Lege Artis Medicinae

[At the Forefront of Modern Art: The Eight Painters]

NEMESI Zsuzsanna

JUNE 20, 2011

Lege Artis Medicinae - 2011;21(06-07)

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Further articles in this publication

Lege Artis Medicinae

[An Instant Culture Demands for Medicine – An Interview with Béla Buda]

NAGY Zsuzsanna

Lege Artis Medicinae

[Oral allergy syndrome in childhood]

CSIMA Eszter, CSERHÁTI Endre, MEZEI Györgyi

[As the prevalence of pollen allergy is increasing, the incidence of oral allergy syndrome is becoming more frequent. We expect, therefore, an increasing incidence of this syndrome among in children as well. The prevalence of oral allergy syndrome among adults with birch pollen allergy is estimated to be 20-70%. The prevalence of the disease among children is currently unknown. The aims of our study were to identify the characteristics of oral allergy syndrome in children and to assess its frequency. In order to identify children with oral allergy syndrome, we have used the children’s medical history, measured total IgE and serum specific IgE levels, performed skin prick tests and food challenge tests. Among the 743 children suffering from allergic rhinitis and/or bronchial asthma we found 463 children with pollen allergy, 6 of who had oral allergy syndrome. Thus, the prevalence of oral allergy syndrome among children with pollen allergy was 1.3%.]

Lege Artis Medicinae

[From the medical aspect]

BÁNFALVI Attila

Lege Artis Medicinae

[Committed physicians, emotional resonance for a better physician-patient relationship]

LAZÁNYI Kornélia, SZLUHA Kornélia

[With the advent of holistic medicine in the second half of the 20th century, the range of behavioural patterns that are expected from healthcare workers has also changed. Nowadays, numerous references in literature put emphasis on the potential positive impact of personal interactions between physician and patient on the healing process and overall well-being of patients. However, it does not come naturally to all workers with caring professions to seek personal interactions with their patients or display appropriate emotions. Some will have to make deliberate efforts, perform emotional labour, to achieve that goal. A healthcare worker’s commitment to healing and caring may make it easier for him/her to perform emotional labour. Emotional labour and commitment of 84 healthcare workers involved in oncology, and organizational factors with impact thereupon, were studied to explore the potential relationship between commitment and emotional labour. PANAS-X questionnaires were used to quantify emotional labour, while commitment and influencing factors were surveyed by means of explicative questions. Our findings confirmed a correlation between commitment and genuine acting as corroborated by literaure data. It was demonstrated that committed healthcare workers’ spontaneous emotions were more in compliance with what their patients expected them to display, and even their behavioural patterns were more in tune with the patients’ expectations. Confirmation as an organizational factor and colleague/ patient attitudes were found to have the strongest impact on commitment. It is essential that selection criteria for healthcare workers include examination for an altruistic caring attitude. Even more importantly, operators and managers of healthcare institutes should make efforts to create a good working environment and offer regular confirmative feedbacks for improved commitment by their employees.]

Lege Artis Medicinae

[The role and significance of vascular aging in the risk stratification of cardiovascular prevention]

VÉRTES András

[The structure and function of arteries change throughout one’s lifetime. The most important changes include lumenal dilation, diffuse intimal and medial thickening, increased stiffness, reduced compliance of central arteries and endothelial dysfunction. Arterial stiffness, an increased pulse wave velocity (PWV) and an increased carotid intima-media thickness (IMT) are independent predictors of cardiovascular events. The early vascular aging (EVA) could help clinicians to determine the increased cardiovascular risk. EVA can be be determined by noninvasive methods, as arterial stiffness and carotid IMT. EVA can be suitable for the early detection of cardiovascular diseases.]

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Clinical Neuroscience

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

[Clinical neurophysiological methods in diagnosis and treatment of cerebrovascular diseases]

NAGY Ildikó, FABÓ Dániel

[Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient’s condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology. ]

Clinical Neuroscience

The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy

UNAL Yasemin, KARA Murat, GENC Fatma, OZTURK Aslan Dilek, GÖMCELI Bicer Yasemin, KAYNAR Taner, TOSUN Kursad, KUTLU Gülnihal

Purpose - Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that “DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder”. DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. Materials and methods - Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. Results - We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. Conclusion - The methylation of NKCC1 can be a mecha­nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

LAM KID

[New findings in the cortical bone biology and its role in bone fractures]

BALOGH Ádám, BHATTOA Harjit Pál

[The authors surveyed the already known factors responsible for the osteoporotic bone fragility. Then the results of using modern imaging techniques (micro-CT, high-resolution peripheral computed quantitative tomograph - HR-pQCT) and advanced computer analytic methods (finite element analysis, FEA) are presented. These data - beyond the already known fracture risk factors (age, risk of falling, bone mineral density - BMD, and fine structure damage of trabecular bone) are stressing the importance of the (micro)damage of cortical bone as a fracture risk factor, which has been still underrated. The cortical thickening and increased porosity - verified on various population samples - are increasing the risk of fractures in certain subgroups of subjects having identical BMD values, even among those, who are considered only osteopenic by the earlier classification based on BMD values. Backed with modern software batteries, the new imaging techniques are expected to enter clinical application in the near future. Pharmacologic agents with stronger cortical effect are already available and research is continuing to find new drugs to use in the management of osteoporotic patients of high fracture risk.]

Lege Artis Medicinae

[MODERN TREATMENT OF COLORECTAL CANCER]

KALMÁR Katalin, HORVÁTH Örs Péter

[The incidence of colorectal cancer has dramatically increased in the past decades, rendering it the second most frequently diagnosed cancer in the Western world. Disease outcome can be improved both by early diagnosis, e.g., through the introduction and extension of screening programs, and by increased therapeutic efficiency. The latter is achieved by increasing the radicality of interventions in surgical oncology to total mesorectal excision, thereby significantly decreasing the frequency of local recurrence. High ligation of the inferior mesenteric artery aims to enhance the efficiency of lymphadenectomy. With the introduction of techniques that spare vegetative nerves, the quality of life will not be adversely affected by the increased radicality. Another direction of progress in colorectal surgery is the increased use of minimally invasive approaches, such as local excision by transanal endoscopic microsurgery or laparoscopic methods. Increased acceptance of a multimodality approach, i.e., combined application of surgical and oncological methods in the treatment of colorectal cancer, has been a great step forward recently. Beyond the long-applied adjuvant treatments, the pre-surgical use of neoadjuvant chemo-radiotherapy has become standard for locally advanced rectal cancers. Adjuvant and neoadjuvant chemotherapy also supplements the surgery of metastases with improving results and impressive long-term survivals. A very important prerequisite for tailored multimodality treatment is reliable staging, which is facilitated by the wider availability of endorectal ultrasound.]