. The disease lasts for 3-6 months. 2 to 18% of the patients develop chronic arthritis and 12 to 26% of the patients develop ankylosing spondylitis. ]
Lege Artis Medicinae
MAY 01, 2000
[The cervical spine in rheumatoid arthritis]
[The neck is the third most common site of involvement after the hands and feet in rheumatoid arthritis (RA). Deformities of the cervical spine can appear in the early stage of the disease, but most often they are seen in patients with rheumatoid arthritis with more than ten years of duration. Progression of the deformity is unpredictable, but follow up for five to ten years has shown the worsening of the instability in 16-80% of the patients. Many patients with rheumatoid disease of the cervical spine remain asymptomatic for years, but they are at risk of a range of neurological complications and even sudden death from me dullary compression. Neurological abnormalities may be subtle and difficult to establish in the presence of deforming arthritis. Once myelopathy develops, it is usually rapidly progressive. The primary goal in the management of the cervical spine is to prevent the onset of irreversible neurological deficit. Patients should have regular physical examinations to avoid the masking of subtle changes of myelopathy by severe peripheral joint disease. Use of the different measurements, especially posterior atlantodental interval and subaxial canal diameter measured on plain lateral cervical radiograph is a reliable screening tool to identify high risk patients who require further evaluation. The primary technical objective of surgery is stabilization of the diseased spinal segments and relief of spinal cord compression via reduction of subluxation or decompression. Complications are not uncommon, but tend to occur less frequently, and neurological recovery is most favorable when severe cord compression is not present preoperatively. ]
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
[Hemodynamic changes during simulated orthostasis]
[INTRODUCTION – „Lower body negative pressure" (LBNP, simulated orthostasis) is an experimental method to simulate orthostatic stress. METHODS – The aim of this study was to quantitate hemodynamic and thoracic bioimpedance changes with four levels of LBNP (-15, -35, -55, -65 mmHg) in 7 healthy men in supine position 20 min before (pre-LBNP), 30 min during, and 20 min after suction as well as without suction (rest control). RESULTS - Thoracic bioimpedance computed stroke volume index continuously decreased with time by the end of simulated orthostasis of -15, -35, -55 and -65 mmHg. The decrease of cardiac index was largest at LBNP of -15 and -35, where the highest relative increase of total peripheral resistance index occurred. Mean arterial pressure did not change in any systematic way with lower LBNP levels, but increased at the end of LBNP -55 and -65. Heart rate remained unchanged at LBNP-15, but increased continuously with simulated orthostasis duration at higher levels by the end of LBNP-35, -55, and -65. Having finished simulated orthostasis, heart rate fell below pre-stimulus levels and also below rest control levels for 25 min; computed stroke volume index transiently returned to pre-stimulus levels, whereas mean arterial pressure increased above pre-LBNP level after finishing the stimulus. CONCLUSIONS - Different levels of lower body negative pressure produced quantitatively different time course and dose-response patterns and subjects remained non-hypotensive up to -65 mmHg suction. The heart rate was depressed after simulated orthostasis, while arterial blood pressure and impedance computed total peripheral resistance exceeded pre-stimulus levels indicating an altered cardiovascular (neuro-humoral) state after 30 min of simulated orthostasis. ]
Lege Artis Medicinae
MAY 01, 2000
[Recent results in intensive care]
[In the last few years, intensive care has had a rather high level of publicity, but it is not so much the significant development of the profession, but rather, due to the scarcity of available resources. Although research is cumbersome because the patient population is heterogeneous and relatively small, the area has been enriched with a number of significant results in recent years. In this article, we present some recent results as well as innovations introduced in the field of vocational training.]
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
[Parliamentary debate on healthcare]
[On the proposal of the MSZP, the National Assembly organized a health debate day entitled Reform or Rhetoric. Árpád Gógl began his 40-minute introduction by criticizing the health policy of the Horn-Kuncze government. He stated that the Bokros package had shattered some elements of Hungarian health care: dentistry, sports health care, the sanatorium system, and in 1995 the expenditure had been halved from the 1990s.]
Lege Artis Medicinae
MAY 01, 2000
[ Mental hygiene of staff accompanying dying patients; Options for reducing burnout and psychological burden]
[Hospice work also has its myths and limits. Even the most careful care cannot always ensure good death for the sick and peaceful escort for the caregivers. A nurse working in a French hospice writes about the myth of good death and the often bitter reality: “The patient is lying tube-free in a quiet room; there may be pleasant background music; he is surrounded by his and his favorite pets. The nurse is always ready to hold her hand to the passer-by all the time. And if the situation is very stressful, the case discussion group will do its best to erase the thoughts that limit the ideal accompaniment.]
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
[Hungarian and European Lung Medicine Congress in Budapest]
[April 12-15 The 51st of the Hungarian Pulmonary Society and the 1st Congress of the European Region of the International Union against TBC and Lung Disease (IUATLD). The program was grouped around three main themes: tuberculosis, bronchial asthma, and smoking. The location in Budapest and the main themes together indicate that the goal of the union was to open up to Eastern Europe. Of the three public disease problems, there is a significant difference between the western and eastern parts of our continent in terms of tuberculosis and smoking, both in terms of the severity of the problem and the methods of solving it. In our report, we too these two issues are highlighted.]
Lege Artis Medicinae
MAY 01, 2000
[Medical and health information literature in 18th century Hungary]
[The 18th century has led to very diverse developments in the cultural and scientific life of the country, as well as in areas affecting general welfare issues. The new ideas still came to us a little late, by intellectuals educated abroad - scientists, doctors, humanities. Everyone in their field tried to alleviate the backwardness of the country, to spread knowledge. As a general principle, following the spiritual currents abroad, it was professed that the basis of everything is the knowledge from which all citizens of the country have the right to benefit. Similarly, it is a fundamental human right for everyone to lead a healthy lifestyle under the right conditions. The most well-known personalities of the Enlightenment, though extremely sympathetic, were nevertheless naively idealistic, also had an idea of the optimal social model. "... science is one of the main means of the country's happiness, and the more common it is among the inhabitants, the happier the country is ..." György Bessenyei confessed with his knowledge gained in Vienna. He believed that , mundane you can live with satisfaction in the sure knowledge of your destiny.]
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
Lege Artis Medicinae
MAY 01, 2000
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Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
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[The new target population of stroke awareness campaign: Kindergarten students ]
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Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
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Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
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Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
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