Lege Artis Medicinae

[Conclusions of a 1980 year long-term health care prognosis]

FORGÁCS Iván

APRIL 20, 2001

Lege Artis Medicinae - 2001;11(04)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Introduction of hepatitis G and TT virus diagnostics in Hungary]

TAKÁCS Mária, RUSVAI Erzsébet, BROJNÁS Judit, TÓTH Gábor, SZOMOR Katalin, TÓTH Etelka, SZENDRŐI Andrea, MEZEY Ilona, BERENCSI György

[INTRODUCTION - The majority of the viral hepatitis is caused by five hepatitis viruses (A, B, C, D, E). In 1995, three new flaviviruses were discovered, the GBV-A, GBV-B and GBV-C (also known as HGV) viruses. The TT virus was discovered in 1997. Based on literature data, it is now supposed that a part of the unknown hepatitis cases is caused by the recently discovered hepatitis G or TT virus. The aim of this study was to determine the occurrence of hepatitis G and TT viruses in Hungary. PATIENTS AND METHODS - To reveal the RNA of the HGV viruses in the sera of patients suffering from hepatitis of unknown origin, RT-PCR was applied using the primers published in the literature. Seminested PCR was used to detect the DNA of TTV. The nucleotide sequences of nested PCR products were determined. Anti-HGV antibodies were detected by ELISA. RESULTS - The sera of 408 healthy persons older than 60 years were tested for the presence of hepatitis G virus antibodies: 113 tested positive. HGV virus antibodies were found in the sera of patients suffering from hepatitis of unknown origin or aplastic anaemia. 51 sera were tested and 20 were found to be positive for GBV-C antibodies, 4 for HGV RNA. Altogether, 213 sera of patients suffering from hepatitis of unknown origin or from aplastic anaemia were tested for HGV RNA and 26 were found to be positive. Eight PCR products were sequenced, and these sequences were found to be different from each other. 154 sera of patients with hepatitis of unknown origin were tested for the presence of TTV-DNA and 72 of them were positive. Seven PCR products were directly sequenced. Genotype 2 was found to be the most frequent one in Hungary.CONCLUSION - Our results show that both HGV and TTV are present in Hungary and none of them can be considered rare. Further studies are needed to reveal the association between the genotypes of these viruses and hepatitis of unknown origin.]

Lege Artis Medicinae

[Type 2 diabetes in children and adolescents: early complications]

KÖRNER Anna, MADÁCSY László

[INTRODUCTION - The prevalence of type 2 diabetes mellitus in children and adolescents is increasing worldwide. PATIENTS AND METHODS - Authors have investigated the prevalence of type 2 diabetes mellitus and of impaired glucose tolerance among the patients of the 1st Department of Pediatrics at the Semmelweis University between January 1989 and September 1998. RESULTS - During this period, 161 children with impaired glucose tolerance and 34 patients with type 2 diabetes mellitus were diagnosed. There was a female predominance. 53% of the patients were already in puberty. The majority of the patients were obese. Serum triglyceride and cholesterine levels exceeded normal values as compared to age matched healthy children. Ambulatory blood pressure monitoring revealed relative nocturnal hypertension. 35% of the patients also had microalbuminuria. CONCLUSION - In type 2 diabetes mellitus the early signs of late complications can be detected in the young. It reveals the importance of establishing the diagnosis of this disease as soon as possible.]

Lege Artis Medicinae

[Effectiveness of patients’ rights in Hungary]

VAJDA Angéla

Lege Artis Medicinae

[New oral antidiabetic agents - New aspects in the management of type 2 diabetes mellitus]

GERŐ László

[During the past years several new oral antidiabetic agents have become available and more new drugs of this type are expected to appear on the market. New products appeared in both groups of insulin sensitizers and insulin secretagogues. Modern insulin secretagogues are characterized by immediate and short action. As a consequence, insulin secretion will approach the physiological secretory pattern. The rapid, short-term insulin output prevents the abnormal increase of postprandial glucose level and - at the same time - the danger of late hypoglycemia will decrease. The combination of insulin sensitizers with the new insulin secretagogues provides the possibility to apply the basisbolus therapeutical principle to type 2 diabetic patients treated with oral agents.]

Lege Artis Medicinae

[Weak-hearted composer of monumental forms - Anton Bruckner]

MALINA János

All articles in the issue

Related contents

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.