Lege Artis Medicinae

[Dependency, Self-Help, Recovery]

NAGY Zsolt

NOVEMBER 20, 2009

Lege Artis Medicinae - 2009;19(11)

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Lege Artis Medicinae

[Wolf or lamb?]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[In wine, the truth?]

FEHÉR János

Lege Artis Medicinae

[Diabetes mellitus and cancer risk]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past decades, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. On the basis of the latest publications that have created a storm we have to highlight the associations between diabetes mellitus, its treatment protocols and tumours. Analysing the often controversial human results, in the absence of relevant prospective studies, we have to consider preclinical observations to choose a safe treatment method.]

Lege Artis Medicinae

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

Lege Artis Medicinae

[Treatment of severe infections: principles of therapy and problems of resistance]

LUDWIG Endre

[The basic principles of the treatment of severe infections have recently been delineated : after having samples for microbiological tests, empiric therapy based on local resistance patterns should be introduced immediately, possibly within 1 hour in severe sepsis or in septic shock, the empiric therapy should be simplified according to the results of microbiological tests and/or improvement of the condition of patient , the antibiotics should be applied according to their pharmacodynamic properties, the duration of therapy should be shortened to the minimum time, in case of well responding non-complicated infection to 5-7 days., The most frequent problem pathogens in Hungary are the MRSA and ESBL-producing Gram-negatives. In severe infections with MRSA bacteremia, the therapy sholud be based on the vancomycin MIC of the pathogen. If MIC is below 1,5 mg/l, vancomycin is probably effective with a serum minimum concentration of 15 mg/l, while in case of less sensitive pathogens the administration of an alternative agent, such as linezolid, tigecyclin or daptomycin should be considered. In severe infections due to ESBL-producing pathogens, the carbapenems are the firts line antibiotics, while tigecyclin seems to be a promising alternative agent. The treatment of severe infections requires thorough care of the patient and skillnes in antimicrobial therapy in the period of multiresistant pathogens]

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[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

Delirium due to the use of topical cyclopentolate hydrochloride

MAHMUT Atum, ERKAN Çelik, GÜRSOY Alagöz

Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.

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

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.