Lege Artis Medicinae

[Dilemmas in obstetrics]

FRENKL Róbert

MARCH 20, 2002

Lege Artis Medicinae - 2002;12(03)

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Lege Artis Medicinae

[Cough syncope]

AVRAMOV Katalin, MAYER Péter, KISS Éva, PAPRIKA Dóra, ZÖLLEI Éva, VÉCSEI László, RUDAS László

[Cough syncope is an infrequently diagnosed form of situational syncope. Most of the reported cases occurs among middle-aged or elderly overweight males, suffering from chronic obstructive lung disease. In our report of four cases we demonstrate the underlying mechanism of cough syncope. Hemodynamic recordings at the time of simulated cough attacks demonstrated the equalisation of the arterial and central venous pressures with consequent cerebral hypoperfusion. The first case illustrates the difficulties of the diagnostic work-up and the confounding effects of the co-existing arrhythmia. The second and fourth cases draw attention to the relationship between cough syncope and accidents. All four patients suffered from chronic obstructive pulmonary disease resulting from heavy smoking which seems to be the most important underlying factor of this syndrome.]

Lege Artis Medicinae

[VIIth Debrecen Cardiology Days]

MOHÁCSI Attila

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

[TACT]

MATOS Lajos

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.]

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Related contents

Clinical Neuroscience

[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. ]

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.]

Lege Artis Medicinae

[Ethical dilemmas]

KOVÁCS József

Lege Artis Medicinae

[Dilemmas in the Research of Rare Diseases ]

VARGA Orsolya

Lege Artis Medicinae

[Hepatitis C - Facts and dilemmas]

LOMBAY Béla