Lege Artis Medicinae

[Fine Art Column]

NASZLADY Ágnes

APRIL 29, 1992

Lege Artis Medicinae - 1992;2(04)

["As long as you are alive among the living..." In the Iliad we read: '... for he who is a physician is worth as many, if he has to cut out an arrow and administer medicine' (translated by G. Devecseri) From the Homeric epic we know the names of two physicians in the Achaean army....]

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Lege Artis Medicinae

[Malnutrition syndrome in childhood part I.]

BAKSAI László, PHILIP W. H. Eskes

[Malnutrition is a chrocic nutritional disorder resulting from insufficient intake of caloric energy and/or some the fundamental nutrients. Since it is the most common public health problem in the world it has a great impact on pediatric morbidity and mortality. The etiology is extremely complex. When one considers the less severe symptoms and signs caused by vitamin-, mineral-, and trace element deficiencies, it is apparent that not only children living in underprivileged countries are affected. In the course of making the diagnosis an assessment of the nutritional status should also be made, especially considering the above-mentioned marginal nutritional deficiencies. The most common manifestation of nutritional disorders is anemia, which is mostly caused by lack of iron, vitamin B12, folic acid and can be complicated by infections. Nutritional requirements can be affected by several drugs. That is why this medication-nutrition interaction has to be kept in mind during treatment. The interaction of malnutrition and infection is very important, primarily for three reasons: mechanisms by which infection complicates the metabolic and nutritional status of the host; importance of suboptimal nutritional status on susceptibility and severity of intercurrent infections; clinical and therapeutic implication of these interactions. ]

Lege Artis Medicinae

[The bleeding time]

BODA Zoltán

[The bleeding time is considered to be the best screening test for the detection of disorders of primary haemostasis. Despite a large number of bleeding time tests, the exact pathophysiological background of the prolonged bleeding time is unknown. The significance of the cellular (platelet) von Willebrand protein is emphasized. A sensitive method (Ivy) and standardized devices (Simplate) are suggested. Examination of the bleeding time in cases of von Willebrand disease and congenital or acquired thrombocytopathy is essential. Specific recommendations regarding the rational use of the bleeding time (diagnostic algorythm) are presented. ]

Lege Artis Medicinae

[Clinical importance of pharmacogenetic investigation]

VAS Ádám, RÓNA Kálmán, GACHÁLYI Béla , SZABÓ Ildikó

[This is a brief review on the most important monogenically determined metabolic polymorphisms, their biochemical background and clinical significance. Relevant data from literature are also featured. The authors review data on possible connections between metabolic polymorphism and the risk of certain diseases.]

Lege Artis Medicinae

[Correspondence]

SZOMBATI István, MANNINGER Jenő, KAZÁR György, HARMAT Pál, MÁRTON Éva, KRASZNAI Géza

[Includes the following letters : Little Hungarian point system; ...and the injured?; Abuse of psychosomatics the organic dimension of psychiatry; Psychogenic horsekick; ]

Lege Artis Medicinae

[P300 wave evoked by visual and acustic stimuli in parkinsonian patients with or without dementia]

MOGYORÓS Ilona, SZOMBATHELYI Éva

[Authors analysed the relationship between cognitive function disturbance observed in patients with Parkinson's disease and clinical features of the disease. Relationship between the latency prolongation of the P 300 wave and the duration of substitution therapy, clinical form and severity of the disease (the Hoehn-Yahr stage) was examined. 75 randomly selected young patients with Parkinson's disease were divided in to two groups: one with and the other without dementia as determined by the Wechsler. Hunt and Mini Mental State tests. The latency of the P 300 wave using visual and acoustic stimuli was determinated. Significant prolongation of the latency of P 300 wave evoked both by visual and acoustic target stimuli was found in parkinsonian patients with dementia. Patients with dementia have longer duration of disease and substitution therapy. The akinetic-rigid form of the disease was more frequent in this group as well. A significant part of younger patients are chacarterised not only with motor but with cognitive function disturbance, too. Determination of the latency of P 300 wave helps to select these patients and to choose the adequat therapy. ]

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CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.

Lege Artis Medicinae

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