Lege Artis Medicinae

[Call for a chamber law - in opposition]

DECEMBER 25, 1991

Lege Artis Medicinae - 1991;1(18)

[Gyula Kincses, Károly Mezey and Gyula Pánczél, MDF members of the MDF, have submitted an amendment to the draft parliamentary resolution on the concept of the renewal of social security, proposing that a sentence be added to the text of the resolution, stating that the draft laws following the concept should be harmonised not only with the new health and social law, but also with the law on the Chamber of Doctors and Pharmacists.]

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[Metoprolol treatment in dialated cardiomyopathy]

DÉKÁNY Miklós, NYOLCAS Noémi, FIÓK János, VÁNDOR László, SEREG Mátyás, BALOGH Ildikó

[Authors applied metoprolol for treating heart failure in with dilated cardiomyopathy. Patients were given digitalis, diuretics as well as ACE-inhibitor and vasodilator drugs. The grade of heart failure was according to NYHA classification in the mean 2.5 class. For assessing the effect of metoprolol clinical variables and results of non-invasive tests were evaluated and compared in 3 consecutive periods: 1) before starting metoprolol, 2) 2–4 weeks after reaching its definitive dose (short-term effect), 3) 3-6 months later (medium-term effect). Early intolerance appeared in 3 patients; signi ficant progression of heart failure in 2 and hypotension causing complaints in 1. Evaluating the actually treated 17 patients clinical signs of heart failure (NYHA class) decreased, left ventricular ejection fraction improved, though not significantly in case of every considered variables, left atrial filling pressure decreased, exercise capacity did not alter, rate-pressure product decreased at rest and at low level of exercise as well. The authors stress the significance of "up-regulation" of myocardial beta-1 receptors in the reduction of myocardial toxic catecholamin effect and myocardial oxygen demand as well as in the increase of myocardial blood supply. Referring to the data of the respective literature and to their own experiences the authors suggest metoprolol treatment in cases of dilated cardiomyopathy, where previus therapy did not prove to be efficient.]

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[Role of oxygen derived free radicals during myocardial reperfusion]

KÓNYA László , FEHÉR János, JUHÁSZ Nagy Sándor

[Oxygen derived free radicals are now considered to be important contributors to tissue (myocardium) injury associated with ischemia and reperfusion. Normaly the tissue concentration of these toxic intermediate products of oxygen is strietly limited, but production of oxygen free radicals overwhelming the capacity of the tissue elimination may cause serious damage. Thus reperfusion has it's own danger with the extension of the injury produced by the ischemia alone. Several experi mental studies have shown that different free radical scavengers can reduce the post-ischemic tissue injury, however, there are contradictory results and unresolved problems. Further investigation is necessary to establish the relevance of oxygen free radical mediated myocardial injury and the effective antioxidant treatment. ]

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UHER Ferenc

[Frank M. Burnet's clonal selection theory declares the deletion and/or anergy of self-reactive clones to be the fundamental mechanism responsible for self tolerance. There is ample evidence, however, that all healthy individuals have lymphocytes and , natural” antibodies that recognize self structures. In the 1970s, Niels K. Jerne postulated the network theory. It is based on the idea that the idiotype, the region of an immunoglobulin that is unique because it comprises the antigen-binding portion of the molecule, can act as both antigen and antibody within the same individual. Network theory views the immune system as a single, highly interconnected system, through idiotypes, a web of V domains. Antonio Coutinho adressed this problem and divided the repertoire of the B lymphocytes into two parts. He suggested that a set of naturally activated cells and the immunoglobulins they secrete, is reflected in the autonomous immune activities of the self-related network as the central immune system. In contrast, immune responses to external antigens are essentially allonomous clonal activities of another set of resting, rapidly turning over lymphocytes that follow the predictions of the clonal selection theory, making up the peripheral part of the system. Finally, Irun R. Cohen suggested that some, perhaps all, major autoantigens are indeed dominant because each one of them is encoded in the organizational structure of the immune system. This picture was termed the immunological homunculus by its analogy to the picture of the body encoded in the central nervous system. ]

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[Modern therapy of intracerebral and subarachnoidal hemorrhages]

LEEL-ŐSSZY Lóránt

[The frequency of the intracerebral hemorrhages among the strokes is most commonly quoted around 10 percent. The rupture of an intracranial aneurysm is often complicated with subarachnoideal hemorrhage as well as with intracerebral hematoma therefore this latter type of intraparenchymal hemorrhage may also be discussed in this topic. The modern imaging procedures (Computed to mography, Nuclear magnetic resonance) are of crucial importance in the urgent and exact diagnosis of intracranial hemorrhages. The first essential step in the diagnosis of stroke is to distinguish the ischemic lesion from the hemorrhage by means of CT. When an intra cerebral hemorrhage threatens life and the patient's condition is relatively good there must be an urgent decision considering the choice between medical therapy or surgical intervention. Although clearcut indications for surgery are now available, the clinical and computed tomographic guidelines play indi vidually an important role in the final decision. The individual judgment is always desirable in every case of intracerebral hemorrhage as well as in the surgical intrvention of intracranial aneurysm during the acute phase (two days).]

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[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]

Hypertension and nephrology

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[In the background of resistant hypertension (RHT) the neurovascular pulsatile compression (NVPC) of the left rostral ventrolateral medulla may play a role. In these cases a microvascular decompression (MVD) may decrease the blood pressure (BP). The aim of this work was to investigate how the BP has changed after the MVD in the operated patients recorded at the farthest time from the MVD up to maximum 31 December 2016. We have retrospectively collected data from 9 patients whose follow-up data fór 2 years has already been published earlier. Data collection was carried out from the patient register program of the University of Szeged Albert-Szent Györgyi Clinical Centre. The MVDs were performed between 2000 and 2004. The mean follow-up time was 11.1±4.6 years. Both the systolic and the diastolic BPs were significantly lower at the time of last record compared to the BPs at the time of MVD (systolic BP 211±40 vs. 135±20 mmHg, p=0.003; diastolic BP 116±17 vs. 81±14 mmHg, p=0.007). Last recorded BPs compared to the 24-month data alsó were lower bút nőt signffi- cantly (systolic BP 148±32 vs. 135±20 mmHg, p=0.25; diastolic BP 96 vs. 85 mmHg, p=0.11). The mean number of antihypertensives at the last Office visít was nőt sig- nificantly higher compared to MVD (5.9±1.4 vs. 6.3±1.5; p=0.5) bút signfficantly increased compared to MVD +1 month data (4.7±0.9vs. 6.3±1.5; p=0.03). These results confirmed our previous opinion that in severe RHT nőt respond- ing to conventional therapy an MVD of the left side NVPC could be a therapeutic option and may guarantee a long-lasting BP reduction. Evén if the number of antihypertensives increased in the meantime, as they still responded better to therapy. ]

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Title of the article: Bilateral acute angle-closure glaucoma induced by duloxetine

ATUM Mahmut, VILDAN Tunc, ENES Demiryurek, ALAGOZ Gursoy

Introduction - To present a rare case of bilateral acute angle-closure glaucoma secondary to duloxetine administered for the treatment of depression. Case presentation - A 46 year old woman developed bilateral closed angle glaucoma after 15 days of duloxetine usage. Intraocular pressures (IOP) were 52 and 55 mm Hg in right and left eyes respectively, with shallow anterior chamber and angle closure on gonioscopy. Discontinuing duloxetine treatment, initiation of antiglaucomatous treatment and bilateral Nd:YAG Laser iridotomy obtained normalized IOP and anterior chamber depth. Conclusion - Duloxetine, used in the treatment of depression can be responsible for acute angle-closure glaucoma by leading to mydriasis and ciliary effusion.