Lege Artis Medicinae

[Either you sink or swim?]

KAPÓCS Gábor

APRIL 20, 2002

Lege Artis Medicinae - 2002;12(04)

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Lege Artis Medicinae

[One year follow-up of patients after successful Helicobacter pylori eradication therapy]

VINCZE Áron

Lege Artis Medicinae

[Recognition of mental disorders in primary care]

FÜREDI János, RÓZSA Sándor, SZÁDÓCZKY Erika, ZÁMBORI János

[BACKGROUND - Several studies have shown that a substantial part of patients with mood and anxiety disorders seeks help at their primary care physician. It is well known that recognition of these disorders cause difficulties for general practitioners. In our study starting in 1998, we attempted to map the psychiatric disorders present in primary care patients. This paper investigates the factors that may contribute to the difficulties in recognition and diagnosis of mental disorders. METHOD - 1815 primary care patients in 12 general practice offices has been evaluated for mood and/or anxiety disorders with DIS interview. The DIS diagnosis was compared with complaints and symptoms of patients and diagnosis given by their GPs. RESULTS - Diagnosis given by GPs and DIS evaluation showed low concordance. The main factor in this proved to be the presence of somatic disorders, whereas socio-demographic factors played little role. The highest concordance of diagnosis was found when acute or chronic somatic disorders were not present.]

Lege Artis Medicinae

[Rapid-acting human insulin analogues: new possibilities in the therapy of diabetes mellitus]

KERÉNYI ZSUZSA, TAMÁS GYULA

[Modifications of the insulin molecule at the end of the B chain resulted in the development of some new, more physiological meal-related insulins, the rapid acting human insulin analogues. This survey summarises the characteristics (structure, absorption, immunogenicity, efficacy and safety) and the conditions of clinical application of the rapid-acting insulin analogues available at the moment in Hungary. Furthermore, authors evaluate the effect of application of rapid-acting insulin analogues on the quality of life and glycaemic control of the patients. The collaboration between the well-prepared health-care team and the well-educated and cooperative diabetic patient using rapid-acting insulin analogue could lead to a level of freedom of lifestyle that approximates that of healthy people.]

Lege Artis Medicinae

[Cochlear implantation: results and perspectives in the therapy of profound deafness in Hungary]

KÜSTEL Marianna, RIBÁRI Ottó, RÉPÁSSY Gábor

[Cochlear implantation is a relatively new method that revolutionised the therapy of bilateral deafness and profound hearing loss of inner ear origin which could not be treated with surgery before. The function of the inner ear that is irreversibly damaged either because of congenital causes, trauma, infection or unknown origin is substituted by cochlear implant. In implanted patients the device fixed in the middle ear transmits the previously transformed electrical stimuli directly to the cochlear nerve via the electrodes inserted in the inner ear. Prior to implantation there is a detailed selection process and also a lengthy, followed by a several-year-long rehabilitation period, resulting in nearly perfect speech discrimination without lipreading in most cases. Cochlear implantation is indicated in the first place in case of prelingual deafs under 5 and postlingual deaf patients of any age. In the article authors discuss the theoretical basis, technical background and indications of cochlear implantation, while also providing an overview of the whole procedure from the preoperative examinations to postoperative rehabilitation.]

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[National and international experience of mammography screening]

PÉNTEK Zoltán

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Hyperhomocysteinemia in female migraineurs of childbearing ages

ALEMDAR Murat, SELEKLER Macit Hamit

Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

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[The diagnostic and management challenges for posterior reversible leucoencephalopathy syndrome]

KILIC COBAN Eda, GEZ Sedat, KARA Batuhan, SOYSAL Aysun

[Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by epileptic seizures, headaches, altered mental status and focal neurological signs. Hypertension is the second most common condition associated with PRES. The 50-year-old-male patient with right-sided hemiparesis and speech disturbances admitted to our clinic. His blood pressure at the emergency service was 220/140 mmHg. A left putaminal hematoma was seen in his CT and MRI. In his brain MRI, FLAIR and T2 –weighted sequences showed bilateral symmetric diffuse hyperintensities in the brain stem, basal ganglia, and occipital, parietal, frontal, and temporal lobes. After the intense antihypertensive drug treatment, his blood pressure came to normal limits within a week. During his hospitalisation he had a recurrent speech disturbance lasting an hour. His electroencephalography was normal. In his repeated diffusion weighted MRI, an acute lacunary infarct was seen on right centrum semiovale. Two months later, the control MRI showed only the previous lacuner infarcts and the chronic putaminal hematoma. We presented a case developping either a cerebral hemorrhage or a lacunar infarction due to PRES. The main reason of the following complications of the disease was delayed diagnosis. Uncontrolled hypertension was guilted for the events. ]

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[Psychosocial conditions of adult epileptic patients in Hungary]

RAJNA Péter, SÓLYOM András, VERES Judit

[Authors analyze the possible connections among psychosocial, more important epileptological and social conditions in the population of the Hungarian Epilepsy Database. The inclusion criteria were the presence of repeated epileptic seizures, the strict diagnosis of epilepsy and at least three registered control visits. Four hundred and fifty 30 or more years old patients fulfilled the criteria. Based on the answers to four questions in the database considering some conditions potentially modifying the way of life the patients were scored and distributed into 3 subgroups (good, average and bad) concerning their psychosocial conditions. In contrast to previous expectations they found that the type of epilepsy does not influence the attainable psychosocial conditions. Presence of generalized tonic-clonic or complex partial seizure did not exhibit influence either. Analysis of the seizure frequency showed that generalized convulsions, if occurred rarely were accompanied by good psychosocial level and if occurred frequently they were accompanied by a less acceptable level. Psychopathological symptoms independently from their nature and evidenced brain lesion as etiology also made the psychosocial conditions worse. No difference was found concerning the gender of the population. It contradicts the hypothesis that epilepsy has a greater impact on females. Psychosocial conditions are better in patients with higher education and living in pairs. Based on the study authors support the statements of the literature emphasizing that for achieving the best quality of life and psychosocial level an appropriate medical care is not enough. They need also the relative highest level of education and a stable partnership.]

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[Depression in neuropsychiatric diseases]

HIDASI Zoltán, SALACZ Pál, CSIBRI Éva

[Depression is frequently observed together with neurological disorders. Moreover this connection is bidirectional in the case of several neurological disorders, as depression can be either a comorbide syndrome or also a risk factor of them. Neurobiological background of depression involves neuroanatomical structures, their interconnected networks, disturbances of neurotransmitters, neurohormonal, neuroimmunological and neurotrophic changes, genetic background. Disfunction of these systems also plays a role in the pathogenesis of comorbid depression of neurological disorders. Interactions and clinical aspects of biological factors involved in the pathogenesis of depression in dementias, Parkinson’s disease, cerebrovascular disorders and epilepsy are discussed further. Depression as a result of neurobiological factors responsible for both neurological and psychiatric consequencies of these disorders, are often atypical as a clinical manifestation, however chracteristic for the particular neurological disorder. Evaluation of the biological backgound and clinical features of depression in neurological disorders makes the complex neuropsychiatric approach of these disorders possible.]