Lege Artis Medicinae

[Intellectualism in a white coat]

ANDRÁS László

OCTOBER 28, 1992

Lege Artis Medicinae - 1992;2(10)

[Interview with István Mikola, Director of Szent László Hospital, member of the Health Insurance Supervisory Committee.]

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Further articles in this publication

Lege Artis Medicinae

[Diagnosis and treatment of acute obstetrical DIC]

RÁKÓCZI István

[Modern management of acut obstetrical diffuse intravascular coagulation (DIC) was evaluated. A large variety of obstetrical conditions are associated with acute DIC such as amniotic fluid embolism, abruptio placentae, intrauterine infection (septic abortion), dead fetus syndrome and prolonged shock of any aetiology. Typically, acute obstetrical DIC is associated with haemorrhage (mainly vaginal bleeding) and shock. The whole blood coagulation time, platelet count and fibrinogen level are the most clinically useful indicators in evaluating the patient with acute DIC. Management of acute DIC includes prompt treatment of precipitating factors (delivery of fetus in placental abruption, evacuation of the uterus in septic abort union plus administration of antibiotics, delivery of a dead fetus by induction of labor). Careful attention to fluid and blood cell replacement is needed to prevent and treat hemorrhagic shock. The coagulation failure is treated with fresh-frozen plazma or cryoprecipitate and platelets. In acute obstetrical DIC complicated by hemorrhage heparin has no use and will only cause the bleeding to worsen. Recently several clinical studies indicate that antithrombin III concentrates are efficacious in DIC.]

Lege Artis Medicinae

[Disseminated intravascular coagulation in the newborn]

GOLDSCHMIDT Béla

[A review is given on disseminated intravascular coagulation in the newborn period. DIC is not a single disease entity, but a complication of several underlying diseases. The author summarizes the physiologic and pathophysiologic conditions which promote the development of this blood coagulation disorder in this age. Further on the clinical symptoms, the difficulties of laboratory analysis as well as of differential diagnosis are discussed. Finally a detailed description of the treatment of the neonatal DIC syndrome is given. ]

Lege Artis Medicinae

[The risk of ischemic heart disease in patients with ischemic cerebrovascular disease]

HORVÁTH Sándor

[A strong association is supported between ichemic cerebrovascular and heart diseases by several studies. Death is more commonly caused by myocardial infarction than by stroke itself in patients with asymptomatic carotid stenosis, amaurosis fugax, transient ischemic attack or ischemic stroke. Signs and symptoms of ischemic cerebrovascular diseases or asymptomatic atherosclerosis of the arteries of the neck are harbinger for both myocardial and cerebrovascular infarction. Patients suffering from ischemic cerebrovascular diseases should be routinely investigated, treated and cared for coronary artery disease in order to prolong survival. ]

Lege Artis Medicinae

[Results and perspective of gene therapy in the treatment of primary immunodeficiency]

SÓFI Gyula, MARÓDI László

[During the last decade research has been directed toward gene-replacement therapy of genetic disorders, including primary immunodeficiencies. Efficient methods for gene transfer were developed to correct the gene defect in adenosine desaminase deficiency, leukocyte adhesion deficiency and chronic granulomatous disease. Somatic gene therapy in a patient with ADA deficiency was performed two years ago. This paper summaries inicial clinical applications of gene transfer and gene therapy in primary immunodeficiency and the future prospects of gene therapy in cohort of patients. ]

Lege Artis Medicinae

[Third International Study of Infarct Survival]

MATOS Lajos

[There was no significant difference in 35-day mortality between the aspirin + heparin and aspirin-only groups. The incidence of re-infarction was slightly lower with aspirin plus heparin (2p <0.09). When patients also received heparin in addition to aspirin, transfusion was needed more often and non-cerebral haemorrhage was more frequent (2p < 0.01) Combining the results of ISIS-3 and GISSI-2, mortality was significantly reduced during the treatment period (p < 0.01). There was no appreciable difference in mortality or re-infarct incidence between the use of streptokinase or APSAC, but there were more allergic events in the APSAC group. There was no difference in 6-month survival between the two groups. There was no difference in the efficacy of streptokinase and tPA treatment at either 0-35 days or 6 months survival. Allergies were less frequent with tPA, but non-cerebral haemorrhage was more frequent. Treatment with tPA led to stroke significantly more often than streptokinase (2p < 0.01). Combining the data from the similar GISSI-2 trial and ISIS-3, no difference was observed between streptokinase and tPA in either mortality between 0-35 days or survival at 6 months. ]

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Clinical Neuroscience

Parry-Romberg syndrome: is it a “relapsing-remitting” disease?

KAYA TUTAR Nurhan , AKKAS Yazıcı Sinem, OMERHOCA Sami, KALE Nilufer, SAIP Sabahattin

Parry-Romberg syndrome, also known as progressive hemifacial atrophy, is a rare, slowly progressive disorder characterized by unilateral, painless atrophy of the skin and subcutaneous tissue of the face. Neurological manifestations such as epilepsy, migraine and trigeminal neuralgia are relatively common and accompany in 15-20% of cases. Various etiologies such as infection, trauma, embryonic developmental dysfunction, sympathetic dysfunction and autoimmune disorders have been suggested as possible causes. Here we describe a 37-year-old woman whose disease manifested with dynamic contrast enhanced white matter changes over a period of two years, suggesting a “relapsing-remitting” course. Besides the inflammatory activity, positive serum-autoantibodies, inflammatory findings in cerebrospinal fluid, and an overlapping systemic autoimmune disorder may further support the hypothesis of autoimmune-inflammatory mediated pathogenesis.

Clinical Neuroscience

Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in essential tremor

TAK Zeynal Abidin Ali, SENGUL Yildizhan

Introduction - Although essential tremor (ET) is the most common cause of tremor, the pathology and underlying mechanisms have not fully understood yet. In addition to kinetic tremor, patients may present several types of tremor, gait ataxia, hearing deficits and eye movement abnormalities. Non-motor symptoms and signs have also added to definition of ET. There is significant evidence indicating the neurodegenerative nature of the disease. New studies indicate that inflammation may have a place in the etiology. The neutrophil-to lymphocyte ratio (NLR) and the platelet-to lymphocyte ratio (PLR) have recently begun to be used as a marker of systemic inflammation. Our study aims at finding a clue for systemic inflammation in ET. Methods - 67 patients with ET and 40 healthy controls were recruited for the study. The total white blood cells (WBC), absolute neutrophil count, lymphocyte count and platelet count were retrieved. The NLR was calculated by dividing the neutrophil count by the lymphocyte count and the PLR was calculated by dividing the platelet count by the lymphocyte count. Results - Patient and control groups were similar in terms of age and gender. The mean age of patient group was 25.29 ± 8.24 years and that of control group was 26.77 ± 6.73 years. The NLRs were 1.85 ± 0.58 in the patient group and 1.96 ± 0.53 in the control group. For the patient group and the control group the PLRs were 103.52 ±32.80 and 91.26 ± 31.57 respectively. There were no statistically significant differences between the participants for both NLR and PLR. Conclusion - The pathophysiological mechanism for essential tremor (ET) remains unclear. However, there is an increasing amount of research being conducted on the subject. Discussions about ET’s definition as a neurodegenerative disease are ongoing. Although previous studies showed that neuroinflammation could be a part of etiology of disease, this study has failed to demonstrate systemic inflammation in ET.

Lege Artis Medicinae

[Rescue dictionary]

N Gy

[A few words about the people in grey clothes speeding in white cars. ]

Clinical Neuroscience

[Tissue water content determination based on T1 relaxation time of water and quantitative cerebral 1H MRS at 3T using water as an internal reference]

FILE Györgyi, BAJZIK Gábor, DÓCZI Tamás, ORSI Gergely, PERLAKI Gábor, LELOVICS Zsuzsanna, ARADI Mihály, SCHWARCZ Attila

[Objective - Application of a quantitative MR-spectroscopic method for 3T clinical scanners based on tissue water content as an internal reference. Patients and methods - Six (22±2 yrs) volunteers were involved in the study. We performed T1 relaxation time measurements in a particular slice of the brain at 1T and 3T. Based on the validated water content measurement at 1T, the correlation of relaxation time T1 and water content was determined at 3T. The resulting water content served as internal reference for the quantification of localizated MRspectroscopic measurement. Results - At 3T our method resulted in 37.6±0.5 mol/l and 46.4±1.5 mol/l tissue water content in the white and gray matter, respectively. Calibration based on water content led to following metabolite concentrations: N-acetyl-aspartate 7.79±0.67 mmol/l; creatine 3.76±0.28 mmol/l; choline 3.68±0.47 mmol/l; myo-inositol 10.35±3.70 mmol/l in the white matter; and N-acetyl-aspartate 8.20±0.45 mmol/l; creatine 4.76±0.18 mmol/l; choline 2.64±0.35 mmol/l; myo-inositol 8.32±1.42 mmol/l in the grey matter. Conclusions - Tissue water content based on T1 value at 3T shows good accordance with gravimetric or other MR methods in the literature. Using it as an internal reference resulted in white matter metabolite concentrations that are in the range of previously published data. Comparing metabolite values of grey matter is more difficult because data in the literature substantially differ. The presented method is simple and easily applicable on any MR scanner without complicated correction and calibration steps.]

Lege Artis Medicinae

[Health care and general practice in South Africa]

KÖVESI Ervin

[With the establishment of diplomatic relations and the start of economic cooperation, the Republic of South Africa has come to the fore. Public opinion at home has been watching President De Klerk's political reform efforts with a similar interest, which were endorsed by a large majority of white voters in a referendum held in mid-March.]