Lege Artis Medicinae

[Heart attack primary prevention in hypertension trial]

MATOS Lajos1

FEBRUARY 28, 1994

Lege Artis Medicinae - 1994;4(02)

[Comparison of diuretic versus beta-blocker antihypertensive treatment in men with mild-to-moderate hypertension in terms of nonfatal infarction, coronary mortality and all-cause mortality. ]

AFFILIATIONS

  1. Országos Kardiológiai Intézet

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Further articles in this publication

Lege Artis Medicinae

[Management of inhibitory haemophilia A and aquired haemophilia]

PFLIEGLER György, RÁK Kálmán, KRÁLL Géza, SAS Géza, HAYNAL Imre

[The authors survey the occurrence and the laboratory and clinical differences of factor VIU antibodies in haemophiliacs (allo) and in non-haemophiliacs (auto) as well as their titer and measurement. The recent therapeutic modalities used in prevention, management of acute bleeds and suppression of antibody development or in duction of immune tolerance are detailed. ]

Lege Artis Medicinae

[Back pain]

ANDREW Frank

[The studies to be presented show that the duration and severity of episodes of low back pain can be reduced, thus reducing the risk of recurrence and the costs of sick leave and absenteeism. Frank reviews differential diagnosis; acute, chronic and intractable pain; and the health services needed. Modern treatment principles emphasise self-care at home, usually with no more than 48 hours bed rest. The importance of regaining physical fitness and resuming other activities, including work, is also stressed. Medication helps to achieve these goals. Two issues are emphasised: the strategy for the management of low back pain should be long-term and preventive; it is the responsibility of the patient, not the doctors, to maintain fitness, exercise regularly, do relaxation exercises and avoid damaging the spine. ]

Lege Artis Medicinae

[Eating attitudes and eating disorders among secondary school dancers: a high risk group?]

TÚRY Ferenc, WILDMANN Márta, LÁSZLÓ Zsuzsa, JOÓ Mária Nóra

[The authors assessed the morbidity of eating disorders and the frequency of pathological eating attitudes in two secondary school populations in a two-stage study. The first sample consisted of two classes specialized in dancing (n=54), the second was a control group of two age-matched classes without specialization (n=61). In each group one girl met the criteria of bulimia nervosa, which was 2% of the whole population. No anorectic subject was identified while pathological eating attitudes were significantly higher among dancers characterized by an increased slimness ideal. On the basis of the study the risk of eating disorders is higher in this special population. However, this difference can be shown only in the frequency of subclinical, attitudinal disorders, not in that of clinically severe syndromes.]

Lege Artis Medicinae

[Correspondence]

SELMECZY Kamill

[Reflections on GP (family doctor) reform, training and more]

Lege Artis Medicinae

[Technical considerations to the anti-endomysium antibody assay]

KORPONAY-SZABÓ Ilma, B. KOVÁCS Judit, LŐRINCZ Margit, KÖRMENDY Miklós, SASHEGYI Julianna

[Anti-endomysium antibody and its equivalent anti-jejunum antibody were investigated in 5000 and 3444 serum samples, respectively. 2928 persons, among them 441 are known gluten intolerant patients (170 coeliac disease proven by gluten challenge, 95 dermatitis herpetiformis, 176 suspected coeliac disease with at least one jejunal biopsy result showing severe villous atrophy); 251 by biopsy proven non coeliac children served as controls. The mentioned antibodies were detected by indirect immuno fluorescence in IgA (in IgA-deficient persons also in IgG) subclass. Specificity of both anti-endomysium and anti-jejunum antibody results was 100% for gluten intolerance. Sensitivity in gluten consuming patients was: 100% in proven coeliac disease (66/66), 92,4% (61/66) in dermatitis herpetiformis and 85,9% (110/ 128) in suspected coeliac disease. 13,5% of all sera contained aspecific IgA-stainings of the following types: anti-smooth muscle, basement membrane, pemphigoid-like and anti-nuclear faktor like antibodies. Simultaneous positivity for anti-endomysium and aspecific antibodies occured too. Assessment accuracy have been improved with the use of 8–10 microns thick tissue sections. Detection of this specific autoantibodies merits first line use in the diagnosis of gluten sensitive enteropathy, but specialized laboratory centers are needed to overcome technical pitfalls. ]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]