Lege Artis Medicinae

[Christmas in Art]

KRAMER Imre

DECEMBER 10, 2009

Lege Artis Medicinae - 2009;19(12)

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Lege Artis Medicinae

[Christmas vaccine]

FRENKL Róbert

Lege Artis Medicinae

[Systemic adjuvant pharmacotherapy of colorectal cancer]

BODOKY György

[Colorectal cancer is one of the most frequent cancer in the postindustrial world; its most common form is adenocarcinoma. In Hungary, colorectal cancer has the second highest mortality among tumours. If diagnosed early, it might be successfully treated by surgery, however, chemotherapy is necessary to prevent tumor relapse and development of metastases and achieve adequate palliation. In the past few years, adjuvant treatment of colorectal cancer has improved substantially. Many new drugs have been developed, which are also being used in combination with previously known agents. This article will discuss the novelties in the field of adjuvant chemotherapy for colorectal cancer and the main guidelines of adjuvant treatment.]

Lege Artis Medicinae

[Insulin analogues and pregnancy]

TAMÁS GYULA, KERÉNYI ZSUZSA

[Near-normoglycaemic metabolic control in pregnant women with diabetes - started before conception in pregestational diabetes - decreases the frequency of maternal and foetal complications. Such control can be achieved by using optimalised systems of insulin therapy. A number of (ultra)rapid and long-acting insulin analogues became available during the last decade, which - on the basis of theoretical considerations - might be used to maintain normoglycaemia. Summarising the data available today, the use of rapid insulin analogues (lispro, aspart) seem to be effective and safe during pregnancy. Some questions arise, however, about their modes of application. The use of long-acting insulin analogues in pregnancy is currently not indicated. Further trials are needed to prove their efficacy and safety in diabetic pregnancy.]

Lege Artis Medicinae

[Resistant hypertension - differential diagnosis and therapy]

TISLÉR András

[Hypertension is considered resistant to therapy if the target blood pressure is not achieved despite treatment with three different types of antihypertensive drugs, including a diuretic. Causes of therapy resistance may be grouped into three broad categories: Pseudoresistance can be the result of inadequate blood pressure measurement technique, the “white-coat” effect or the patients’ noncompliance with pharmacological and nonpharmacological medical advices. Evaluation of the measurement technique - including the size of the cuff used - and blood pressure monitoring at home can help identify the causes of pseudoresistance. Secondary resistance comprises drug interactions and concomitant medical conditions that elevate blood pressure or antagonize antihypertensive therapy. In addition, secondary resistance can result from disorders associated with secondary hypertension, among which appropriate screening for hyperaldosteronism as well as for renoparenchymal and renovascular hypertension need special emphasis. Suboptimal therapy is frequently related to subclinical volume overload and the use of inappropriate type or dosing of diuretics. Furthermore, when choosing the optimal drug combination, care should be taken to inhibit the various systems that regulate blood pressure as much as possible. In addition to combining the most frequently used antihypertensive drugs, the use of aldosterone antagonists, vasodilators, nitrates or drugs affecting the central nervous system might help to optimise treatment.]

Lege Artis Medicinae

[The relevancy of measuring the level of D-dimer test in clinical practice]

PINCZÉS István, SPEER Gábor

[Plasma levels of D-dimer may rise in a number of pathological conditions, which might be relevant for diagnosis as well as for prognosis. Its concentration increases with age, perhaps because of the wide-spread co-morbidity. In this article we demonstrate the diagnostic role of Ddimer in the well-known thromboembolic diseases. Beyond that, we highlight the importance of measuring D-dimer levels in other, lesser-known conditions, about which important findings have been published, such as cardiovascular, inflammatory or malignant diseases. It seems that in these disorders - provided that appropriate clinical conditions are available -, measuring D-dimer levels might have a role not only in diagnosis but in the prognosis as well. Furthermore, our aim was to discourage inappropriate clinical practice. Ignoring to measure the D-dimer levels (for fear of it being high) might lead to diagnostic errors. On the other hand, routinely performing the D-dimer test without clinical consideration (in the hope of it being negative) might cause diagnostic confusion in case of unexpected positivity and - mostly because of false interpretation - lead to further, unnecessary examinations.]

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[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

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[Christmas inventory]

BRYS Zoltán

[Overall, it is clear that humanity is facing perhaps its greatest challenge ever; humanity needs a consciously done reform, in its established economic and social mechanisms. A kind of passionate self-reflection, a dedogmatisation. This requires a deeper and more comprehensive understanding of its history and of itself. The way to a peaceful Christmas 2073, I suggest...]

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Surveillance and management of patients with tuberous sclerosis complex

FOGARASI András, GYORSOK Zsuzsanna, BODÓ Tímea

Tuberous sclerosis complex (TSC) is an autosomal dominant disease due to the uncontrolled differentiation, proliferation, and migration of cells in several organs. Clinical expression is highly variable, from mild skin findings and asymptomatic brain lesions to seizures, mental retardation, autism, and potentially fatal kidney, cardiac, or pulmonary disease. Aim of this paper is to summarize the diagnostic criteria, surveillance and therapeutic issues of this multisystemic disorder emphasizing the most important neurological consequences. Presenting the state-of-the-art management recommendations and comparing them with the local protocols, we hope that our review might help in the proper assessment of one of the most important single gene disorder.

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[The facets of creativity in the light of bipolar mood alterations]

SZAKÁCS Réka

[The link between creativity, as the highest expression form of human achievement, and bipolar disorder came into focus of scientific investigations and research. Accomplished writers, composers and visual artists show a substantially higher rate of affective disorders, prodominantly bipolar mood disorders, comparing to the general population. Then again, patients afflicted with bipolar II subtype (hypomania and depression), as well as persons presenting the mildest form of bipolar mood swings (cyclothymia) possess higher creative skills. It evokes therefore that certain forms and mood states of bipolar disorder, notably hypomania might convey cognitive, emotional/affective, and motivational benefits to creativity. The aim of this paper is to display expression forms of creativity (writing, visual art, scientific work) as well as productivity (literary and scientific work output, number of artworks and exhibitions, awards) in the light of clinically diagnosed mood states at an eminent creative individual, treated for bipolar II disorder. Analysing the affective states, we found a striking relation between hypomanic episodes and visual artistic creativity and achievement, as well as scientific performance, whereas mild-moderate depressed mood promoted literary work. Severe depression and mixed states were not associated with creative activities, and intriguingly, long-term stabilised euthymic mood, exempted from marked affective lability, is disadvantageous regarding creativity. It seems, thereby, that mood functions as a sluice of creativity. Nevertheless, it is likely that there is a complex interaction between bipolar mood disorder spectrum and psychological factors promoting creativity, influenced also by individual variability due to medication, comorbid conditions, and course of disorder.]