Lege Artis Medicinae

[Dilemmas in obstetrics]

FRENKL Róbert

MARCH 20, 2002

Lege Artis Medicinae - 2002;12(03)

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Lege Artis Medicinae

[A case of restrictive cardiomyopathy due to anthracycline treatment]

HELTAI Krisztina, SZABÓKI Ferenc

[INTRODUCTION - A case of restrictive cardiomyopathy with consecutive arrhythmia is presented which developed 20 years after adriablastin treatment CASE REPORT - A 30 years old women has already been treated for 3 years at an outpatient clinic for paroxysmal supraventricular tachycarcia (PSVT) and shortness of breath. All therapeutic interventions were ineffectual, since the patient refused to take the prescribed medicines because of feeling worse after taking them. This lack of compliance was first explained by vegetative neurosis, but later she was examined with the suspicion of dilatative cardiomyopathy and coronary heart disease. The patient was admitted to the Cardiology Intensive Care Unit with cardiogenic shock which developed after injection of propafenon that had been given due to PSVT. On admission sinus rhythm was seen, but later PSVT and non-sustained VT were recorded. Echocardiography showed diffuse hypokinesis, normal diameter of left ventricle and increased right ventricle pressure. Considering the low EF and the recurring high frequency arrhythmia, amiodarone treatment was introduced successfully. From the medical history of the patient it emerged, that in 1977, she underwent surgery due to neuroblastoma with consecutive combined chemotherapy containing adriablastin. CONCLUSION - It is presumed that the recurring arrhythmia was a consequence of restrictive cardiomyopathy resulting from anthracycline treatment. To prove the diagnosis of restrictive cardiomyopathy echocardiography, Swan-Ganz catheter insertion, coronarography and myocardium biopsy were performed to exclude other possible causes of restrictive cardiomyopathy and to verify the toxic effect of anthracycline.]

Lege Artis Medicinae

[Psychiatric disorders associated with childbearing]

PÁLL Irén

[The aim of this brief literary review was to draw attention to psychiatric disorders accompanying childbearing and to point out their importance. Authors begin with a historical perspective, the definition of concepts and the presentation of epidemiological data. It is followed by the mapping of multiple entwining etiological factors, then focus on the risc factors. Finally the principles are outlined to be followed in screening, prevention and treatment. Although these conditions develop quite frequently and have serious consequences regarding the individual (“unity of mother and child”) as well as the family and the society, their recognition still present difficulties. Following the establishment of the diagnosis, it is also important to start adequate therapy in time. The solution of the future would be to focus on prevention. This would be realized through the teamwork of would-be parents, health care specialists and researchers.]

Lege Artis Medicinae

[Who will remain a member of the Hungarian Chamber of Physicians? - Reflecting on home birth in Hungary]

SZEBIK Imre

[The Hungarian Chamber of Physicians (HCP) has suspended the membership of two physicians since they provided medical care in planned home births. The idea of planned home births is vehemently opposed by the HCP declaring this practice as unprofessional and unethical. There is no scientific evidence from Hungary to justify the opinion of the HCP. Since data from Western European and North American countries suggest that planned home birth may be as safe as hospital birth for certain low risk mothers, an objective scientific research is suggested in Hungary to evaluate the risks of home birth versus hospital birth.]

Lege Artis Medicinae

[Localised and generalised osteoporosis in autoimmune polyarthritis]

TÓTH EDIT

[In this article, recent data are summarised on the osteoporosis occurring in autoimmune polyarthritis. Involvement of the bone in patients with autoimmune diseases occurs in two forms: localised (around inflamed joints) and generalised. Paraarticular osteoporosis has been known for a long time but new methods of bone measurements highlight the rate and cause of bone loss. Generalised skeletal changes in rheumatoid arthritis, in systemic lupus erythematosus and juvenile chronic arthritis have been proved by epidemiological studies. At present, there is no evidence supporting generalised bone loss in other chronic inflammatory diseases. Despite the fact that clinically apparent osteoporosis in autoimmune diseases is associated with severe health impairment and reduced survival rates, osteoporosis is still underdiagnosed and prophylactic strategies have yet to be found for this group of patients. These facts indicate calling specialists’ attention to the importance of osteoporosis in inflammatory diseases.]

Lege Artis Medicinae

[VIIth Debrecen Cardiology Days]

MOHÁCSI Attila

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[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

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MARTON István, ELEKES Tibor, CSERMELY Gyula

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[SOME ETHICAL DILEMMAS OF PLACEBO-CONTROLLED STUDIES]

KOVÁCS József

[The article deals with the question where and when is it ethically acceptable in a randomized controlled clinical trial to give the investigational drug to one of the groups, while placebo to the other. First, it gives a short overview on the origin of the problem and the history of its reemergence before and after the revision of the Declaration of Helsinki 2000. It examines the various forms of placebo use, the pros and cons of its implementation, the international debate before the revision of the Declaration of Helsinki 2000 and the corrections after its acceptance. Finally it declares some principles in connection with placebo controlled clinical trials and examines when such a trial is acceptable in various psychiatric disorders.]

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[Pain in the knee - and what’s behind it - The dilemmas of management]

BÁLINT Géza

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[Suppressing the Passion to Paint, or Basic Dilemmas of Female Existence – Peder Severin Krøyer and Marie Triepcke ]

GEREVICH József