Lege Artis Medicinae

[A Painful Conversation of Statues ]

GEREVICH József

FEBRUARY 15, 2015

Lege Artis Medicinae - 2015;25(01-02)

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Lege Artis Medicinae

[Five-year results of „Comprehensive Health Screening of Hungary 2010-2020”]

KISS István, BARNA István, DAIKI Tenno, DANKOVICS Gergely

[The „Comprehensive Health Screening of Hungary 2010-2020” have finished the 5th jubilee season. Int he past five year the program was working succesfully as a model for the primer and secondary prevention. The results of comprehensive screening have shown caracteristic picture about the health of population, and many people received education, informations about health protection, prevention and healthy lifestyle. More than 900 places, 7 millions of filled risk queries, 112 000 people’s comprehensive screening and 250 000 counsellings are the summary of activities. Some 200 000 people received the information pack. Significant is the familiar occurence of tumors and cardiovascular diseases, that means 20% of prevalence in test subjects. We are obese, smokers, physically inactive, our health behavior is poor. The improvement of the populational health care activity is among the strategical plans of health politics, and it is badly needed based on the results of MÁESZ Program.]

Lege Artis Medicinae

[Stories of the Black Square ]

RÁCZ József

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[Barbie’s Own Life ]

TÚRY Ferenc

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[The Significance of Stress and the Body Adaptability ]

PIKÓ Bettina

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[Physician and Science 2. The Science of Schizophrenia... But Which One? ]

BÁNFALVI Attila

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[Negative pressure wound care while covid-19 pandemic: treatment of necrotizing fasciitis and retroperitoneal abscess]

ZÁDORI Gergely, SUSÁN Zsolt, TÓTH Csaba Zsigmond, TÓTH Dezső, SZENTKERESZTY Zsolt

[Necrotizing fasciitis is a rare and high mortality condition. Most commonly it is spreading in the extremi­ties, abdominal wall soft tissues and perineal region, but occurs rarely in the retroperitoneal space too. Primary treatment is debridement with administered antibiotics, supported by negative pressure wound care. The present case report concerns a successful treatment of an extensive necrotizing fasciitis spreading from the hip region and ending up in a retroperitoneal abscess. A gradually increasing, painful, ulcerated swelling developed in the patient’s right hip region. On the first examination, elevated laboratory markers of inflammation were identified while the necrotizing lesion raised concerns of sarcomatic background. Initially, we started antibiotics and took tissue samples. The prompt CT scan confirmed a large abscess complex involving also the retroperitoneal space. The surgical exploration verified a typical necrotizing fasciitis and after removing debridement negative pressure wound care was started. After 14 days of this treatment the patient recovered successfully. Negative pressure wound therapy is pivotal in the treatment of necrotizing fasciitis. The number of wound dressings and of medical staff – patient contacts can be significantly reduced by this me­thod. It has a major advantage in the COVID-19 pandemic, since minimalizing close contacts is of vital importance in controlling the spread of the virus.]

Clinical Neuroscience

Case report of a woman with anti amphiphysin positive stiff person syndrome

FABÓ Dániel, BOROS Erzsébet, KAMONDI Anita, DÉNES Zoltán, ERÕSS Loránd, BOKOR Magdolna, MANHALTER Nóra, GYÖRFI Orsolya, FAZEKAS Ferenc

Stiff person syndrome is a rare neuroimmunological disease, characterized by severe, involuntary stiffness with superimposed painful muscle spasms, which are worsened by external stimuli. The classical form is associated with high levels of antibodies against glutamic acid decarboxylase. One of the variant forms is associated with antibodies against amphiphysin. This entity is a paraneoplastic syndrome, caused primarily by breast cancer, secondarily by lung cancer. Symptomatic therapy of anti amphiphysin positive stiff person syndrome includes treatment with benzodiazepines and baclofen (including intrathecal baclofen therapy). The effect of immunological therapies is controversial. Treatment of the underlying cancer may be very effective. In this report, we describe a 68 year old female presenting with an unusally rapidly developing anti amphiphysin positive stiff person syndrome, which was associated with breast cancer. Her painful spasms abolished after intrathecal baclofen treatment was initiated. Her condition improved spontaneously and significantly after cancer treatment, which enabled to start her complex rehabilitation and the simultaneous dose reduction of the intrathecal baclofen. The bedridden patient improved to using a rollator walker and the baclofen pump could be removed 18 monthes after breast surgery. This highlights the importance of cancer screening and treatment in anti amphiphysin positive stiff person syndrome cases.

Lege Artis Medicinae

[50 years of tolperisone in clinical practice]

BÁLINT Géza

[Tolperisone is a centrally acting muscle relaxant that has both antispasticity and antispasmodic properties, but lacks the sedative effect of other muscle relaxants. In the past 50 years, millions of patients with spasticity due to neurological diseases and painful reflex muscle spasm have been treated with this drug. Although few welldesigned, double blind, controlled clinical trials have been published, the efficacy of tolperisone in the treatment of both spasticity and painful reflex muscle spasm is convincing. The tolerability and safety of the drug are well documented. In this respect, one of its greatest advantages is that it has no sedative effect, does not lengthen reaction time, and does not interfere with driving. Further, well-designed controlled trials are clearly required for widening the use of this excellent drug.]

Clinical Neuroscience

Burning mouth syndrome: Evaluation of clinical and laboratory findings

HALAC Gulistan, TEKTURK Pinar, EROGLU Saliha, CIKRIKCIOGLU Ali Mehmet, CIMENDUR Ozlem, KILIC Elif, ASIL Talip

Background and purpose - Burning mouth syndrome is a chronic and persistent painful condition characterized by burning sensation in the oral mucosa. We investigated the etiological factors of patients presented with the history of burning in the mouth who admitted our outpatient clinics over the 8-years period and who had no underlying identifiable local factors. We also tried to determine their demographic and clinical characteristics. Our aim was to investigate the association between burning mouth and psychiatric disorders such as depression and anxiety, chronic diseases like diabetes mellitus (DM) and other laboratory studies in patients complaining of solely burning in the mouth. Methods - The study included patients with the history of burning in mouth who presented in our outpatient clinic between 2005 and 2012. They were evaluated by a neurologist, a psychiatrist, an internist, and a dentist. Complete blood counts, biochemical analysis and cranial magnetic resonance imaging (MRI) were performed for all patients. Results - A total of 26 (22 (84%) females, 4 (15%) males; mean age 55.9 years) patients were enrolled in this study. Five (19.2%) of the patients had depression, 2 (7.7%) had anxiety disorder, 2 (7.7%) had diabetes mellitus, 8 (30%) had B12 vitamin deficiency, 3 (11.5%) had decreased ferritin levels in blood, and 1 (3.8%) had folic acid deficiency. Cranial MRI of all patients were normal. Nine patients (34.6%) had no etiological causes. Conclusion - A multidisciplinary approach in the management of burning mouth and establishment of common criteria for the diagnosis would provide insight into the underlying pathophysiological mechanism.

Clinical Neuroscience

[The quality of life of the cluster headache patients during the active phase of the headache]

ERTSEY Csaba, BOZSIK György, GYÜRE Tamás, CSÉPÁNY Éva, BALOGH Eszter, MAGYAR Máté, DIÓSSY Mária

[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]