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Lege Artis Medicinae - 2000;10(06)
Content
Lege Artis Medicinae
JUNE 01, 2000
[Infectiosus diseases - Past, present, future]
[The complex interactions between microorganisms and humans include the well known, traditional infectious diseases and also the symbiotic relationship with the human endogenous normal flora. Forty years ago everybody was convinced that medicine would soon be able to eradicate most of the infectious diseases. Perception of victory over infectious diseases has been blunted in recent years by nosocomial infections and by the new and re-emerging diseases. The spectrum of infectious diseases is expanding and many of those once thought conquered are increasing in numbers. Moreover, the problems of infection are present in all aspects of medicine and with the field turning more and more complex its challenge for practitioners has become increasingly demanding. It is now clear, that at the dawn of the new millennium infectious disease remains the number one killer in the world. ]
Lege Artis Medicinae
JUNE 01, 2000
[Practical aspects of screening for microalbuminuria in diabetic patients]
[INTRODUCTION - The importance of measuring microalbuminuria is well established, however, controversy still exists regarding the type of urine specimen to be used for detecting early renal impairment of diabetic patients. PATIENTS AND METHODS – To evaluate practical aspects, albumin concentration and albumin to creatinine ratio of first void urine samples as well as urinary albumin excretion in timed specimens were determined by immunoturbidimetric method 3 times within 3 weeks in 192 adult diabetic patients (136 men, 56 women; type 1/type 2: 90/102; age: 51.4=10.8 years; duration of diabetes: 15.3+9.1 years; body mass index: 27.9+4.6 kg/m2; HbA1c: 8.5+1.5 %; actual blood pressure: 13814/82+8 mmHg; serum creatinine: 94+20 umol/l; x+SD). RESULTS - According to the urinary albumin excretion values, one third of patients (31.2%-30.7%-34.4%) were normoalbuminuric (<30 mg/24 hours), more than half of the patients (55.8%-57.3%-53.6%) proved to be microalbuminuric (30-300 mg/24 hours), while the remaining group of patients (13.0%-12.0%–12.0%) was macroalbuminuric (>300 mg/24 hours). Comparing the results of successive measurements good correlation was found between the same laboratory values (urinary albumin excretion: K=0.64; K=0.67; urinary albumin concentration: K=0.60; K=0.62; albumin to creatinine ratio: K=0.54; K=0.61; first vs. second and second vs. third measurements, respectively). The percentage of patients being in the same range of albuminuria (i.e. normo-, micro-or macroalbuminuria) at successive measurements was 79.7-81.2% with urinary albumin excretion values, 77.1-77.6% with urinary albumin concentration and 74.5-78.6% with albumin to creatinine ratio. Good correlations were found between urinary albumin excretion and urinary albumin concentration (K=0.54; 0.54; 0.57) and nearly the same correlations were observed between urinary albumin excretion and albumin to creatinine ratio (K=0.49; 0.47;0.54) at different series. Using values of urinary albumin excretion for comparison at all measurements, 79.3% sensitivity and 69.5% specifity were found for urinary albumin concentration whereas 74.6% sensitivity and 68.8% specifity were documented for albumin to creatinine ratio. CONCLUSION - Beside the standard measurement of urinary albumin excretion in timed urine samples, the use of the more convenient morning urinary spot collection could also provide useful results (urinary albumin concentration or albumin to creatinine ratio) for detecting early renal involvement in diabetic patients. ]
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
[Postnatal development of the human hippocampal formation]
[Jean Piaget's theory suggests that cognitive development proceeds in discrete steps. The first is the sensorimotor period that happens in the first two years of life. In recent years it became clear, that it is necessary to have an intact and mature hippocampus for adequate memory formation, both in experimental animals and humans. In the present study, the morphological development of the human hip pocampus was correlated with the developmental changes of intellectual development. Our results suggest that neuronal cell formation of the human hippocampus terminates several weeks before birth. In the dentate gyrus, a small number (less than 1%) of granule cells are still formed around birth. Immature granule cells migrate through the hilar region to their final position in the granule cell layer during the first six postnatal months. Light microscope studies of individual neurons indicate that connections between granule cells and their target neurons are not yet formed at birth. Such connections develop during the third postnatal year. If the development of the synaptic connections is damaged in experimental animals, the hippocampal function will be permanently impaired. Newborns may have basic synaptic circuits for memory formation, but the postnatal morphological changes suggest the significant modification of the hippocampal circuits happening continuously from the newborn age until late childhood. These changes may cause the phenomenon of the "infantile amnesia". ]
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
[Pathophysiology of myocardial ischemia and reperfusion]
[Complete and long lasting loss of coronary circulation results in myocardial cell death (ischemic necrosis). Short lasting ischemia (few minutes) is well tolerated and it may bring certain protection against recurrent ischemia (ischemic preconditioning). Contractile force promptly diminishes following the onset of ischemia and the changes in the intracellular ATP or Ca2+ concentration do not explain this phenomenon. With the progression of ischemia, myocardial relaxation ceases and hypertonic muscle activation appears (ischemic contracture). During myocardial reperfusion following short-term ischemia, arrhythmias often develop and pump function is regularly depressed transiently (myocardial stunning). Permanent reduction in coronary blood supply results in sustained ventricular dysfunction (hibernation). It has been established, that pathologic processes leading to ischemic injury are distinct from those of reperfusion injury. Cellular events are complicated (Ca2+-overload, free radical injuries, activation of proteolytic processes, energy loss, membrane damage, hypercontracture, etc.), and complete understanding of the background of ischemic/reperfusion disorders is still awaited. ]
Lege Artis Medicinae
JUNE 01, 2000
[Cardiovascular risk management ]
[Recent success in the management of cardio vascular disease does not render prevention unimportant, rather emphasizes its importance. The process of prevention begins with setting the priorities, followed by determination of the risk of the patient based on clinical data. Life style, laboratory results and signs of subclinical atherosclerosis have great impact on the combined multifactorial risk. Professional advice to lifestyle modification can significantly reduce the risk. Additionally, adequate treatment of hypertension, diabetes mellitus and cholesterol abnormalities serve as preventive procedures, as well as the necessary coronary intervention and revascularization. Longer life expectancy, as the result of prevention, has both social and financial benefit. This result can only be expected after the required investment. ]
Lege Artis Medicinae
JUNE 01, 2000
[ Report on gastroenterological endoscopic activity in Hungary in 1999]
[ The Endoscopic Section of the Hungarian Gastroenterological Society has been monitoring the development of endoscopic activity in Hungary for a quarter of a century. [See LAM 1990; 1 (3): 180-81 and 1999; 9 (7-8): 574-6). So far, we have found a consistent increase in test numbers (1975: 24 379, 1980: 60 043, 1985: 112 367, 1990: 203 675, 1995: 293934) from year to year. 1999 was the first year in which, despite the industrial, large-scale upswing of some centers, the number of endoscopic examinations declined nationally.]
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
[Gratitude money in Hungarian healthcare; Formation and legal situation]
[The most interesting and most controversial part of the Thanksgiving Committee was written by György Ádám, a lawyer and the author of several books dealing with the phenomenon of parasolvency. The theoretical goal is to establish a legally free contractual relationship in the doctor-patient relationship in the foreseeable future. He adds that this has never been achieved in Hungary, as the development of medical incomes in the 18th century. they have been moving in a forced orbit since the end of the century. The Austro-Hungarian Monarchy, the Horthy system, and the post-1945 coalition period were not conducive to private medical practice in various ways either, so the formation of gratitude money is not only a harmful consequence of those 40 years.]
Lege Artis Medicinae
JUNE 01, 2000
[ Relationship between suicidal ideation and health status among young women]
[Extreme cases of seeking medical attention are well known: some patients often and unnecessarily visit their doctor with even the slightest complaints, their symptoms are closely monitored and overestimated, while others are characterized by neglect of their health, lack of perception of symptoms, and their elimination. The perception and classification of bodily processes and symptoms, and within this, the self-assessment of health status are related to many factors: it is closely related to cognitive patterns, culture, personality traits, knowledge, current emotional states, and realistic illnesses.]
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
Lege Artis Medicinae
JUNE 01, 2000
[ The Hungarian Diabetes Society XV. Congress]
[According to the traditions of the Hungarian Diabetes Society, the congress is held every two years; this year, April 13-16. The venue of the event was Club Tihany. The host of the Congress did an excellent job of organizing; Thanks to the chief physician of the Internal Medicine and Diabetes Center of the Ferenc Csolnoky Hospital of Veszprém County, Győző Vándorfi and his colleagues, the event was held at a high standard and smoothly in terms of both scientific and social programs.]
Lege Artis Medicinae
JUNE 01, 2000
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
21. MAY
2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]
21. MAY
3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
27. NOV
4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
27. SEP
5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
1.
2.
Clinical Oncology
[Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up]
29. AUG
3.
Clinical Oncology
[Pharmacovigilance landscape – Lessons from the past and opportunities for future]
29. AUG
4.
5.