Lege Artis Medicinae

[Alcoholism: a national habit or a national disease?]

NÉMETH István

OCTOBER 27, 1993

Lege Artis Medicinae - 1993;3(10)

[Johan van Beverwijck, the eminent Dordrecht physician and theoretician, published in 1636 in his "Schat der gezondheid" (The Treasure of Health), he wrote a chapter on the harmful effects and dangers of excessive alcohol consumption and drunkenness. The author of this handbook, which was intended for a general audience and acted as a kind of health advisory, did not devote such special attention to the issue by accident, since, according to numerous contemporary sources, the Dutch citizens of the 17th century were very careful about their drinking. ]

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Lege Artis Medicinae

[The surgical treatment of shoulder instability]

BÁLVÁNYOSSY Péter

[The author briefly reviews the static and dynamic stabilizing system and the biomechanics of the shoulder and describes his principles and techniques of the surgical treatment of instability. A modified Bankart procedure is used for recurrent anterior dislocation. Bone blocks are implanted in cases of locked posterior dislocation. Different forms of cranial instability are described as well as partial and total superior glenoidal lesions. The author discusses surgical procedures used in the treatment of these instabilities. Cranial instability leads to impingement syndrome, which results in rotator cuff lesions. These lesions increase instability and the increased impingement leads to further rotator cuff damage. This vicious cycle can be interrupted by surgical intervention.]

Lege Artis Medicinae

[Clinical application of specific antibodies in immunotherapy of transplantation]

PETRÁNYI Győző, PÁLÓCZI Katalin

[In organ and tissue transplantation practice as well as in the therapy of autoimmune, haematological, immunological and oncological diseases, the possibility for applying immunotherapy is occuring more frequently. The paper deals with all those reagents which are primarily of polyclonal or monoclonal immunglobuline origin and play a significant role in the various cell-bound immune reactions on the surface of lymphocytes. In addition to the anti-lymphocyte or/rather anti-thymocyte globuline as well as the Orthoclone (anti-CD3 monoclonal antibody) reagents well known in clinical practice, it also refers to other lymphocyte surface anti-marker monoclonal anti-bodies (anti CD4, -CD8; anti TCR, anti-LFA reagents) under clinical trial. The article reviews the possible uses of the group of immunotherapeutical reagents in the clinical practice of Kidney and bone marrow transplantation. The pharmacological mechanism, side effects, and prospects for a wider use of these reagents in the future are discussed.]

Lege Artis Medicinae

[The origin of serum catalase in healthy subjects and in some diseases]

GÓTH László

[The activity of serum catalase is highly increased in acute pancreatitis, hemolytic disorders and in some liver diseases, but there is no data on its tissue origin. The serum catalase activity was determined by a spectrophotometric assay in healthy subjects (n = 4275) as well as in increased erythropoesis (n = 424), in hemolytic diseases (hemolytic anemia = 12, megaloblastic anemia = 28, Zieve syndrome = 8, hemorrhage = 38), in acute pancreatitis, (n = 111), in liver diseases (fatty liver = 21, alcoholic hepatitis = 42, acute yellow atrophy = 18, toxic hepatitis = 15), and in liver congestion due to cardiac circulatory failure (n = 28). These diseases yielded increased serum catalase activity. This enzyme has no tissue specific isoenzymes, therefore mathematical and statistical approaches were used. The correlation between serum hemoglobin and serum catalase was analysed. The catalase release was estimated from the time activity curves of serum catalase and compared to its tissue equivalent. In healthy subjects about 60 percent of serum catalase derived from the erythrocytes and the rest from other tissues. During enhanced erythropoesis and in hemolytic diseases, similarly to hemoglobin, its source was the erythrocyte pool. In acute pancreatitis also the erythrocytes might be responsible for the increased serum catalase level. in some liver diseases as well as in liver congestion due to cardiac circulatory failure the increase of serum catalase derived from the liver cells. The diagnostic analysis of serum catalase requires the consideration of its increase as well as its origin. ]

Lege Artis Medicinae

[Prenatal follow up of a complex cardiac malformation complicated with complete AV block]

SZABÓ István, CSABAY László, NÉMET János, HAJDÚ Júlia, PAPP Zoltán

[In a congenital disorder of heart development where the complex cardiac malformation is pared with complete atrioventricular block heart rate is stabile between 50–60 beats/min. Transfer of atrial impulses through the AV node is fully blocked and the slow rhythmic heart beat is maintained by a ventricular pacemaker. In a case of such a complete cardiac malformation recognized in week 32 of gestation and the AV block complication caused stabile 57–58 beat/min bradycardia. 2-di mensional, pulsed and color Doppler ultrasonography was used to identify the disorder and to follow up the intrauterine condition of the fetus. Cardiotocography (CTG) could not generate appreciable results at such a low heart rate. During observation no centralization of fetal circulation causing intrauterine hypoxia was recorded. Updated knowledge on the pathogenesis and obs tetrical management of the fetal third degree AV block is also presented. In this case ultrasonography allowed clear-cut identification of the disorder and also ensured correct evaluation of the intrauterine status of the fetus when other diagnostic methods for evaluation were not applicable. ]

Lege Artis Medicinae

[Eurpean Concerted Action on Thrombosis and Disabilities Angioma Pectoris Study]

MATOS Lajos

[Patients with more than 50% stenosis in one or more coronary arteries had significantly higher fibrinogen levels (p<0.0001). Reduced fibrinolytic activity was also observed in patients with coronary artery stenosis, mainly due to higher levels of plasminogen activator inhibitor-1 (PAI). Decreased fibrinolytic activity was strongly associated with diabetes, elevated triglyceride levels, smoking and impaired left ventricular systolic pump function. Cholesterol levels correlated mainly with protein C and plasminogen levels.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

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

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Clinical Neuroscience

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Lege Artis Medicinae

[History of vaccine production in Hungary ]

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[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Lege Artis Medicinae

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[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]