Lege Artis Medicinae

[Electrophysiologic study versus electrocardiographic monitoring]

MATOS Lajos1

JULY 27, 1994

Lege Artis Medicinae - 1994;4(07)

[Both invasive electrophysiological techniques and Holter monitoring are used to assess and predict the efficacy of drug therapy in patients with ventricular arrhythmias. These two modalities were compared in this study, the largest of its kind to date. ]

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  1. Országos Kardiológiai Intézet

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Lege Artis Medicinae

[Ultrasonic signs of suspected fetal chromosomal aberration]

ÁDÁM Zsolt, NÉMET János, SZABÓ István, CSABAY László, TÓTH-PÁL Ernő, HAJDÚ Júlia

[The authors summarize the relevant ultrasonic findings in case of suspected fetal chromosomal aberration. Some of these signs are detectable during routine ultrasonic screening examinations. In high-risk cases, prenatal chromosomal analysis is recommended. The following ultrasonic findings indicate a situation of high risk: disturbances of the lymphatic and amniotic fluids (e.g. hydrops, hygroma colli, polyhydramnios, nuchal edema), certain skull and brain alternations, abnormalities of the thorax and abdomen, and „minor” findings such as a single umbilical artery, choroid plexus cyst, pyelectasy, or changes in the size or shape of the long tubular bones, if these signs are accompanied by other anomalies or growth retardation.]

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[Advantages and limits of the open tube and flexible esophagoscopes]

TÓTA Julianna, IRÁS Béla

[The two types of endoscopes presently available for examination and treatment of the esophagus are the traditional open tube esophagoscope and the flexible endoscope. Despite the many advantages offered by the flexible endoscope, its limitations should not be forgotten. The open tube esophagoscope should not be thought of as out-of-date, since its new variations have important therapeutic applications. The authors examine the advantages and disadvantages of the two types of esophagoscopes as discussed in the literature. ]

Lege Artis Medicinae

[An update on obstructive sleep apnea]

METES Ágnes, HIRSCHBERG Andor

[Obstructive sleep apnea, which occurs in approximately 2% of the adult population, is the more common of the two major forms of sleep apnea. The conse quences and dangers of excessive daytime sleepiness are emphasized along with the other well-known characteristics of sleep apnea syndrome. Both the decreased upper airway muscle tone during sleep and the negative pressure due to breathing through the obstructed airways may cause upper air ways to collapse. The history has a very important role in the clinical assessment, while the role of the physical examination is limited. An exact and reliable diagnosis may be arrived at through laboratory evaluation, e. g. polysomnography (PSG), Multiple Sleep Latency Test (MSLT), or radiologic examinations. Among conservative treatments, reduction of the body weight is usually effective in mild to moderate cases. In severe apneas, nasal continuous positive airway pressure (nCPAP) is the current treatment of choice. The efficacy of surgical intervention is still controversial. According to most authors, uvulopalatopharyngoplasty (UPPP) has a 50% success rate. Most recently good results have been obtained with maxillo-facial surgery in a variety of selected patients. ]

Lege Artis Medicinae

[The role of echocardiography in the management of ventricular free wall rupture ]

PÁL Mátyás, LENGYEL Mária

[Our goal was to evaluate which diagnostic and therapeutic approaches could provide a better chance of survival. Between January 1, 1987, and December 7, 1992, 772 patients with acute myocardial infarction were treated in the Hungarian Institute of Cardiology. Cardiac rupture was investigated by the retrospective analysis of clinical data, electrome chanical dissociation, echocardiographic signs and autopsy findings. Ventricular free wall rupture was found in 28 cases. The diagnosis was confirmed by autopsy in 23, by intraoperative findings in 4 cases, and by echocardiography and pericardiocentesis in 1 case. Pericardial effusion was detected in 12 of 14 cases undergoing emergency echocardiography. Seven of these had pericardiocentesis and 2 patients underwent surgical pericardial fenestration. Following this 4 patients were referred to surgery. All 4 patients died: 2 during and 2 shortly after operation. The bleeding stopped in 1 case, after pericardiocen tesis and continous drainage and during the 12 month follow-up the patient is alive and well. In acute myocardial infarction, electromechanical dissociation or signs of tamponade are indications for emergency echocardiography, and if pericardial effusion can be visualized, pericardiocentesis should be performed. This can lead to a temporary haemodynamic improvement, providing sufficient time for emergency surgery.]

Lege Artis Medicinae

[Rapid photocopy documentation of histological speciments]

KISS Ferenc, CSABA Andrea, KELLEI Ilona, CSELLÁR Mihály, SZERDAHELYI Andrea

[A simple photocopy technique for histological slide preparations of surgically removed specimens is described. Standard office copy machines may be used for this method which is faster than traditional photography and cheaper than polaroid technique. Significant information is quickly provided by the copies for both the physician and the pathologist, including location and extent of the lesion, the state of its neighbouring structures and the resection margins. Retrospective identification of the tissue sections chosen for histological investigation is also facilitated. Despite some technical limitations, this copy technique may effectively support the diagnostic work of the surgical pathologist.]

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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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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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