Lege Artis Medicinae

[Developing a complex approach to hospice and home-care]

MOLNÁR Lajos, BÖSZÖRMÉNYI Dalma

MARCH 30, 1994

Lege Artis Medicinae - 1994;4(03)

[The home-care and hospice movement has been sporadically encountered in the hospital and care network for a long time, and we have already seen all that this paper aims to do. Across the country, hospitals and specialist outpatient departments alike are seeking ways and means of providing this care. ]

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Lege Artis Medicinae

[Hormone replacement therapy from a gynaeco oncological point of view]

BŐSZE Péter

[In Hungary, hormone replacement therapy (HRT) has been used more extensively in the last few years. The benefits of HRT in cardio vascular diseases, osteoporosis and quality of life have been well established. Breast cancer and endometrial carcinoma have been considered as contraindications for HRT. A reappraisal of this practice is necessary since we have no evidence that HRT may adversely influence the outcome of these tumours, al though this is theoretically possible since the effect of estrogens on occult metastases is unknown. The relationship between replacement therapy and the uterine sarcomas is of particular concern. HRT is safe in patients successfully treated for carcinoma of the vulva, vagina, uterine cervix and in those with ovarian cancer. Experience suggests that estrogen can also be used safely in women treated previously for endometrial cancer. As far as breast cancer is concerned, it appers logical to discuss the risk-benefit considerations with our patients before embarking on using HRT. Consultation with a gynaecological oncologist prior to HRT in patients with endometrial and/or breast cancer is strongly recommended. ]

Lege Artis Medicinae

[Letters - Spontaneous pneumothorax]

KESZLER Pál, RÁCZ Egon

[Dear Editorial Team! In the 30 November 1993 issue, AC Miller and JE Harvey's "Guidelines for the management of spontaneous pneumothorax" was published as a position paper of the British Thoracic Society. It may seem an ungrateful undertaking to enter into a debate with the principles of such a venerable and long-established society.]

Lege Artis Medicinae

[The increasing threat of antibiotic resistance: implications for antibiotic prescribing in community practice]

ROBERT Sutherland

[Infectious diseases caused by bacteria have been treated successfully by antibiotic the rapy for the past half century, and a diversity of antibacterial agents with widely differing mechanisms of action has been developed by the pharmaceutical industry. However the selective pressure of antibiotic usage has inevitably led to the isolation of resistant bacteria and the rate of emergence of antibiotic resistance appears to be increasing rapidly, reducing the effectiveness of existing agents. Factors responsible for the wide dissemination of antibioticresistant bacteria in both community and hospital practice include the acquisition and spread of resistant genes by plasmids and transposons, inappropriate anti biotic usage and social factors. Mechanisms to controll the emergence of antibiotic resistance require optimal usage of antibiotics by clinicians, control programmes to improve hygiene and to reduce the transmission of resistant bacteria within and between communities, and the continued development of new antibacterial agents.]

Lege Artis Medicinae

[Highly located and intrahepatic malignant biliary stenoses treated by interventional radiological procedures]

KÓNYA András, VIGVÁRY Zoltán

[In the palliative treatment for patients with highly located and/or intrahepatic malignant biliary stenoses or obstructions interventional radiological procedures may play a significant part. In 12 patients with obstructive jaundice caused by highly located malignant stenosi(es) or obstruction(s) 23 endoprostheses were implanted. In 5 cases double endoprosthesis placement was performed to connect isolated lobes or segments of the liver. Patients' survival was 4–22 (average 8, 7) months. In 6/12 patients surviving for 4-8 months, occlusion of the endoprostheses did not occur. In the other half of the patients, in whom the disease permitted a longer life-expectancy, prosthesis occlusion led to recurrent jaundice within 3–11 months. In all but one case, in which endoscopic exchange was successful, percutaneous interventions were necessary. Successful endoprosthesis placement was carried out 3 times in one patient and once each another 5 patients following percu taneous extraction (3 times), distal displacement (twice) and endoscopic removal (twice) of the occluded endoprostheses. Authors consider percutaneous endoprosthesis placement an effective procedure in the palliative treatment of the aforementioned patients' group, both for improving their survival and quality of life. They emphasize the fact that lengthy and difficult manipulations are required for these procedures which consequently result in a considerable amount of scattered radiation exposure to those performing the procedures.]

Lege Artis Medicinae

[Relationship between ventricular arrhythmias left ventricular dysfunction and late potential after myocardial infarction and during follow up]

LÁSZLÓ Zoltán, KEMPLER Pál, JÁNOSKUTI Lívia, KELTAI Katalin, FENYVESI Tamás

[The prognostic significance of post myocardial infarction dysrhythmias and left ventricular dysfunction is well established. We studied the role of late potentials to predict these two abnormalities. A prospective study of the relationship between signal averaged electrocardiogram, left ventricular function and 24 hour Holter ECG monitoring was performed in 39 patients 16,3 + 17,7 days and 16,3 +8,9 months after myocardial infarction. The late potentials were determined by the following parameters: duration of the high-frequency and low amplitude signals (HFLA), voltage in the terminal 40 ms (RMS) and duration of filtered QRS waves (QRS). The left ventricular function was measured by 2D-echocardiography and the rhythm disturbances were detected by Holter ECG monitoring or by our self-developed on-line arrhythmia monitoring. No difference was noted in age (63 versus 58 years, NS), and in the three late potential parameters (HFLA: 34 versus 34 ms, NS; RMS: 43 versus 38 uv, NS; QRS: 109 versus 114 ms, NS) between the groups of patients with normal( 1 group: EF > 40%) and abnormal (2nd group: EF < 40%) left ventricular function. There was a significant difference in all three late potential parameters between the two groups of patients (A. and B. groups) based on the appearance of ventricular rhythm abnormalities (HFLA: 43 versus 31 ms, p<0,01; RMS: 24 versus 47 uv,p<0,05; QRS: 121 versus 106 ms, p<0,01). High resolution electrocardiography may be of prognostic value in selecting a high risk subset of patients (ventricular arrhythmias, sudden death) after myocardial infarction. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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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.

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SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

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[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]