Lege Artis Medicinae

[Gastrointestinal stromal tumour in the stomach causing acute bleeding]

HUSSAM Saleh, DANCS Nóra, KÁRÁSZ Tibor, ERÉNYI Ákos, HORVÁTH Viktor, PAUKOVICS Ágnes, RÁCZ István

JANUARY 20, 2007

Lege Artis Medicinae - 2007;17(01)

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Lege Artis Medicinae

[Episodes from the History of Self-Experimentation in Medicine]

MAGYAR László András

Lege Artis Medicinae

[THE PLACE OF DIURETICS IN MODERN HYPERTENSION TREATMENT]

CSIKY Botond

[According to national and international guidelines, thiazide diuretics are considered first-line antihypertensive agents. They lower blood pressure and cardiovascular risk efficiently without serious side effects in low-dose monotherapy or in combination with other antihypertensives. Furthermore, when given in combination with certain antihypertensive agents, a synergistic effect develops. Indapamide is a thiazide-like diuretic, virtually without metabolic side effects. Diuretics may have special benefit in the elderly and in certain target organ damage or concomittant disease (heart failure, hypervolaemia, etc). Adequate use of diuretic therapy can prevent hypertensive end-organ damage and other complications, and improves the patients' quality of life.]

Lege Artis Medicinae

[SELF-PERCEIVED HEALTH AND PSYCHOSOCIAL WORK ENVIRONMENT. - STUDY AMONG HEALTH CARE STAFF IN SUBOTICA, SERBIA]

PIKÓ Bettina, PICZIL Márta

[INTRODUCTION - Studies have shown that work environment has a significant impact on workers’ health status and their reactions to stress, which may contribute to the development of illness, or, among health care staff, to burnout syndrome. The goal of the present study was to look at the relationship between psychosocial work environment and self-perceived health in a sample of health care staff living in Szabadka (Subotica, Serbia). METHODS - There were 253 health care workers in the study group. The majority were registered nurses, head nurses and assistants (together, 80.1%). Self-reported data were collected using a questionnaire on self-perceived health, frequency of psychosomatic symptoms, work shift pattern, and psychosocial work environment (e.g., the frequency of emotionally provoking situations or the level of dissatisfaction with work). RESULTS - Health care workers reported frequent experience of emotionally provoking situations. However, they often lack a connection network that would provide effective social support in these situations. In addition to the frequent occurrence of emotionally provoking situations and the lack of social support, voluntarily chosen extra work, shift work, and the low level of work satisfaction influence negatively their self-perceived health. CONCLUSIONS - The psychosocial work environment has a significant impact on the health care workers’ self-perceived health and the occurrence of psychosomatic symptoms. It would be necessary for health care workers to learn skills and techniques that help them cope with emotionally hard situations.]

Lege Artis Medicinae

[Management of hyperglycemia in type 2 diabetes]

JERMENDY György

Lege Artis Medicinae

[Not With, Neither Without – After the Freud year]

dr. BÁNFALVI Attila

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Simultaneous subdural, subarachnoideal and intracerebral hAemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Clinical Neuroscience

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Clinical Neuroscience

To handle the HaNDL syndrome through a case: The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis

ÇOBAN Eda, TEKER Ruken Serap, SERİNDAĞ Helin, SAKALLI Nazan, SOYSAL Aysun

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

Lege Artis Medicinae

[MANAGEMENT OF GASTROINTESTINAL DISEASES DURING PREGNANCY]

NOVÁK János, TAKÁCS Tamás, ÚJSZÁSZY László, BENE László, OLÁH Attila, RÁCZ István

[Medical treatment of gastrointestinal diseases has developed dramatically in the past 10 years. However, management of gastrointestinal disorders in pregnancy is still a serious challenge and requires special expertise. This paper provides recommendations on the indications of gastrointestinal endoscopy and treatment options based on the best available evidence, primarily from large retrospective studies and case reports. Currently there are no generally applicable, widely accepted, evidence-based guidelines available on the treatment of pregnant women. The risks of the gastrointestinal disease versus those of the medications used to treat it should be considered with regard to the health of both the mother and the foetus in each individual case. The risks and benefits of treatment and the consequences of withholding treatment should be discussed with the patient, the obstetrician and any other clinicians involved, and should be carefully documented.]

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[Diagnosis of interstitial lung diseases]

MÜLLER Veronika

[Recognition and diagnosis of interstitial lung diseases (ILD) is one of the most challenging tasks of respiratory medicine. In the wide range of different ILD-s idiopathic pulmonary fibrosis (IPF) is one of the most common. Improvements in the diagnosis made the recognition of IPF easier. Typical clinical features and usual interstitial pneumonia pattern on high resolution CT are now enough for the confident diagnosis of IPF in the multidisciplinary ILD-team discussions. Bronchoscopic cryobiopsy is a great achievement of histological sampling as this can give appropriate size tissue for histological analysis making surgical intervention rare. As IPF cannot be cured early diagnosis is crucial. Today available treatments can only slow down progression of the disease, so early stages and better clinical condition of the patients are essential for therapeutic success. Follow-up of IPF patients includes complex lung functional measurements in dedicated centers in Hungary. Former studies confirmed forced vital capacity (FVC) decline as an important measure of disease progression and mortality. Available IPF treatments decrease FVC decline and can prevent the mostly deadly acute exacerbations of the disease. Additionally palliative treatments including supplementary oxygen and in selected patients lung transplantation can be offered. This is the first of a series of three articles about IPF. ]