Lege Artis Medicinae

[Concerning the Interview with Gyula Szegedi]

RÁCZ Egon

SEPTEMBER 15, 2006

Lege Artis Medicinae - 2006;16(08-09)

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Lege Artis Medicinae

[A new simple tool for tonometric determination of the pCO2 in the gastrointestinal tract]

BODA Domokos, TÁLOSI Gyula, KASZAKI József

Lege Artis Medicinae

[STATE-OF-THE-ART DIAGNOSIS AND TREATMENT OF PITUITARY ADENOMAS SECRETING GROWTH HORMONE]

CZIRJÁK Sándor

[The history of the treatment of pituitary adenomas that cause acromegaly is as long as that of neurosurgery. While in the first half of the past century the aim of surgery was to save the patient's life, later the radical removal of the tumour was coupled with an effort to decrease complications, morbidity and mortality to the minimum. Today, beside all these, the complete sparing of the remaining hypophyseal substance and restoration of normal pituitary function are also important goals. The achievement of these goals is efficiently served by recent advances in microscopy, the minimally invasive methods of craniotomy, the availability of endoscopy in neurosurgery, three-dimensional computerguided neuronavigation, intraoperative colour Doppler sonography, as well as intraoperative real-time MRI. Recent developments in pharmacological research have created new promising conservative treatment modalities that supplement surgery, including somatostatin analogues and growth hormone receptor agonists. Also as supplementary treatment to surgery, occasionally replacing it, new radiosurgical methods, such as stereotaxic radiation, gamma knife, and heavy particle irradiation have gained grounds in neurosurgical practice.]

Lege Artis Medicinae

[BRONCHUS ASSOCIATED LYMPHOID TISSUE LYMPHOMA]

HERTEL Katalin, ZSIRAY Miklós, SOLTÉSZ Ibolya

[INTRODUCTION - Primary lymphomas rarely occur in the lung. CASE REPORT - The authors present the case of an asymptomatic 61-year-old man. The patient was identified on routine chest X-ray having a streak infiltrate in the upper lobe of the right lung, which did not respond to antibiotics. On histological examination of the bronchoscopic specimen BALT- (bronchus associated lymphoid tissue) lymphoma was presumed. Since staging showed the disease to be localized, lobectomy was performed. The patient is symptom-free 16 months after surgery and there is no relapse. CONCLUSION - Although BALT-lymphomas are of low-grade malignancy in most of the cases, relapses can develop in the original organ or in other extra-nodal locations years later and BALTlymphomas may also transform into large-cell lymphomas of more aggressive behaviour.]

Lege Artis Medicinae

[DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF HYPERPROLACTINAEMIA]

IVÁN Gabriella, GÓTH Miklós

[Hyperprolactinaemia is one of the most common endocrine diseases. Besides hypothyroidism- associated hyperprolactinaemia and that arising as a side effect of certain drugs, the most common cause of hyperprolactinaemia is a pituitary microadenoma (<10 mm in diameter) or macroadenoma (≥10 mm) that produces prolactin (prolactinoma). In addition, several physiological conditions can elevate (mostly temporarily) the serum prolactin level, therefore, setting up the precise diagnosis requires careful evaluation of the patient’s history and the laboratory, clinical, and imaging findings. Moreover, macroprolactinaemia, which is usually not a pituitary tumour-related disease, should also be ruled out. Prolactinomas represent the most common form of functioning pituitary adenomas, accounting for 30-40% of such tumours. The typical clinical symptoms of hyperprolactinaemia may be modulated by the mass effect of macroadenomas. In women the disease typically manifests as menstrual disturbance of various degree, including primary or secondary amenorrhoea, oligomenorrhoea, short luteal phase, infertility and galactorrhoea. In men reduced libido, impotence, infertility, gynaecomastia and, rarely, galactorrhoea are the typical symptoms. Dopamine agonist therapy is the first choice of treatment. Dopamine agonist therapy (bromocriptine and the recently developed quinagolide and cabergoline) successfully lowers the serum prolactine level in nearly 90% of cases, and, importantly, it also reduces the size of the tumour in the majority of cases. This explains why today surgery and radiotherapy are only used in rare special cases of prolactinoma.]

Lege Artis Medicinae

[BREAST CANCER CARE: FROM PREVENTION TO SURVEILLANCE]

KAHÁN Zsuzsanna

[Breast cancer is the most common malignancy in women in developed countries. The development of most breast cancers is related to various hormonal effects, while 10% is associated with inherited gene mutations. Most of the primary prevention methods aim at decreasing the effects of hormones, but education on proper lifestyle is also an important risk-lowering method. The primary treatment of early breast cancer is usually breast-conserving surgery, either with the targeted removal of regional lymph nodes (by sentinel lymph node labelling) or with axillary block-dissection. The aim of postoperative radiotherapy is the eradication of the tumour cells left behind. Beside the locoregional tumour control this also plays a role in the prevention of recurrence or a secondary systemic dissemination. Adjuvant systemic treatments are used for the eradication of disseminated microscopic tumour foci. The use of modern adjuvant treatments may reduce death from the disease by up to 50%. The risks of relapse or death may be estimated based on established prognostic factors. While in low-risk patients it is not worth starting medical treatment, especially in view of the side effects, while in other cases chemo- or hormonal therapy may save the patient's life. The choice of the medical treatment should also depend on the patient's general health, the concomittant diseases and her preferences. The collaboration of the various specialists involved in the care of breast cancer patients can best take place at specialised breast centres that are equipped with the necessary technical basis, knowledge and professional experience.]

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Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Lege Artis Medicinae

[Vigilance for Drug Safety: the SCOPE Project – An Interview with Mick Foy, Pharmacovigilance Working Group Leader of the British Medicines Authority (MHRA) ]

CZIGLÉNYI Boglárka

Lege Artis Medicinae

[Education and psychological support of parents in cases of postnatally detected Down syndrome]

MÁTÉ Orsolya, KÍVÉS Zsuzsanna, OLÁH András, FULLÉR Noémi, PAKAI Annamária

[OBJECTIVE - Since the 60’s several publications dealt with the phenomenon how physicians inform parents of newborns about postnatal recognition of Down’s syndrome and the support they receive right after breaking the bad news. Howe - ver, the rest of these studies concentrated on surveying parental satisfaction, while relatively few international studies deal with the other side of the communicational situation, the opinion of the informer. Our study focused on the circumstances of parental information in Hungarian institutions of obstetrics in order to evaluate the possibilities for interventions. METHODS - The Down’s team operating at the University of Pécs Faculty of Health Sciences carried out a national survey in 2005 - an interview-based questionnaire filled by physicians of institutions of obstetrics - with the help of the National Register for Congenital Diseases of the National Centre for Epidemiology and Down’s Foun dation. RESULTS - The coverage of the survey reached 74%. Rest of the surveyed institutions did not have information protocol, however, 70% of them believes it would be necessary. Only 44% of the physicians received communication training and 81% of them believe they can manage communication, 33% have felt that the mother of a newborn with Down’s syndrome would expect special help that the institutions are unable to provide. CONCLUSION - There are serious problems with the circumstances of parental informing in Hungarian institutions of obstetrics. This situation would obviously require intervention. An aimed communicational training based on international experience and exploiting the openness of physicians, as well as the establishment of information protocol could be elements of such intervention.]