Lege Artis Medicinae

[ACTION ]

MATOS Lajos

NOVEMBER 21, 2004

Lege Artis Medicinae - 2004;14(11)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Analgesic nephropathy in Hungary: the HANS study]

PINTÉR István, MÁTYUS János, CZÉGÁNY Zoltán, HARSÁNYI Judit, HOMOKI Marietta, KASSAI Miklós, KISS Éva, LADÁNYI Erzsébet, LŐCSEY Lajos, MAJOR Lajos, MISZ Mihály, NAGY Lajos, POLNER Kálmán, RÉDL Jen

Lege Artis Medicinae

[The 46th Congress of the Hungarian Society of Gastroenterology]

ABONYI Margit

Lege Artis Medicinae

[BENIGN SOLITER FIBROTIC TUMOR OF THE PLEURA - A CASE REPORT]

BOHÁCS Anikó, TAMÁSI Lilla, SOMOSKÖVI Ákos, MÉSZÁROS Zsolt, SÁPI Zoltán, BÁRTFAI Zoltán

[INTRODUCTION - Rare asymptomatic pleuropulmonary neoplasms can represent serious differencial diagnostic difficulties both for clinicans and pathologists. Immunohistochemical tests are essential tools for the diagnosis of soliter fibrotic tumor of the pleura. These tests are also of diagnostic and prognostic importance. CASE REPORT - The report summarizes the case of an asymptomatic 63 years old man. The patient was admitted to hospital with a parahilar infiltrate of the right lung. Based on this chest X-ray abnormality pulmonary malignancy was suspected. The patient was referred to surgical intervention and the diagnosis of was based on post-surgical histology. These fibrotic tumors have typical immunohistochemical features. Although the histomorphology of the tumor suggested the presence of a benign tumor the p53 positivity and focal CD34 positivity indicated the possibility of malignant transformation as well. The patient is alive 17 months after surgery and there is no relapse of the disease. CONCLUSION - Although histologically benign, soliter fibrotic tumors of the pleura may occasionally transform into malignant variants. Therefore complete surgical resection and longterm clinical and close radiological follow-up is recommended for these patients. Clinician can plan well ahead the frequency and time of the follow-up with the help of the prognostic factors of hystology.]

Lege Artis Medicinae

[PHYSICAL AND PSYCHOLOGICAL CONDITION OF HEALTH CARE WORKERS DEALING WITH THE SERIOUSLY ILL]

HEGEDÛS Katalin, RISKÓ Ágnes, MÉSZÁROS Eszter

[INTRODUCTION - Health care professionals undertaking treatment/nursing of the seriously ill are equally overburdened emotionally, intellectually and physically. This condition might have several, sometimes irreversible negative consequences: avowed difficulties within the communication with patients, families and colleagues, various harms of accumulating, unprocessed stress, severe physical and psychological symptoms of mental burn-out which is very frequent and failures and difficulties of the private life. In our survey we aimed to gain a realistic image of the physical and psychological condition and quality of life of professionals working in Hungarian clinical care in order to provide with indelayable help. METHODS - The basis of the survey was a version of the Hungarostudy 2002 questionnaire, modified for health care professionals. In our sample there were 200 health care professionals dealing with seriously ill and in the control groups 1356 non health care professionals, and 227 health care professionals, choosen from the Hungarostudy survey. In all three groups the proportion of gender, age and education were the same. The results were analysed by the SPSS 10.0 statistical program and the relationship analysis was completed by ANOVA test. RESULTS - The analysis of the answers of those attending in our questionnaire survey - compared to those working in other health care field and to the control group of non health care workers - proves that the ratio of exhaustion and stress-dependent physical and psychological symptoms are prominently, in many cases significantly higher among health care workers dealing with the seriously ill, addiction is more frequent and social net is more unfavourable. These data are even worse for nurses than for doctors and other graduates. CONCLUSION - In treating difficult cases we can start to help with special education that should be general both in gradual and postgradual training.]

Lege Artis Medicinae

[THE ROLE OF ORAL ANTIDIABETIC AGENTS AND ACE INHIBITORS IN THE PREVENTION OF TYPE 2 DIABETES MELLITUS]

KEMPLER Péter

[Nowadays Type 2 diabetes is considered as a cardiovascular disease,. The cause of death among 80% of people with Type 2 diabetes is of cardiovascular origin, with the most common cause of death of myocardial infarction. Optimal solution would be the prevention of the disease and there are also some possibilities for intervention. The present paper summarises the role of antidiabetic agents and ACE inhibitors in the prevention of Type 2 diabetes mellitus. The incidence rate of Type 2 diabetes decreased by 36% using acarbose in the STOP NIDDM Trial and by 31% using metformin in the Diabetes Prevention Program. The rate of risk reduction regarding the incidence of Type 2 diabetes during the ALLHAT Study compared the subjects treated with thiazid diuretics among those treated with amlodipine was 25% by the end of the second year and 16% by the end of the fourth year, while the corresponding data for patients treated with lisinopril were 40% and 30%, respectively. The action of lisinopril on the better bioavailability of Insulin like growth factor I. (IGF-I) probably contributes to the beneficial effect of lisinopril on insulin sensitivity.]

All articles in the issue

Related contents

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

[Transcranial direct current stimulation in neuroscientific researches – pitfalls and solutions]

PESTHY Orsolya, JANACSEK Karolina, NÉMETH Dezső

[Transcranial direct current stimulation (tDCS) is a promising brain stimulation tool which is non-invasive, easy to use and relatively cheap. Since it can change brain activity in a temporal manner, it can contribute to both clinical practice and neuroscientific research. However, the effectiveness of tDCS has been questioned considering the lack of full understanding of its mechanism of action and the seemingly contradictory results. In this review, we aim to provide a summary of potential problems and possible solutions. Our main focus is on the inter-individual differences in the effect of tDCS which can explain the noisy data, thus, controlling for them is important in order to show reliable results. This review is hoped to contribute to maximizing the potential of tDCS by helping future researchers to design replicable studies.]

Clinical Neuroscience

[Current questions of multiple sclerosis: the secunder progressive form of the disease]

VÉCSEI László

[Recent data suggest that long-term worsening is common in relapsing-remitting multiple sclerosis patients and is largely independent of relapses or new lesion formation on brain MRI. The current definition of secunder progressive multiple sclerosis is worsening of disability independent of relapses over at least 6-month interval. Early focal inflammatory disease activity and spinal cord lesion are predictors of very-long term disease outcomes in relapse - onset multiple sclerosis. The potential of PET imaging to visualize hidden inflammation in MS brain in vivo is an important contribution for better understanding the progression of the disease. Therefore, PET imaging is a promising tool in detecting the conversion from relapsing remitting multiple sclerosis to secunder progressive form of multiple sclerosis. Furthermore, neuro-axonal damage is the pathological substrate of permanent disability in different neurological disorders including multiple sclerosis. The neurofilament proteins have promise in this context because their levels rise upon neuro-axonal damage not only in the cerebrospinal fluid but also in blood. Patients with increased serum levels of neurofilament at baseline, independent of other clinical and MRI variables, experience significantly more brain and spinal cord volume loss over 2 years and 5 years of follow-up. The kynurenine-pathway abnormalities may be associated with the swich from early-mild stage multiple sclerosis to debilitating progressive forms of the disease. Analysis of these metabolites in serum may have application as multiple sclerosis disease biomarkers. Free radical action has been suggested as a causal factor in the illness. Increased free radical production and consumption of the scavenger molecules were found during the active phase of the disease. Based on the clinical findings (EXPAND Study) and pathomechanism of the disease siponimod is approved by the US Food and Drug Administration for the treatment of relapsing remitting forms of multiple sclerosis, to include secunder progressive multiple sclerosis with active disease, relapsing-remitting multiple sclerosis and clinically isolated syndrome.]

Clinical Neuroscience

[Valproate in the treatment of epilepsy and status epilepticus]

JANSZKY József, TÉNYI Dalma, BÓNÉ Beáta

[According to Hungarian guidelines, valproate - with the exception of infants and small children as well as fertile women - is the first drug of choice in generalized and unclassified epilepsies because it is effective in most seizure types and epilepsy syndromes. It is highly effective in juvenile myoclonic epilepsy. Even though it is not the first-line drug in focal epilepsies, if the first-line therapy is ineffective, it is a plausible alternative as second choice therapy, owing to its different mechanism of action. If the type of epilepsy can’t be surely established, valproate is the drug of choice, as it possesses the broadest-spectrum among antiepileptic drugs. After administration of benzodiazepines, intravenously applied valproate can be a first choice therapy in all types of status epilepticus, owing to its broad-spectrum and efficacy. Valproate is the first-choice therapy in patients with glioblastoma - independently of the seizure type -, as it is likely to improve the survival rate with 2-10 months and the effectivity of chemo- and radiotherapy. Valproate is generally not suggested for fertile women, but - as it is the most effective therapy in some epilepsy syndromes -, the patient has the right to choose valproate therapy, thus undertaking the elevated risk of developmental abnormalities, for higher safety regarding seizures. If only valproate therapy owns the ability to obtain seizure freedom, then stopping its administration is not suggested, but a low dosage has to be aimed (500-600 mg/day, but not more than 1000 mg/day): according to some studies, most idiopathic generalized epilepsies can be controlled by low valproate dosage. Stopping valproate therapy in case of an ongoing pregnancy is not suggested. ]

Lege Artis Medicinae

[Treatment options for localized and widespread post-COVID pain]

VERECKEI Edit

[Data on the new coronavirus caused di­s­ease and its treatment have been accumulating for more than a year. There are four main disease courses: no or mild symp­toms, unavoidable hospitalisation, severe or lethal outcome, and permanent or post-hoc manifestations. The last course is usually referred to as post-COVID syndrome. As a part of the acute and post-COVID symptomatology there were published pain perceptions with frequent but heterogeneous localisation. It is practical to classify them by the origin of pain: nociceptive/inflammatory, peripheral neuropathic or central. Additionally, we have to clear which phase is the post-COVID patient in i.e. the patient has the prolonged COVID- or persistent post-COVID syndrome. However, in addition to an acute general inflammatory reaction, a true inflammation of joints and muscles is very rare in the musculoskeletal system. The diffuse musculoskeletal pain, chronic fatigue, generalised anxiety and depressive disposition manifest themselves in both acute and persistent forms. Their explanation is essentially of neurological nature: there are para-infectious “neuro-inflammation”, i.e. neuropathic and central mechanisms in the background. Accor­ding­ly, therapeutic options must be chosen while concerning the neuropharmacological action mechanisms of analgesics. El­derly patients at high iatrogenic risk and with multiple co-morbidities may be treated transdermal instead of oral drug administration.]