Lege Artis Medicinae

[An information system for primary care designed with funding aspects in mind]

VÁRHELYI Tamás, KINCSES Gyula

JULY 28, 1993

Lege Artis Medicinae - 1993;3(07)

[It is a truism that health care reform is a matter of urgency. The structure of the health system is unsustainable and its financial unsustainability is foreseeable. Thus, there are compelling reasons to think about reform from a funding perspective. In this respect, action has been taken first in the most underdeveloped area, primary care. ]

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Lege Artis Medicinae

[Features of chronic alcoholic liver and pancreatic diseases]

NEMESÁNSZKY Elemér, DÖNGÖLŐ László

[The most common organ pathologies caused by alcohol abuse are chronic liver disorders and chronic pancreatitis. The incidence of these diseases has not yet been fully established but both are considered to be widespread in Hungary. Since there are forms which frequently occur without symptoms, clinicians might have difficulties in recognizing them. The diagnosis should be based on the results of laboratory screening tests and the findings of the physical examination. A variety of specific and functional tests should be performed. Morphologic damage of the organ can be assessed by analysing the tissuesample obtained by biopsy. In the course of the disease progression, well characterised clinical entities (syndromes) develop. Features of the most advanced stage are as follows: fibrosis of the gland causing functional insufficiency which manifests itself in marked laboratory and clinical alterations.]

Lege Artis Medicinae

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STRAUSZ János, BÖLCSKEI Pál

[The review summerizes the recent broncholo gical possibilities to treat the main airway stenosis. The most of the patient have inoperable central endobronchial or endotracheal tumor. However these methods are of considerable palliativ value for recanalization of the main airway and these way for amelioration of the quality of life. The three methods: the LASER phototherapy, the afterloading irradiation and the stent implantation can be available yet in Hungary. ]

Lege Artis Medicinae

[Antineutrophil cytoplasmic autoantibodies and their pathogenic and diagnostic role in different diseases]

SZŰCS Gabriella, SZEGEDI Gyula

[Antineutrophil cytoplasmic autoantibodies (ANCAs) are found in the circulation of patients with systemic vasculitic syndromes, including Wegener's granulomatosis, polyarteritis nodosa, Churg-Strauss syndrome, and other disorders within the spectrum of autoimmune diseases. ANCAs have specificity for different proteins in the cytoplasmic granules of neutrophils. Two major patterns of ANCA staining are observed by indirect immunofluorescence as say: cytoplasmic (C-ANCA) and perinuclear (P-ANCA). There is in vitro evidence that antineutrophil cytoplasmic autoantibodies are directly involved in the pathogenesis of antineutrophil cytoplasmic autoantibody-as sociated vasculitides. Antineutrophil cytoplasmic autoantibody titers may be useful in modulating treatment regimens.]

Lege Artis Medicinae

[Cutaneous symptoms and reactive arthritis in giardia lamblia infection]

RIESZ Tamás, VÁLYI-NAGY István, TEMESVÁRI Erzsébet, WINKLER Valéria, KASZÁS Ilona

[ The authors discuss reactive arthritis and cutaneous symptoms as two infrequent complications of giardiasis. The incidence of reactive arthritis and cutaneous symptoms in 569 patients with giardiasis with simultaneous characte risticbiliary and gastrointestinal manifestation was investigated. In the majority of cases, parasitic infection was detected from fresh (warm) bile or, in a smaller proportion of patients, from fresh stool. Nine patients presented with reactive arthritis, 59 with chronic urticaria, 17 with rosacea, 8 with prurigo nodularis, and 2 with erythema nodosum. In all cases, initial therapy consisted of metroni dazol (Klion), using a daily dose of 0.75-1.5 g for 10–15 days. Only those patients whose symptoms were eliminated or substantially diminished and whose duodenal aspirate and stool was devoid of the parasite one month following treatment were considered cured. Sixty seven patients remained Giardia positive after metronidazol treatment. A detailed description of the curative therapeutic combinations in the cases of 64 patients is presented in the paper. Despite repetitive and combination therapy, three patients remained Giardia positive and continued to present with the symptoms of the parasitic disease. The authors emphasize that in patients having cutaneous allergic symptoms, reactive arthritis, or erythema nodosum with simultaneous gastrointestinal symptoms (even of the gastroin testinal symptoms are mild or absent), biliary or gastrointestinal Giardia infection must be considered. ]

Lege Artis Medicinae

[Color doppler imaging of the eye and orbit]

BARTA Miklós, DANIEL A Merton , BARRY B Goldberg, ROBERTA M Sandy

[Color Doppler Imaging (CDI) has added new dimension to orbital sonography. The indications of this method are basically the vascular and neoplastic diseases of the eye and orbit. After demonstrating the scan technique and normal findings the authors present some pathologic entities, such as reversed flow in ophthalmic artery as a result of occlusion of the internal carotid artery, lack of blood flow in central retinal artery in another ocular ischemic syndrome and the blood flow within a choroidal melanoma. The authors' experience reveals that CDI with pulsed Doppler spectral analysis is a promising new technique for the evaluation of vascular structures of the normal orbit as well as ocular and orbital vascular pathology.]

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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.

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[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. ]

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