Lege Artis Medicinae

[Interdisciplinary quality assurance of hospital infrastructure Part II]

EUGEN Hauke

AUGUST 26, 1992

Lege Artis Medicinae - 1992;2(08)

[The common task of ensuring the quality of patient care as a whole makes it clear that services not directly provided are not an end in themselves. They merely provide the conditions under which the medical-care and service process can take place at all, within the framework of the division of labour. The service requirements for indirect services therefore essentially come from doctors, nurses and those who are directly involved in the treatment of patients. ]

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[The significance of interleuktin-6, it's molecular regulation in acute phase reaction]

FALUS András, BÍRÓ Judit, RÁKÁSZ Éva

[The multiple effectiveness of a hormone-like cytokine, interleukin-6 (IL-6) is highly important in a series of immunological, neuroendocrinological and inflammatory reactions of the mammalian organism. In this review a complex view of the gene and its regulation of IL-6 and the significance of the cytokine network in acute phase reaction is discussed. Manipulation of this complex network studied by the methodology of molecular biology and genetics provides entirely new approaches for the biotechnological and pharmacological regulation of inflammation.]

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[Call for support for the Healthy Breasts Foundation]

MONOS Emil

[Hungary is one of the world's leading countries in the grim international statistics on cardiovascular disease mortality, with around 80 000 people dying every year from serious cardiovascular disorders. This figure represents nearly 55% of all deaths! The vast majority of heart disease is related to the failure of the heart's own coronary arteries, and a significant proportion of brain disease is related to damage to the brain vessels themselves.]

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[The application of argon laser in cosmetological therapy]

DIMITRIJE Katalinic

[The author was one of the first in 1976 who began to use the various types of lasers for plastic-esthetical reasons and for therapy of skin lesions. He considers the indication spectrum of the argon laser to be the largest and its results are the best. The author summarizes and makes known the tissue-effects of the argon laser and compaes it with the tissue-destruction of other lasers and classical methods. The quality of the tissue destruction determines the indications and the applications, among them the therapy of the port wine syndrome. In the author's opini on, not the exposition time and the energy of the argon laser could be exactly determined. The experience of the physician plays the most important tole in the therapy. ]

Lege Artis Medicinae

[The mode of action of bath therapy]

BENDER Tamás

[Bath therapy includes both hydro- and balneotherapy. During hydrotherapy the patient is treated by the physical parameters of the water. The effect of balneotherapy is based on the penetration of the mineral water. Its me chanism is not yet clear. There are several double-blind studies which prove the benefits of balneotherapy. Further studies are needed to judge the objective effects of balneotherapy. ]

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[Correlation between clinical data and histologycal findings assessing the severity of ulcerative colitis]

NAGY Ferenc, KARÁCSONY Gizella

[ A knowledge of the current activity of ulcerative colitis is essential in planning appropiate follow-up. Histological findings obtained from 209 colonoscopies were compared with the values of 22 clinical variables. One way analysis of variance was carried out. Of the 22 variables 11 proved to be significantly different between the groups of the clinically valuable classification (inactive, chronic, acute). Each of the three groups differed in the number of bloody stools. The acute inflammatory process was characterized by the high numbers of bowel movements, mucus and bloody mucus defecation, bowel movements at night, and haematocrit values suggesting anaemia. The serum iron levels in the inactive group differed significantly from the levels of both the acute and the chronic groups. The count of thrombocyte and the general well being were found to be valuable only in the differentiation between the acute and the inactive inflammatory processes. The computed haematocrit value proved to be useful in distinguishing the acute stage from the inactive and the chronic process. Out of the 22 variables only 11 had clinical importance in the evaluation of the activity of ulcerative colitis. ]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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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

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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.

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[What happens to vertiginous population after emission from the Emergency Department?]

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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.]