Lege Artis Medicinae

[Applying musical tools in healing children]


JUNE 20, 2018

Lege Artis Medicinae - 2018;28(04-05)

[The aim of the study is drawing the attention to the possibilities of applying musical tools in healing children. After doing research in main medical databases (PubMed, Web of Science, Medline) some research works were discovered and harmonized in which the researchers give proof of the effectiveness of music therapies implemented in therapeutic circumstances and by proper experts on medical fields. The study focuses on the following topics: applying music for reducing stress caused by medical interventions and hospitalization, treating speech disturbances, improving communication and social abilities of autistic children, improving capabilities of people suffering from visual and hearing impairment, providing help during anaesthesia, stimulating different parts of the brain in children suffering from PDOC (Prolonged Disorder of Consciousness), improving capabilities of children living with disabilities and helping creating harmonic relationship between children, their parents and the healing staff. ]



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[Concerning Madness for the Mad and Others]

GAJDOS Ágoston

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[Tiotropium and olodaterol in the prevention of chronic obstructive pulmonary disease exacerbations (DYNAGITO): a double-blind, randomised, parallel-group, active-controlled trial (Review)]

VARGA János Tamás

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[Why is it important and ethical to treat anxiety patients?]


[The identification of anxious patiens is not always an easy task. The diagnose is clear in that case, when the symptoms (psychic or somatic) are evident or/and patients complain about anxiety. Anxiety itself is not a pathological symptom if it is adequate in strength and duration. Anxiety reactions have large individual variety -, they are pathological if inadequate and irrelevante and don’t match with the actual situation. According to epidemilogical data one third of patients of family doctors suffer from anxiety but somatic symptoms come to the front, so the patients participate in a great number of medical examinations. It is important to emphasise that medical examinations are necessary to preclude the possibility of any somatic disease. The di­ag­nostic criteria of DSM-5. are an excellent assistance for a good diagnosis. Anxiety is a risk factor for cardiological diseases and diabetes mellitus. The prevalence of anxiety disorders are 12.6-17.2%. Anxiety di­sorders are well-manageable, they need complex therapy: benzodiazepines, antidepressants, hypnotics and psychotherapy. They frequently co-exist with depression and insomnia so they have to be treated together. ]

Lege Artis Medicinae

[“Vires unitae agunt” - way of the unification: medical professionalization in 18-19. centuries Hungary]

SIMON Katalin

[European and Hungarian medicine and its representatives changed a lot between the sixteenth and nineteenth centuries. The varied ’medical market’ altered significantly from the eighteenth century. The acts of the enlightened absolutism, which were attentive to the health of the citizens and the public, set up those processes, which led to modern medical education and medical professionalization. During this process, some kind of healers were raised out of craftsmen, folk healers (such as surgeons, pharmacists, midwives, veterinarians), others were supplanted (for Example sellers of essential oils). After the initiation from above, doctors of medicine and masters of surgery became self-conscious in the Hungarian Reform Era, first forms of self-organization, as so the demand of professional retraining and discussions appeared via the new journals, associations and assemblies. The biggest question was the liquidation and the unification of the dual education of doctors of medicine and masters of surgery, which descended from the Middle Ages, but became obsolete, thanks to the new achievements of the medicine and surgery. The two were united in 1872, when the title doctor medicinae universalis set up. The Public Health Act of Hungary in 1876 (Art. XIV) and the independent la­bour organizations of doctors (for Example the Associations of Doctors in Budapest and in the countryside, which were established in 1897) promoted the formation of the modern medical profession. ]

Lege Artis Medicinae

[The “room” for death in the family - dying as a role]


[The Hungarian literature has quite ignored so far Noyes & Clancy’s Role Theory approach of dying. I present the outline and a critique of this conception, then lay the foundations of a reformed concept of the dying role. For the optimal and desired dying role is not one of peripherising and objectifying, rather one of placing the dying in the centre of the system of relations and roles radically restructuring under the influence of such role. The personality of the dying remains a true value in this central position. The reintegration of the dying can begin parallel to her disintegration by the progressive loss of her normal social roles (‘the loneliness of the dying’). Death can thus transform into a social phenomenon. I illustrate the argumentation on the central dying role with a case study using the method of a heterophenomenological, second-person character. By promoting the central and autonomous dying role, i.e. by the development of the necessary social role competences, or at least by publicising the thanatological knowledge, death can turn from an avoided, socially disintegrative taboo into a phenomenon that can strengthen the community even after the dying departed.]

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KÁRPÁTI Krisztián, MÁJER István, BONCZ Imre, NAGY Attila, BERECZKI Dániel, GULÁCSI László

[Our aim was to assess the social insurance costs of hospital treatments for acute stroke in Hungary between 2003 and 2005. We studied how much burden stroke patients impose on the financer (National Health Insurance Fund Administration) in acute and chronic hospital admissions. We extracted the data of “new” stroke patients (ICD-10: I60-64 diagnosis) hospitalized in May 2003 from the database of the financer. We analyzed active and chronic hospital treatment costs of these patients in the period of 12 months before the stroke and in the following first and second 12 months. Data were collected by sex and age (age groups: 25-44, 45-64, over 65). We studied patients hospitalized in May 2003 with the ICD-10: I60-64 main diagnosis but not being treated with the same diagnosis in the previous 24 months. In the first 12 months of the active care the burden of the disease was (male vs. female) 65+: 254.6 vs. 205.8; 45-64: 341.4 vs. 280.5; 25-44: 370.1 vs. 306.1 thousand HUF per patient. In the second 12 months the costs were 50.6 vs. 36.2; 24.2 vs. 32.6; 27.6 vs. 24.8 thousand HUF respectively. In the first year following the episode the costs of the chronic hospital treatment were (age groups as above) 23.3 vs. 31.3; 28.9 vs. 22.2; 22.8 vs. 22.5 thousand HUF. A year later the chronic hospital costs were 9.0 vs. 10.9; 6.7 vs. 12.2; 1.4 vs. 38.1 thousand HUF respectively. Average costs of stroke are higher in the case of males as are in the case of females, 364.8 vs. 303.0 thousand HUF in the first 24 months. The remarkable difference results from active hospital treatment costs (331.5 vs. 262.1 thousand HUF), while the discrepancy is smaller in the chronic hospital care (33.3 vs. 40.9 thousand HUF).]

Clinical Neuroscience

Stress-induced corticosterone rise maintain gastric mucosal integrity in rats

LUDMILA Filaretova, MARINA Myazina, TATIANA Bagaeva

Background - To investigate contribution of glucocorticoids to the maintenance of gastric mucosal integrity during stress we predominantly used ulcerogenic stress models. Using these models we demonstrated that glucocorticoids released in response to the ulcerogenic stimuli attenuated their harmful action on the gastric mucosa. Purpose - In the present study we hypothesized that mild stressors does not damage the gastric mucosa due to gastroprotective action of glucocorticoids released in response to these stressors. Methods - To verify the hypothesis the effects of normally non-ulcerogenic mild stimuli (15-30 min cold-restraint) on the gastric mucosal integrity have been studied under the circumstances of inhibition of the hypothalamic-pituitaryadrenocortical axis in rats. The hypothalamic-pituitary-adrenocortical axis was inhibited by: 1) fast inhibitory action of metyrapone, inhibitor glucocorticoid synthesis; 2) fast inhibitory action of NBI 27914, the selective antagonist of cortricotropin- releasing factor receptor type 1; 3) delayed inhibitory action of a single pharmacological dose of cortisol injected one week before the onset of stress stimulus. Results - Each of these pretreatments significantly decreased 15-30 min cold-restraint-produced corticosterone levels: 37.2±1 vs 22.5±1.2 (p<0.05) after metyrapone; 52.1±0.9 vs 41.4±1 (p<0.05) after NBI, and 64.2±4.2 vs 16.7±1.5 (p<0.05) after cortisol pretreatment. The inhibition of stress-induced corticosterone rise resulted in an ap - pearance of gastric lesions after the onset of these mild stressors in rats. Conclusions - The results suggest that in rats with inhibited stress-induced corticosterone rise normally non-ulcerogenic stimuli are transformed into ulcerogenic ones and confirm the hypothesis. The findings further support for the point of view that glucocorticoids released during acute stress are gastroprotective factors.

Clinical Neuroscience


SZABÓ Sándor

[Although Hans Selye is mostly known for his discovery & development of the stress concept, he also introduced the first physiologically sound, structure-activity classification of steroids that was also based on the chemical structure of steroids in 1943. He not only introduced the names of glucocorticoids & mineralocorticoids but discovered the anti- & pro-inflammatory properties, respectively, of these steroids in animal models. Furthermore, he not only described the first stress-induced gastric ulcers in rats (1936) & characterized the first human ‘stress ulcers’ during the air-raids in London during World War II (1943). Thus, Selye was a much more productive & creative scientist than it is generally considered.]

Clinical Neuroscience

[10 years, 600 monitoring sessions - our experience with the video EEG monitoring of children]


[Introduction- The only Hungarian video EEG laboratorywhere children of ages 0-18 can be continuously monitoredfor several days was opened 1 June 2001 at Department ofNeurology of Bethesda Children’s Hospital.Objectives- Summarizing our 10 years of experience withthe video EEG monitoring (VEM) of children and defining theplace of VEM in the treatment of childhood epilepsy inHungary.Patients and methods- We have processed data from 597monitoring sessions on 541 patients between June 1, 2001and 31 May, 2011 based on our database and the detailedsummaries of the procedures. Results- 509 patients were under the age of 18. The average length of the sessions was 3.1 days. We haveobserved habitual episodes or episodes in question in 477(80%) sessions. 241 (40%) sessions were requested with anepilepsy surgery indication, and 74 patients had 84 opera-tions. 356 (60%) were requested with a differential diagnosisindication, and 191 (53%) cases of epilepsy werediagnosed. We most commonly diagnosed symptomaticgeneralized epilepsy (57 cases). In 165 sessions the episodein question was not diagnosed as epilepsy. Among theparoxysmal episodes we have identified events ofpsychogenic origin, movement disorders, sleep disordersand behavioral disorders. Only 3% of the differential diag-nosis procedures brought no additional clinical information.Discussion- The diagnostic efficiency in our VEM laborato-ry is in accordance with the data found in the literature.Besides epilepsy surgery VEM is recommended if suspectedepileptic episodes occur and interictal epileptiform signs arenot present or are not in accordance with the symptoms, ifthere is no explanation for therapy resistance and if paroxys-mal episodes of non-epileptic origin are suspected but theycannot be identified based on the anamnesis. VEM is also helpful in diagnosing subtle seizures. The procedure hasnumerous additional benefits in patient care and in trainingthe parents and hospital staff. ]

Clinical Neuroscience

[Minor physical anomalies in autism]

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[Background and purpose - Minor physical anomalies are mild, clinically and cosmetically insignificant errors of morphogenesis which have a prenatal origin and may bear major informational value for diagnostic, prognostic and epidemiological purposes. Since both the central nervous system and the skin are derived from the same ectodermal tissue in utero, minor physical anomalies can be external markers of abnormal brain development and they appear more commonly in neurodevelopmental disorders. In a recently published meta-analysis Ozgen et al. have published the results of seven studies - all have used the Waldrop Scale which contains 18 minor physical anomalies - and reported on the higher prevalence of minor physical anomalies among patients with autism. There are only a very few data on the individual analysis of the prevalence of minor physical anomalies in autism. Methods - In our study we have studied the prevalence of 57 minor physical anomalies in 20 patients with autism and in 20 matched control subjects by the use of the Méhes Scale. Results - The prevalence of minor physical anomalies was significantly higher in the autism group (p<0.001). The individual analysis of the 57 minor physical anomalies showed the significantly more frequent apperance of four signs (primitive shape of ear p=0.047, abnormal philtrum p=0.001, clinodactylia p=0.002, wide distance between toes 1 and 2 p=0.003). No correlation was found between the four significantly more common minor physical anomalies. Conclusion - The higher prevalence of minor physical anomalies in autism supports the neurodevelopmental hypothesis of the disorder and the individual analysis of minor physical anomalies can help to understand the nature of the neurodevelopmental defect.]