Lege Artis Medicinae

[A Reviewer’s Opinion Lying on the Street ]

BÁNFALVI Attila

MAY 02, 2018

Lege Artis Medicinae - 2018;28(03)

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Lege Artis Medicinae

[‘Bánk Bán’, our National Opera – Historical Background, Preceding Works, Variants ]

WINKLER Gábor

Lege Artis Medicinae

[The realization of public health strategies and health-screening in the light of the results of the “comprehensive health screening of Hungary 2010-2017” program]

KISS István, BARNA István, DAIKI Tenno, DANKOVICS Gergely, KÉKES Ede

[The European Healthcare Consumer Index (EHCI) 2017 of Hungary is critically low. Hungarian’s EHCI evaulation are particularly bad in obesity, in nutrition and in physical activity. The ”Comprehensive Health Screening of Hungary 2010-2020" (MÁESZ), has been designed for 10 years, and the first eight years can be considered succesfull. In 2017, 23 931 people participated in a comprehensive screening test, which results 183 655 individuals over the eight years. In this paper, the authors summarize the main achievements of 2017 of MÁESZ. The eight years of the program has been demonstrating the lack of health-conscious behavior, and the deficiencies of health care in Hungary. ]

Lege Artis Medicinae

[Everyday practice of atrial fibrillation treatment]

KISS István, BENCZÚR Béla

[The clinical importance of atrial fibrillation - the most frequent arrhythmia - is derived from the fact that it means a 5-fold risk of stroke/systemic embolism which contributes to the increased cardiovascular morbidity/mortality. Long-term oral anticoagulant therapy is a cornerstone of stroke prevention in patients with atrial fibrillation. Until recently Vitamin-K antagonists were the only available therapeutic option but its everyday use has several limitations, eg. bleeding risk, narrow therapeutic range, drug and food interactions and the need of monthly INR-control. The advent of NOAC-s may prevent a lot of difficulties regarding VKA-treatment and lead to as efficacious as and safer therapy than VKAs. These benefits can help better adherence of patients to the anticoagulant therapy which is one of the most important element of more effective stroke prevention. NOACs can be used more safely both in real life and in special patient populations (eg. elderly, type 2 diabetes, chronic kidney injury) than VKAs so they can contribute to effective cardiovascular risk reduction.]

Lege Artis Medicinae

[The role of fathers in the family therapy of eating disorders, with special regard to mosaic families]

TÚRY Ferenc, SZENTES Annamária

[Eating disorders (anorexia nervosa, bulimia nervosa) are the typical forms of modern disorders of civilization. In the therapy of young (below age of twenty years) patients the family therapy can play a decisive role. During family therapy, in the case of mosaic families (newly organized families after divorce and second marriage) it is a frequent question, which family members should be involved into the therapeutical sessions: the biological parents, or the members of the actual families. In this paper two cases are reported where mosaic families were consulted. In the family therapy the new distribution of parental roles, the strengthening of the paternal responsibility of the foster-father were crucial in the families. In both cases a full remission occurred. As a conclusion we can state that during family therapy of eating disordered patients - and supposedly in other psychosomatic disorders - in the case of mosaic families the involvement of the actual family members, and the strengthening of the parental role can be an important factor in the therapeutical efficacy.]

Lege Artis Medicinae

[A Journey of Hardships, or the Secret of a Strange Marriage – Gerda Wegener and Lili Elbe ]

GEREVICH József

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Clinical Neuroscience

[Thrombolysis in case of ischemic stroke caused by aortic dissection]

LANTOS Judit, NAGY Albert, HEGEDŰS Zoltán, BIHARI Katalin

[Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis. ]

Hungarian Radiology

[Breast core needle biopsies yielding uncertain results - Experience at the complex mammographic screening unit in Kecskemét]

AMBRÓZAY Éva, BORI Rita, LŐRINCZ Margit, LÓRÁND Katalin, CSERNI Gábor

[INTRODUCTION - On occasion core biopsies yield an inconclusive (B3 or B4) result in the triple diagnostics of breast lesions. These cases may turn to be malignant in the operation specimen. This study evaluates the value of B3 and B4 diagnoses and the consequences of these diagnoses. MATERIALS AND METHODS - Core needle biopsies were generally taken under imaging guidance with an automatic gun using G14 gauge needles. They were evaluated using internationally and nationally accepted categories from B1 to B5. The analysis was based on data collected between 2000 and March 2005. RESULTS - Of the 663 core needle biopsy specimens 31 (4.7%) were classified as B3 and 22 (3.3%) as B4. Specimens were more often fragmented in the latter category (a rate of 0.64 as compared with a rate of 0.26). Patients with a B3 diagnosis were operated on in 23 cases, eight of which turned to be malignant (0.35). B4 diagnoses were followed by operations in 21 cases and were found to be malignant on 19 occasions (0.9). Whenever a B4 diagnosis was associated with radiological findings of malignancy (category 5 on mammography and/or ultrasound) the cases unanimously proved to be malignant. The same association with B3 diagnoses yielded malignancy in a rate of only 0.67. CONCLUSION - Both B3 and B4 diagnoses represent an indication for operation. Our experience suggests that B4 diagnoses when coupled with a radiological opinion of malignancy can be candidates for definitive (therapeutic breast conserving) surgery whereas B3 diagnoses require diagnostic excisions.]

Lege Artis Medicinae

[A Street Child’s Way to the Nobel Prize]

KÖVES Péter

Lege Artis Medicinae

[Education and psychological support of parents in cases of postnatally detected Down syndrome]

MÁTÉ Orsolya, KÍVÉS Zsuzsanna, OLÁH András, FULLÉR Noémi, PAKAI Annamária

[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]

Lege Artis Medicinae

[JAK2 V617F: a new risk factor of stent thrombosis?]

PINCZÉS István, FEKETE Viktória, ZÁMOLYI Károly

[INTRODUCTION - Although the introduction of stents has dramatically improved the efficiency of percutaneous coronary interventions, a new complication, the stent thrombosis has appeared. Owing to intensive research, the incidence of this previously common complication is currently 1%. Because of the high mortality and morbidity, it is important to find more and more predictors, which might help to further reduce the incidence. CASE REPORT - Our elderly male patient presented with acute anterior myocardial infarct. Stent implantation of the left anterior descendent branch was performed using coronarography, with no complications. After five days without any symptoms, ST elevation recurred and subacute stent thrombosis was deteceted. Because of the laboratory results showing thrombocytosis, we performed JAK2 V617F screening, with a positive result. Prolonged heparin therapy, platelet aggegation inhibition at a transiently elevated dose and hydroxyurea treatment because of the myeloproliferativ malignancy were used. At the follow-up visit, the patient did not report any complaints, and cell counts for all three myeloid cell lines were in the normal range. CONCLUSION - The thrombogenic feature of the classic myeloproliferative disorders is well-known, and JAK2 V617F mutations further increase the risk. In our departement, screeing for such genetic alteration was performed in patients with stent thrombosis and a platelet count higher than 450 G/l. Two of the three cases had positive results. Supported by the literature, we think that the hematologic disease lead to the thrombotic complication in our patients. In our opinion, the JAK2 V617F is a potential risk factor of stent thrombosis.]