Lege Artis Medicinae

[Nobel prize in Medicine, 2001]

LÁSZLÓ Valéria

JANUARY 20, 2002

Lege Artis Medicinae - 2002;12(01)

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Lege Artis Medicinae

[Financial management of oriented patient care]

FENYVESI Tamás

Lege Artis Medicinae

[12th Congress of the Hungarian Society for Parenteral Nutrition]

TALLER András

Lege Artis Medicinae

[Vitamin D: biological and clinical effects]

LAKATOS Péter, SPEER Gábor

[The hormone-like effects of vitamin D and its mechanism of action were extensively investigated during the last decade. The key to these effects lies in the receptor, in the interaction of the D hormone/receptor complex and in the regulator effects of vitamin D/receptor complex on other genes. The details of the vitamin D receptor structure became known during the last years. This new data shed light on a number of new aspects of vitamin D action, of which some have already gained clinical significance. Present review attempts to summarize the most recent data available in this field.]

Lege Artis Medicinae

[The role of sentinel lymph node biopsy in surgical oncology]

PÉLEY Gábor, KÖVES István, SINKOVICS István, FARKAS Emil, DUBECZ Sándor, KOVÁCS Tibor, KERESZTES Sándor, VÁMOSI-NAGY István

[Regional lymphadenectomy (or lymph node dissection) is the integral part of the surgical treatment for most solid malignant tumors. The purpose of this procedure is twofold: firstly, to achieve locoregional control of the disease and secondly, the staging of the disease. The subsequent complication and morbidity rate of regional lymphadenectomy can be significant: the tumor can disseminate after surgery in a number of patients conventionally staged as node negative (pN0). In the 90’s, a new and minimally invasive surgical regional staging method, the sentinel lymph node biopsy has been developed and introduced into clinical practice. Based on the theory of the sentinel lymph node concept, the lymphatic drainage of the tumor is mapped, and the first tumor-draining lymph node, the sentinel lymph node is localized and removed. The detailed histological examination of this lymph node determines the regional tumor status more sensitively than routinely used staging methods and is more cost effective. This technique may allow the use of selective surgical or radiation treatment of tumors draining to superficial lymph node basins. The history and theoretical background of sentinel lymph node biopsy are also reviewed with the feasibility, technique and role of this new method in different tumor locations discussed.]

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[SCIENTIFIC DIGEST]

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[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

Hungarian Radiology

[A Neuroradiology Postgraduate and Specialist Training Workgroup is Formed at the Radiology Clinic of the University of Szeged Faculty of Medicine]

PALKÓ András

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[Sports medicine, what about your future?]

FRENKL Róbert

LAM Extra for General Practicioners

[VITAMIN D TREATMENT: HORMONE THERAPY FOR PATIENTS WHO NEED IT OR SIMPLY A SUPPLEMENTATION FOR EVERYONE?]

SPEER Gábor

[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine (IOM), the target vitamin D level is 20 ng/ml, whereas the Endocrine Society (ES) recommends 30 ng/m as the miminum target value. According to the ES, a 1 ng/ml increase of vitamin D level can be reached by a daily intake of 100 NE, while the IOM recommends 3.6 ng/ml. Moreover, the IOM states that the effect of therapy on serum level is nonlinear. These differences show that the ES and IOM have different views on the risk of adverse effects. The IOM recommends 400 IU vitamin D daily for children younger than 1 year, 800 IU for those above 70 years and 600 IU/per day for everyone else. The ES recommend 400-1000 IU daily for all infants and 1500- 2000 IU for adults. Screening, however, is not recommended by either society. To decrease uncertainty concerning the side effects of higher-dose vitamin D treatment, it is important to understand, use and support the function of the pharmacovigilance system of the pharmaceutical industry that manufactures and markets various (prescription, over-the-counter) preparations. This is what the author aims to highlight in the second part of this article. Using this system, both the doctor and the patient can help support and accept the justification of higher-dose vitamin D therapy.]