Lege Artis Medicinae

[Ethical dilemmas]

KOVÁCS József

SEPTEMBER 19, 2007

Lege Artis Medicinae - 2007;17(08-09)

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[THE USE OF ACID SUPPRESSANTS IN PANCREATIC DISEASES]

GERVAIN Judit

[The histamine-2 receptor antagonists and the proton pump inhibitors are part of current therapeutic protocols for most diseases of the pancreas. Acid suppression is definitely recommended to improve the effect of enzyme supplements in chronic pancreatitis and in maldigestion that develop after certain gastric and pancreatic surgeries. For this purpose proton pump inhibitors should be used since they are effective and provide lasting inhibition. In cystic fibrosis, their use is indicated already in the sub-clinical stage and they are also part of the basic protocol for the treatment of Zollinger-Ellison syndrome. Acid suppressants are not routinely used in the therapeutic protocols of acute pancreatitis. Their use is well-grounded in necrotizing pancreatitis in the stage of multiple organ failure to prevent the development of stress ulcer. During enteral tube feeding, their use is indicated to protect the permanently empty stomach and because of the frequent reflux symptoms. The risk of bacterial overgrowth, which is often considered a contraindication, is insignificant if jejunal tube feeding is applied and antibiotic treatment is frequently administered.]

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[Diseased or Possessed?]

dr. BÁNFALVI Attila

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[NON-INVASIVE CORONARY ANGIOGRAPHY BY MULTISLICE COMPUTED TOMOGRAPHY]

PRÉDA István, KERECSEN Gábor, MAUROVICH-HORVAT Pál

[This review summarizes the diagnostic spectrum, ways of application and methodological difficulties of multislice computed tomographic (MSCT) coronary angiography. The non-invasive assessment of cardiac and coronary anatomy is now possible with computed tomographic coronary angiography using the modern 16 to 64-slice technology. This technique finds its main use today in the screening of patients with moderate probability of having coronary artery disease (atypical chest pain). Its negative predictive value varies between 97% and 99%, thus, a negative result of this non-invasive outpatient procedure can reduce the possibility of coronary artery disease to the minimum. Other important diagnostic applications include the follow-up of patients with coronary artery bypass, accurate diagnosis of coronary artery anomalies, and the simultaneous examination of the heart and great vessels. The future development of the technique is directed to coronary plaque characterization, particularly the detection of vulnerable plaques. The radiation exposure is relatively low (7-13 mSv), comparable with that of invasive coronary angiography.]

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[Vascular malformations in Klippel-Trenaunay syndrome recognised by endoscopy]

KOVÁCS Márta, REUSZ György, SZABÓ Attila, DEZSŐFI Antal, GYŰRŰS Péter, JÁNOKI Márta, RÁCZ István

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[“Yesterday no longer exists either…” - End-of-life ethical issues in the care of dementia patients]

HEGEDÛS Katalin

[The number of dementia patiens is rising. Most of them die in various institutions, often after many years of care. The long process of nursing and care entails particular ethical requirements that are built primarily on vulnerability, dignity, and dia-logue. The dialogue, however, is often absent from the care of dementia patients. Do we find - as physicians, patients, relatives - that specific time when the patients can still make decisions about end-of-life treatments in a good mental state? Most patients would like to participate in these decisions. Talking about these issues in the early stage of dementia may help in the great emotional burden of family members and caregivers. Therefore the ethical aim is the ad­vance care planning (ACP) of the end-of-life treatments. The study reviews the latest scientific results, with special regard to resources that may be helpful in the course of conversations between doctor and patient on end-of-life preferences, and in the preparation for decision making. ]

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[THE PRESENT STATE AND CURRENT PROBLEMS OF HUNGARIAN PSYCHIATRY]

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[The changes in attitude that occurred in general medicine 2 to 3 decades ago had a fundamental impact on psychiatry by giving it a greater emphasis due to the wider acceptance of the bio-psycho-social model. In parallel with this change an English-speaking professional dominance took over the former German-French traditions. Hungarian psychiatrists keep pace with the development of psychiatry, with remarkable achievements in some areas. In everyday patient care and clinical practice, however, severe difficulties are encountered. The paper reviews the trends in practice, education, research, and also the development of professional organizations. Certain ethical implications of the sociocultural changes and future trends of national psychiatry are also summarized.]

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[Transcranial Doppler assessment of cerebral vasomotor reactivity in evaluating effects of vinpocetine in cerebral small vessel disease: a pilot study]

ZAGORKA B. Jovanović, ALEKSANDRA M. Pavlović, TATJANA Pekmezović, MILIJA Mijajlović, NADEŽDA Šternić Čovičković

[Background - There are still dilemmas about the vasodilating effect of vinpocetine, a synthetic ethyl alkaloid vincamine. The method of measuring cerebral vasomotor reactivity (VMR) by transcranial Doppler (TCD) technique before and after administration of the medication was used to estimate the degree of arterioles vasodilatation. The aim of this study was to test of the vasodilating effect of vinpocetine in patients with cerebral small vessel disease (SVD) by measuring cerebral VMR. Material and methods - Thirty patients with SVD were on 3-month-long oral treatment with 15 mg vinpocetine daily. Cerebral VMR was determined by breath holding test. The breath holding index (BHI) was calculated in standard manner and values >0.69 were considered normal. At the baseline, before treatment (I), BHI, modified Rankin scale (mRS) score, Mini Mental State Examination (MMSE) score were determined. One month later (II) BHI was assessed again, while after 3 months of treatment (III) we analyzed BHI, mRS score and MMSE score. Results - The average age of patients was 61.4±11.5 years (range 40 to 77 years), 18 (60%) female and 12 (40%) males. Values of BHIs were increased during treatment at the right MCA (I) 1.18±0.53, (II) 1.26±0.54, (III) 1.37±0.41, with statistical significance between I and III measurement (p<0.05). An increase was noted on the left MCA (I) 1.25±0.53, (II) 1.31±0.55 and (III) 1.32±0.42, but it did not reach statistical significance (p>0.05). Mean MMSE score significantly increased from baseline 27.4±2.3 to 28.5±2.0 after three months of treatment (p<0.001). Functional status showed a statistically significant improvement with mRS score increasing from 2.1±1.0 to 1.1±0.6 (p<0.001). Conclusion - This pilot study showed that 3-month-long oral treatment with vinpocetine 15 mg daily had tendency to increase BHI, indicating improvement of cerebral VMR. It is possible that higher doses of vinpocetine are needed to achieve substantial increase of VMR.]

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