Lege Artis Medicinae

[Esomeprazole compared with lansoprazole in the treatment of erosive esophagitis]

NEMESÁNSZKY Elemér

AUGUST 20, 2002

Lege Artis Medicinae - 2002;12(08)

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Lege Artis Medicinae

[Physicians’ attitudes and suppositions in 2001 in the Polyclinic of the Hospitaller Brothers in Budapest]

BALÁZS Péter

[INTRODUCTION - Following the total socioeconomic changes in Hungary in 1989, no scientific analysis has been made about physicians' religious attributes in the new circumstances. These attributes, after four decades of political anticlericalism may affect essentially the ideological and socio-economic patterns of medical professionalism. Hungary’s 2001 census favoured such an inquiry, since it went back to the traditional questions about religious affiliations. METHODS - The ”sensitive” questions ot the census were accepted without any obstacle in the whole population and backed up the present study together with the newly established religious atmosphere in the hospital of roman catholic Hospitaller Brothers of St. John of God, which was reopened on the 1st of July, 2000. The collection of data started in November 2000 ending in December 2001. All 98 full time employed physicians participated in the inquiry carried out by personal interviews guided by the same 51 questions. Following more than half a century span, the aim of the present study was to gain measurable information about the doctors’ unknown religious affiliation and its impact on clinical problems with ethical dimensions. RESULTS - All the doctors cooperated willingly in face-to-face interviews. There was a high proportion of religious affiliation (83 persons out of 98) without any sign of mysticism in the professional values. However, the pre-eminent role of psychological factors in the healing process was stressed, opposed to the simplified materialism of medicine. The same ideological pattern was represented while ranking other professions in the social hierarchy. No physicians experienced a conflict between their religious belief and professional activity in the dayto- day service. CONCLUSION - According to the extremely underpaid medical profession in Hungary, doctors of the new hospital do not believe that now they should tolerate their underpaid status as altruistic missionaries. However, they know exactly that balancing professionalism and business of medicine, is not a task for a single hospital but an urgent one of the whole society.]

Lege Artis Medicinae

[38th Annual Meeting of the European Association for the Study of Diabetes]

JERMENDY György

Lege Artis Medicinae

[ESPS-2 (European Stroke Prevention Study 2)]

MATOS Lajos

Lege Artis Medicinae

[Atypical forms of the gastroesophageal reflux disease]

KIS János Tibor, NEMESÁNSZKY Elemér

[There is growing interest in the gastroenterology literature towards gastroesophageal reflux disease (GERD) these days. The prevalence of the disease is much higher than estimated earlier and it frequently appears in atypical forms. Literature data suggests that 30-40% of the individuals suffer from gastroesophageal reflux disease. A broad spectrum of presentation of gastroesophageal reflux disease exists, e.g. noncardiac chest-pain, ear-nose-throat symptoms, pulmonary symptoms, dental erosions, chronic cough and hiccups. Atypical forms often cause diagnostic and treatment difficulties. Authors analyze the frequency, morbidity and the pathomechanism of the extraesophageal manifestations, based on self-experience. The main goal of the review is to help to establish the diagnosis of GERD, to recognize its atypical signs and to outline the diagnostic steps to be taken. Most up-to-date treatment strategies are also presented. By the demonstration of interesting cases, authors emphasize the diagnostic importance of intragastric pH-monitoring.]

Lege Artis Medicinae

[The importance of endothelial dysfunction and possibilities of its treatment in chronic heart failure]

MOHÁCSI Attila, LIZANECZ Erzsébet

[Endothelial cells - under autocrine and paracrine control - may have a central role in the regulation of vascular tone. Endothelial dysfunction is a very early sign of heart failure but the clinical consequence is not well understood. Recent evidence suggests that upregulation of the neuro-endocrine-, and the renin-angiotensin-aldosterone system would lead to increased tissue- and circulating angiotensin-II levels. Elevated concentration of angiotensin-II provides a mechanism by which vasomotor responses to nitric oxide, prostaglandins are blunted, while the effects of vasoconstrictors such as thromboxans, endothelin and chatecholamins are enhanced. The higher basal vascular tone leads to the degeneration and atrophy of skeletal muscle, moreover to the the ischaemic damage of myocardial cells. Because renin-angiotensinaldosterone system is under genetic control, the deleterious effects of angiotensin-II depends on the angiotensin-converting enzyme gene. Pharmacological attempts to counteract endothelial dysfunction in heart failure may include the angiotensin-converting enzyme inhibitor, which can potentially improve the endothel dependent vasodilatation response. The importance of measuring endothelial function by non-invasive techniques is yet unknown, thus, before we introduce the widespread testing of patients for endothelial function, more research has to be done.]

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[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

Clinical Neuroscience

Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT

KOCATÜRK Mehtap, KOCATÜRK Özcan

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNCT/SUNA) is a rare severe headache. At the time of an attack, it can hinder a patient from eating and requires acute intervention. The sphenopalatine ganglion is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. Sphenopalatine ganglion block has long been used in the treatment of headache, particularly when conventional methods have failed. Here, we present a patient who was resistant to intravenous lidocaine, but responded rapidly to sphenopalatine ganglion block during an acute episode of SUNCT/SUNA.

Clinical Neuroscience

The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

ALTAY Servet, GÜRDOGAN Muhammet, KAYA Caglar, KARDAS Fatih, ZEYBEY Utku, CAKIR Burcu, EBIK Mustafa, DEMIR Melik

Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, ERDEN Simsek Nazan, YULUG Burak

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.