Lege Artis Medicinae

[Natural law and positivist elements in the rules of medical practice Part II]

LŐRINCZ Jenő

APRIL 27, 1994

Lege Artis Medicinae - 1994;4(04)

[In the Hippocratic collection, in addition to the text of the medical oath, there are also rules and regulations on medical practice. Today, more than fifty works from the 4th to 5th centuries BC are included in this collection, which are diverse in their approach and subject matter, one of the authors being Hippocrates himself.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Laboratory control of the oral anticoagulant therapy]

VAJDA Zoltán, PÁL András, SIKOS Zita, SAS Géza

[There are two basic requirements in the treatment and prophylaxis of thromboembo lic diseases by chronic anticoagulation with coumarin (Syncumar). The first is the preven tion of a new thrombosis while the second is the avoidance of concomitant bleeding complications. For this reason it is necessary to achieve an appropriate anticoagulation level which can be characterised by labora tory measurement of the prothrombin level. In this paper, the theoretical and practical as pects of the laboratory control of Syncumar treatment are reviewed. The most serious problem is that the prothrombin level (Quick time) determinations utilising thromboplastin preparations from different sources give diffe rent values in the same patient plasma, which makes comparison of data from different laboratories impossible. The paper gives a brief overview of the definition and practical use of the International Sensitivity Index (ISI), characterising the different thromboplastin preparations, and the International Normali sed Ratio (INR) which can be calculated on the basis of the ISI. In spite of unquestionable improvements, the uncertainty about instrument-thromboplastin-ISI relationships reduces confidence in the INR system, especially when differences in INR values have clinical significance. Efforts need to be directed toward providing local, laboratory/instrument specific ISI values. ]

Lege Artis Medicinae

[The clinical significance of amaurosis fugax]

HORVÁTH Sándor, SOMLAI Judit

[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]

Lege Artis Medicinae

[Methylprednisolone pulse therapy in systemic lupus erythematosus]

GERGELY Péter

[The aim of this retrospective study was to assess the efficacy and safety of methylprednisolone pulse therapy. Thirty five patients with severe systemic lupus erythematosus (lupus nephritis, severe hemolysis and antiphospholipid syndrome with central nervous system involvement, arterial occlusion and thombocytopenia) were treated by pulse methylprednisolone, followed by long-term corticosteroid (and cyclophosphamide) therapy. Thirty four patients achieved remission, after a mean of 4.7 weeks, which lasted on average for > 2.7 years. Six patients presented with an exacerbation after 1-2.5 years. Twenty eight patients are still in remission. No side effects were observed during pulse therapy. Methylprednisolone bolus therapy is safe and effective in severe systemic lupus erythematosus, including cases of lupus nephritis and severe central nervous system manifestations, but an appropriate choice of long-term therapy is essential.]

Lege Artis Medicinae

[The value of immunoscintigraphy in patients with metastatic malignant melanoma]

PAPÓS Miklós, LÁNG Jenő, CSERNAY László, SZEKERES Lenke, KUBA Attila

[Immunoscintigraphy with 99MTc-labeled F(ab'),fragments of monoclonal antibody (reactive with a high molecular associated antigen) was performed in patients with malignant melanoma. 24 investigations on 23 patients were carried out. A total of 40 lesions in 23 patients were detected by chest radiography, ultrasound, CT, bone scintigraphy or histology. 24 of the 40 lesions (60%) were visualized by immunoscintigraphy. Following correction of the physiological liver background by digital subtraction, 3 liver metastases were localized. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments can provide clinically useful information. ]

Lege Artis Medicinae

[Methodological letter from the Public Health and Epidemiology Technical College on vegetarian and similar diets in crèches and educational establishments]

[The nutritional status of vegetarians is strongly influenced by the type of diet they eat. While semi-vegetarian and lacto-ovo-vegetarian diets can meet the nutrient needs of young children, provided they are carefully and professionally planned, strict vegetarian or macrobiotic diets may not meet the needs for some nutrients and may be deficient in both children and adults. ]

All articles in the issue

Related contents

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

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.

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

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

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

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.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]