Lege Artis Medicinae

[Music history; A favorite of Parisian salons]

MALINA János

MAY 01, 2000

Lege Artis Medicinae - 2000;10(05)

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Lege Artis Medicinae

[Aspirin therapy in diabetes mellitus]

ÁBEL Tatjána

[Patients with diabetes mellitus have an increased risk of cardiovascular events and this risk is often present in the prediabetic phase of the type 2 diabetes. Diabetic patients have altered platelet function, including increased production of thombox ane resulting in increased platelet aggregation. This effect is reversed by aspirin within few days after beginning treatment with 75 mg aspirin daily. These findings of primary and secondary prevention trials in men and women with dia betes mellitus support the view that low-dose aspirin therapy should be used as secondary prevention when not contraindicated, and it should also be used as primary prevention in patients who are at high risk for cardiovascular events. ]

Lege Artis Medicinae

[The role of apoptosis in human diseases]

SZENDE Béla

[Apoptosis and mitosis control the homeostasis of various cell populations. Several diseases are characterised by too much or to small amount of apoptosis. Carcinogenesis itself is connected with a decrease in apoptotic activity and malignant neoplasms are also known to show low apoptotic index. However, each type of malignant tumors should be viewed as a distinct entity, regarding the capacity for the induction of apoptosis especially. The role of apoptosis in the pathogenesis and progression of autoimmune, infectious, neurodegenerative diseases and alterations in the liver, kidney, lung and heart is also discussed, with special emphasis on therapeutic possibilities influencing the imbalance of apoptosis. ]

Lege Artis Medicinae

[Gout]

MITUSZOVA Mila

[In spite of our increasing knowledge about the pathomechanism, clinical classification and therapy of gout as well as the improving care of gouty patients, many problems of the field are unsettled. Among others, the atypical character of female gout, its more frequent occurrence in elderly women, the often aggressive character of the cyclosporin-induced gout belongs to the unanswered questions. Understanding the role of crystals covered by proteins (mostly IgG) in the induction of inflammation was of great importance, however, the changing character of inflammation caused by intraarticular MNU-crystal deposition is still a challenging problem. It is well known, that not all gouty patients are middle aged males, the number of young, drug-resistant gouty males having extensive tophi is increasing. Although the relationship between hyperuricemia and gout was clarified in many respect, it would be important to understand why chronic hyperuricemia is not associated regularly with gout and why gout can develop in patients without high serum uric acid levels. We learned finally, that early diagnosis and adequate treatment of gouty attacks and the therapy resulting in the decrease of high level of serum uric acid are prerequisites for slowing down the progres sion of the gout and for the prevention of its complications. ]

Lege Artis Medicinae

[Reiter-syndrome]

GÉHER Pál

[The Reiter-syndrome is the complex of sterile arthritis, urethritis and conjunctivitis and involvement of other organs (skin, mucosal membranes, cardiac conducting system) following bacterial enteric or urogenital infec tion. Systemic signs can also occur with polyarthritis. This syndrome belongs to the reactive arthritis group. In each year there are 30 40 new cases among 100 000 citizens. The disease can occur at any age, but most of the patients are 20-40 years old. It is the patient's genetic background and the type of invading microbes that play a leading role in the pathomechanism of the disease. The exact pathomechanism is yet unknown, therefore our treatment is symptomatic. It is advised to immobilize the involved joint and aspirate the excess fluid and to take non-steroidal antiinflammatory drugs. The patient's medical history is most important to diagnose the disease, because laboratory tests may show signs of inflammation, the serology can only prove antecedent infection, viable organism can not be cultured from the involved organs and the imaging procedures and histology shows non-specific inflammation only. The importance of diagnostic procedures is to exclude the presence of other diseases. Other causes of monarticular inflammation (infection, crystal induced arthritis, sarcoid arthritis) and rheumatic fever should be excluded. The disease lasts for 3-6 months. 2 to 18% of the patients develop chronic arthritis and 12 to 26% of the patients develop ankylosing spondylitis. ]

Lege Artis Medicinae

[The cervical spine in rheumatoid arthritis]

KORDA Judit, VERES Róbert

[The neck is the third most common site of involvement after the hands and feet in rheumatoid arthritis (RA). Deformities of the cervical spine can appear in the early stage of the disease, but most often they are seen in patients with rheumatoid arthritis with more than ten years of duration. Progression of the deformity is unpredictable, but follow up for five to ten years has shown the worsening of the instability in 16-80% of the patients. Many patients with rheumatoid disease of the cervical spine remain asymptomatic for years, but they are at risk of a range of neurological complications and even sudden death from me dullary compression. Neurological abnormalities may be subtle and difficult to establish in the presence of deforming arthritis. Once myelopathy develops, it is usually rapidly progressive. The primary goal in the management of the cervical spine is to prevent the onset of irreversible neurological deficit. Patients should have regular physical examinations to avoid the masking of subtle changes of myelopathy by severe peripheral joint disease. Use of the different measurements, especially posterior atlantodental interval and subaxial canal diameter measured on plain lateral cervical radiograph is a reliable screening tool to identify high risk patients who require further evaluation. The primary technical objective of surgery is stabilization of the diseased spinal segments and relief of spinal cord compression via reduction of subluxation or decompression. Complications are not uncommon, but tend to occur less frequently, and neurological recovery is most favorable when severe cord compression is not present preoperatively. ]

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Clinical Neuroscience

Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

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

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[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.]

Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

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.]