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Lege Artis Medicinae - 2004;14(08-09)
Content
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
[RISKS AND BENEFITS OF MEDICATION IN PREGNANT WOMEN]
[The Hungarian Case-Control Surveillance System of Congenital Abnormalities can provide appropriate data for the evaluation of risk and benefits of drugs and pregnancy supplements in pregnant women. Among the main principles, the importance of time factor (the first trimester concept is outdated) and the explanation of frequent false teratogenic findings (e.g. recall bias, chance effect, etc.) are discussed. The main conclusion is that at present the exaggerated teratogenic risk of drugs is much more harmful for the fetus than the rare teratogenic effect of some drugs themselves. Medical doctors and other experts therefore need more education to know the principles and findings of modern human teratology because it may help us to have a better balance between the risks and benefits of drug use during pregnancy. On the other hand, the primary prevention of neural-tube defects and some other congenital abnormalities is demonstrated by periconceptional folic acid or folic acid-containing multivitamin supplementation. Unfortunately, this new method is used rarely and inappropriately (due to the late onset of supplementation) in Hungary.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
[FIXED-COMBINATION THERAPY IN ANTIHYPERTENSIVE TREATMENT]
[Target blood pressure and reduction in cardiovascular morbidity and mortality have to be accomplished always with the consideration of target organ lesion. Fixed-combination antihypertensive therapy has become accepted based on the recommendations of international and Hungarian medical associations that are aware of the results of evidence based medicine. The fix combinational treatment is more favorable for patients’ compliance. The daily dosage of drugs with 24 hour effect improves the patients’ cooperativeness. During fix combinational treatment higher efficiency, smaller dose and fewer side effects were observed. In combination, the effects of the drugs on blood pressure are additive without any increase in adverse effects. Last, but not least the cost of drugs of fixed combination are lower than buying the drugs separately. After careful consideration the fixed combination therapy can be recommended to the everyday practice.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
[CHRONIC LYMPHOEDEMA - PREVENTION AND TREATMENT]
[The congenital or acquired damage of the lymphatic system can lead to the increase of the interstitial fluid in the affected extremity which can lead to chronic lymphoedema. Congenital lymphoedema is relatively rare. The interest in chronic lymphoedema is relatively high as the frequency of tumours is increasing (with surgical and irradiation therapy in the background) and of the growing numbers of the secondary lymphoedema cases due to chronic venous insufficiency in the extremities. The diagnosis and early treatment of the disease is important because the illness without therapy can be progressive and lead in severe complications, such as permanent disability of the patient. In the last 10-15 years the conservative therapy protocol of chronic lymphoedema has been introduced in Hungary and the necessary appliances are financed by the National Health Service (OEP). However, it is unfortunate that there are not enough lymphoedemic centres and patients often visit the outpatient departments only after the advice of a fellow-patient. These days, a great proportion of the patients are without treatment and in many cases the therapy can only concentrate for the prevention of the complications.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
[THE VASCULAR BACKGROUND OF ERECTILE DYSFUNCTION]
[With the new era of the medicaments, erectile dysfunction has become of great interest among sexual problems. Earlier, psychogenic origin was thought to be the main background, but today vasculogenetic reasons are have become equally important factors. Experimental data and clinical investigations demonstrate that erectile dysfunction is part and consequence of the same vascular process which is observed in aging and in atherosclerotic processes of the well-known arterial localisations (coronary arteries, cerebral arteries etc.). It was also common previously to associate erectile dysfunction with obliterative atherosclerotic disease but today endothel dysfunction, vascular remodelling and atherosclerosis are thought to be main pathogenetic factors affecting the whole arterial vascular system causing erectile dysfunction. Classic risk factors can also be observed in these patients, such as hypertension, dyslipidaemia, smoking and diabetes. Neurogenic factors are also involved in the development of erectile dysfunction. Based on this, erectile dysfunction is considered as the predictor of cardiovascular diseases preceding the general manifestation of the disease by 2-3 years.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
[BASICS OF MRI MAGNETIC RESONANCE IMAGING]
[Magnetic resonance imaging (MRI) is a young, developing technology used to create images with extraordinary detail of body tissue or the brain by applying nuclear magnetic resonance phenomena. The MRI technique uses a pulse of radio-frequency energy to excite the hydrogen nuclei, the protons. The distribution of hydrogen nuclei of water and fat in the body depends on the tissue type and whether or not the tissue is healthy or diseased. The image brightness is a complex function of properties in the region of interest, which include parameters of protons density and the relaxation times of the protons. Manipulating these properties is accomplished by varying the experiment (pulse sequence) used at the time of examination to yield images that contains different contrast. Although MRI is normally a noninvasive technique, contrast agents can be administered to a subject to enhance a region of interest. There are now more than 22,000 MR systems in use worldwide. MR is one of the best diagnostic exams for imaging many types of soft-tissue including: the brain, the spine, the heart, aorta and coronary arteries, the organs of the upper abdomen and the pelvis as well as the joints.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
[FACTORS INFLUENCING ADOLESCENT BLOOD PRESSURE - THE DEBRECEN HYPERTENSION STUDY]
[INTRODUCTION - The aim of the study was to obtain epidemiological data on the blood pressure (BP) status of high school students and familiar, constitutional and lifestyle factors influencing their blood pressure. METHODS - After a 10 minutes rest, three repeated BP measurements were taken from the right upper arm, separated by 5 minute intervals. All measurements were obtained by a validated, automated, digital OMRON M4 device. A total sample of 10 194 high school students from Debrecen, included 5163 boys and 5031 girls, whose average age was 16.55±0.99 years. RESULTS - Boys had a significantly higher BP than girls (122.51±13.47/69.58±8.92 mmHg vs. 111.24±12.5/67.41±8.92 mmHg) (p<0.001). There was a positive correlation between weight and BP (rsyst =0.42, rdiast =0.286; p<0.001), height and BP (rsyst =0.326, rdiast =0.145; p<0.001), but not between the age and BP. Subjects whose father had hypertension differed significantly from controls’ BP (p<0.001). If the mother was considered being hypertensive only the diastolic BP differed. Subjects with low birth weight (<2500 grams) in the history had significantly greater systolic (p<0.002), but not diastolic BP than those weighting >2500 grams at birth. Subjects smoking, consuming alcohol, living a stressful life, eating salty foods, or doing regular workout did not differ in terms of both systolic and diastolic BP in our sample. CONCLUSIONS - Significant positive associations were found between BP and height and weight, with a stronger relationship to systolic BP. The males’ BP exceeded the females’ values, while those having hypertension in their family history or low birth weight had also higher BP.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
[RARE UTERINE MALIGNANCY: THE ENDOMETRIAL ADENOSARCOMA]
[INTRODUCTION - Müllerian adenosarcoma is typically composed of benign glandular epithelial elements admixed with malignant sarcomatous stroma. This rare tumour usually originates in the endometrium and grows as a polypoid mass into the endometrial cavity. CASE REPORT - We report the case of a woman aged 32, who presented with abnormal vaginal bleeding and was diagnosed with an adenosarcoma after a curettage and subsequent hysterectomy. CONCLUSION - This tumour has a relatively good prognosis among the mixed mesenchymal sarcomas of the uterus and the majority of patients with this neoplasm survive. The gynecologists and pathologists should be aware of this entity and discuss the risks and benefits of radiation and chemotherapy, which is usually indicated for malignant diseases.]
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
Lege Artis Medicinae
SEPTEMBER 18, 2004
[THE PUBLIC OPINION ON ORGAN DONATION IN HUNGARY]
[INTRODUCTION - The aim of this study was to explore the common knowledge and the opinion of the Hungarian population on organ transplants as part of a larger international study about the reception of new achievements in biotechnology and medical science. METHODS - The basis of the study was a representative national survey conducted in 2003 on a sample of 1000 people. We analysed the significant differences in the attitudes towards organ donation using the background variables of gender, age, education, family situation, place of residence, self-rated health and religious beliefs. To explain the differences in the willingness to donate we applied the method of binomial regression. Logistic regression was used to analyse the strength and direction of the linear relationship between dependent and predictor variables. The probability of willingness in a given group was represented by odds ratios. RESULTS - The respondents’ knowledge level differed by gender, age and education. The greater part of the population was not knowledgeable about the legal regulations concerning the transplantation of cadaver organs but after they were properly informed they agreed with the regulations. The odds of the motivation to donate organs after death differed significantly by age, education, family situation and self-rated health. The motivation to be living donors was influenced by age, place of residence and the level of altruism. CONCLUSION - The concerns expressed on the decrease of donation willingness due to the increase of the knowledge level of the population seem to be unfounded.]
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