Lege Artis Medicinae

[About the same thing elsewhere, in a different tone]


JUNE 30, 1992

Lege Artis Medicinae - 1992;2(06)

[It was a gesture of thanks and appreciation that a few days after the publication of the 1992/6 regulation on general practitioners, senior staff from the Ministry of Public Welfare and the OTF presented and discussed it with their colleagues at the LAM Club. Naturally, this was done only after the regulation had been published. They did not receive the same recognition and thanks when they made the same gesture to their colleagues sitting as Members of Parliament in the Committee on Social Affairs and Health. ]



Further articles in this publication

Lege Artis Medicinae

[Immunological aspects of granuloma formation]

DANKÓ Katalin, SZEGEDI Gyula

[The process of inflammation can be classified as acute, subacute and chronic, as well as the special category of granulomatous inflammation. Classification of granulomatous inflammation based on morphologic criteria. These are epitheloid, histiocytic, foreign-body, necrobiotic and mixed inflammatory granuloma. The current knowledge suggests the following sequences for the mechanisms of granuloma formation in sarcoidosis (Fig 2): 1. T-cells are locally activated and proliferating 2. These activated T-cells release lymphokines that recruit and activate monocytes/macrophages 3. These activated monocytes/macrophages may differentiate into granuloma cells such as epithelioids cells and multinucleated giant cells and release pro-inflammatory profibrotic mediators that modulate the granulomatous and fibrotic process. It is hoped that further studies in sarcoidosis will help not only in clarifying the pathogenic mechanisms leading to granuloma formation, but also in eventually revealing the etiology of sarcoidosis. ]

Lege Artis Medicinae

[Transvaginal ultrasound examination of embryo development in early pregnancy (sono-embryology) II. central nervous system]

CSABAY László, SZABÓ István, NÉMET János, PAPP Zoltán

[In the second part of their paper, the authors look over the most important phases of the development of the central nervous system during the first trimester of pregnancy - especially considering the stages, which can be differentiated with a high resolution transvaginal transducer. The closed neural tube is developing at days 40 to 44 by the closure of the posterior neuropore, however at this time no brain structures can be detected by ultrasound. During the 7th week the three primary brain vesicles (prosencephalon, metencepha lon, myelencephalon) can be identified – a single ventricle can be seen by ultrasound. During the 8th week the secondary brain vesicles (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon) can be separated. During the 9th week the lateral ventricles are filled out by the choroid plexus, which are retracted to the occipital horn by the 13th week. The appearance of the brain structures also takes place according to an accurate „calendar". The structures recognized by ultrasound can be compared to those of the central nervous system known from embryology. The problem of the primary prevention of the cerebrospinal malformations, which are among the most frequent congenital disorders, is not yet solved; therefore the early prenatal diagnosis of the structural anomalies has great importance. ]

Lege Artis Medicinae

[Laparoscopic varicocelectomy]

HOLMAN Endre, TÓTH Csaba, PÁSZTOR Imre, FICSÓR Ervin, PAPP Ferenc

[ With the spreading use of the laparoscope in the urological surgery laparoscopic varicocelectomy may become an alternative treatment of varicocele. The method can be advantageous mainly for patients with bilateral cases compared to the open operation. The authors report on two cases that have been the first urological laparoscopic operations in Hungary.]

Lege Artis Medicinae

[Vascular surgical aspects of small bowel ischaemia]

DÓBI István

[A brief account is given of acute and chronic diseases underlying the disorders of blood supply to the small bowel. In cases of acute disorders, considering the diagnostic difficulties involved, the author stresses the importance of commencing of a vasodilatator treatment immediately after the tentative diagnosis has been reached based on the first suspicious symptomes, and also requiring angiography to render the accurate diagnosis. This is the only possibility to increase (without irreversible tissue damages) the number of successful early vascular reconstructions which are the prerequisites to reducing in lethality. Finally, based on his own extensive experimental work, the author proposes to make allowances for the augmented local postischaemic vasoconstrictor trends of vascular reactivity in the complex therapeutic regimen of these diseases. ]

Lege Artis Medicinae

[Cardiovascular effects of sleep-related breathing disorders, a review]

VÁRDI Visy Katalin

[The acute and chronic cardiovascular effects of sleep related breathing disorders are summarized in this review. Obstructive sleep apnoea syndrome is characterized by recurrent upper airway collapse during inspiration. The resulting asphyxia causes hypoxia and arousal. The vigorous inspiratory efforts produce falls in blood pressure coinciding with each effort (pulsus paradoxus). A rise in blood pressure is seen concurrently with each termination of apnoea and arousal. Bradycardia induced by hypoxia in each obstructive period and increased frequency at time of arousals could lead to arrhythmias. This may result in a high prevalence of hypertension, acute myocardial infarction and arrhythmias in sufferers of obstructive sleep apnoea syndrome have. ]

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]


[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]