Lege Artis Medicinae

[Historica Medica; Special ways to determine virginity]

MAGYAR László András1

JUNE 01, 2000

Lege Artis Medicinae - 2000;10(06)

AFFILIATIONS

  1. Semmelweis Orvostörténeti Könyvtár, Budapest

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Lege Artis Medicinae

[Infectiosus diseases - Past, present, future]

SZALKA András

[The complex interactions between microorganisms and humans include the well known, traditional infectious diseases and also the symbiotic relationship with the human endogenous normal flora. Forty years ago everybody was convinced that medicine would soon be able to eradicate most of the infectious diseases. Perception of victory over infectious diseases has been blunted in recent years by nosocomial infections and by the new and re-emerging diseases. The spectrum of infectious diseases is expanding and many of those once thought conquered are increasing in numbers. Moreover, the problems of infection are present in all aspects of medicine and with the field turning more and more complex its challenge for practitioners has become increasingly demanding. It is now clear, that at the dawn of the new millennium infectious disease remains the number one killer in the world. ]

Lege Artis Medicinae

[Practical aspects of screening for microalbuminuria in diabetic patients]

JERMENDY György, FARKAS Klára, NÁDAS Judit, DARÓCZY Atilla, PÉTERFALI Éva

[INTRODUCTION - The importance of measuring microalbuminuria is well established, however, controversy still exists regarding the type of urine specimen to be used for detecting early renal impairment of diabetic patients. PATIENTS AND METHODS – To evaluate practical aspects, albumin concentration and albumin to creatinine ratio of first void urine samples as well as urinary albumin excretion in timed specimens were determined by immunoturbidimetric method 3 times within 3 weeks in 192 adult diabetic patients (136 men, 56 women; type 1/type 2: 90/102; age: 51.4=10.8 years; duration of diabetes: 15.3+9.1 years; body mass index: 27.9+4.6 kg/m2; HbA1c: 8.5+1.5 %; actual blood pressure: 13814/82+8 mmHg; serum creatinine: 94+20 umol/l; x+SD). RESULTS - According to the urinary albumin excretion values, one third of patients (31.2%-30.7%-34.4%) were normoalbuminuric (<30 mg/24 hours), more than half of the patients (55.8%-57.3%-53.6%) proved to be microalbuminuric (30-300 mg/24 hours), while the remaining group of patients (13.0%-12.0%–12.0%) was macroalbuminuric (>300 mg/24 hours). Comparing the results of successive measurements good correlation was found between the same laboratory values (urinary albumin excretion: K=0.64; K=0.67; urinary albumin concentration: K=0.60; K=0.62; albumin to creatinine ratio: K=0.54; K=0.61; first vs. second and second vs. third measurements, respectively). The percentage of patients being in the same range of albuminuria (i.e. normo-, micro-or macroalbuminuria) at successive measurements was 79.7-81.2% with urinary albumin excretion values, 77.1-77.6% with urinary albumin concentration and 74.5-78.6% with albumin to creatinine ratio. Good correlations were found between urinary albumin excretion and urinary albumin concentration (K=0.54; 0.54; 0.57) and nearly the same correlations were observed between urinary albumin excretion and albumin to creatinine ratio (K=0.49; 0.47;0.54) at different series. Using values of urinary albumin excretion for comparison at all measurements, 79.3% sensitivity and 69.5% specifity were found for urinary albumin concentration whereas 74.6% sensitivity and 68.8% specifity were documented for albumin to creatinine ratio. CONCLUSION - Beside the standard measurement of urinary albumin excretion in timed urine samples, the use of the more convenient morning urinary spot collection could also provide useful results (urinary albumin concentration or albumin to creatinine ratio) for detecting early renal involvement in diabetic patients. ]

Lege Artis Medicinae

[Hypertension And BPH Intervention Trial]

MATOS Lajos

Lege Artis Medicinae

[Postnatal development of the human hippocampal formation]

SERESS László

[Jean Piaget's theory suggests that cognitive development proceeds in discrete steps. The first is the sensorimotor period that happens in the first two years of life. In recent years it became clear, that it is necessary to have an intact and mature hippocampus for adequate memory formation, both in experimental animals and humans. In the present study, the morphological development of the human hip pocampus was correlated with the developmental changes of intellectual development. Our results suggest that neuronal cell formation of the human hippocampus terminates several weeks before birth. In the dentate gyrus, a small number (less than 1%) of granule cells are still formed around birth. Immature granule cells migrate through the hilar region to their final position in the granule cell layer during the first six postnatal months. Light microscope studies of individual neurons indicate that connections between granule cells and their target neurons are not yet formed at birth. Such connections develop during the third postnatal year. If the development of the synaptic connections is damaged in experimental animals, the hippocampal function will be permanently impaired. Newborns may have basic synaptic circuits for memory formation, but the postnatal morphological changes suggest the significant modification of the hippocampal circuits happening continuously from the newborn age until late childhood. These changes may cause the phenomenon of the "infantile amnesia". ]

Lege Artis Medicinae

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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.]

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

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

[Tension type headache and its treatment possibilities]

ERTSEY Csaba, MAGYAR Máté, GYÜRE Tamás, BALOGH Eszter, BOZSIK György

[Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic consequences of tension type headache are significant. The pain in tension type headache is usually bilateral, mild to moderate, is of a pressing or tightening quality, and is not accompanied by other symptoms. Patients with frequent or daily occurrence of tension type headache may experience significant distress because of the condition. The two main therapeutic avenues of tension type headache are acute and prophylactic treatment. Simple or combined analgesics are the mainstay of acute treatment. Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat. The first drugs of choice as preventatives of tension type headache are tricyclic antidepressants, with a special focus on amitriptyline, the efficacy of which having been documented in multiple double-blind, placebo-controlled studies. Among other antidepressants, the efficacy of mirtazapine and venlafaxine has been documented. There is weaker evidence about the efficacy of gabapentine, topiramate, and tizanidin. Non-pharmacological prophylactic methods of tension type headache with a documented efficacy include certain types of psychotherapy and acupuncture. ]