Lege Artis Medicinae

[Inflammatory bowel diseases in focus]

NAGY Ferenc

MAY 26, 2008

Lege Artis Medicinae - 2008;18(05)

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[Clinical neurophysiological methods in diagnosis and treatment of cerebrovascular diseases]

NAGY Ildikó, FABÓ Dániel

[Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient’s condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology. ]

Hungarian Immunology

[Long-term follow-up of a large Hungarian lupus patient population]

KISS Emese, SONKOLY Ildikó, SZEGEDI Gyula

[INTRODUCTION - The authors give a report about their experiences obtained by long-term follow-up of a large Hungarian lupus patient population. They also compare their results with literature data. PATIENTS AND METHODS - Clinical and laboratory characteristics of 800 SLE patients followed at this institution were analysed. Issues of diagnosis, therapy and outcome measures were also discussed. RESULTS AND DISCUSSION - Results indicate that the incidence and prevalence of SLE are increasing. Recently, milder cases are also recognised. Early diagnosis makes possible an early adequate therapy. Partly due to these the survival improved, and the mortality reduced. The compliance of patients also improved. The authors suggest the importance of regular medical follow-up. Despite of that, the clinical presentations of SLE have not been changed the disease became milder. Considering the longer survival in lupus, chronic complications, such as vascular diseases, osteoporosis and cancer are suspected to appear more frequently. On the other hand, there is a small group of patients still being in risk, as they fail to respond conventional immunosuppressive therapy. These patients die within a short period due to progression of SLE. This indicates the importance of research work on the pathogenesis of SLE. Based on the results of basic research novell immune modulator modalities should be developed.]

Lege Artis Medicinae

[PSORIATIC ARTHRITIS AND ITS PHARMACOLOGICAL TREATMENT MODALITIES]

KOÓ Éva

[Psoriatic arthritis is a destructive form of inflammatory arthritis that occurs in 10-30% of patients with psoriasis. Its prevalence is about 10.000 to 20.000 in Hungary. The pathogenesis includes both genetic and immunological factors. Average disease progression based on functional status is, on average, 0.05 HAQ score/year. The traditional disease-modifying antirheumatic drugs (DMARDs) are not always successful in controlling the disease and preventing joint damage. Based on the pathogenesis of psoriatic arthritis, several new drugs (anti-tumour necrosis factor alfa, or anti-TNF-α) have been introduced in the therapy, which have been found to be effective both in psoriasis and psoriatic arthritis. The development of the Biological Response Modifying Drugs (BRMDs) makes treatment possible for patients with the most serious, high activity disease, who are refractory to other therapy. There is no significant difference in efficacy among the different biological agents (etanercept, infliximab, adalimumab). The review presents the traditional DMARDs, as well as the indications, effectiveness, side effects and the national prescription regulations of the anti- TNF-alfa agents. Both DMARDs and TNF-α inhibitors can be safely used in psoriatic arthritis under strict specialist control.]

Lege Artis Medicinae

[The treatment of bleeding complications associated with anticoagulant therapy]

SCHLAMMADINGER Ágota

[The last few years have seen an increasingly widespread use of anticoagulant treatment. Not only is it applied in a wider range of diseases, but the duration of the treatment has also become longer on the basis of recent recommendations. Beside the traditional anticoagulant agents, coumarin and heparin, a new generation of anticoagulants has emerged in the past few years. These can be administered orally in a fixed dose, which will make anticoagulant treatment available for an even wider patient population. However, the more widespread use of anticoagulants will result in the growing occurrence of their most threatening adverse effect, bleeding. We summarize the treatment options for the bleeding complications in connection with the administration of the currently used anticoagulants and the available methods of their reversal.]

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[Pain management in rheumatology]

NAGY Katalin

[Pain is the most common symptom in rheumatology, which can be of mechanical or inflammatory origin, acute and chronic, nociceptive, neuropathic and psychogenic. Pain can be relieved by analgesics, nonsteroidal anti-inflammatory drugs, opioids, adjuvants and special drugs depending on the etiology, for example a gout attack can be stopped by colchicine. For pain relief, we use therapeutic guidelines of the World Health Organization (WHO), which recommends the use of analgesics, NSAIDs and adjuvants as the first step, weaker opioids as the second, and strong opioids as the third step. In rheumatology, the first step's drugs are generally used. If possible, NSAIDs should be administered briefly, potentially combined with analgesics and muscle relaxants. If pain management is insufficient, tramadol should be given. Pain relief in rheumatology also include the use of local and intraarticular injections, physiotherapy, TENS and balneotherapy. Complex therapies that combine the above mentioned methods is often more effective than the use of medications only.]