Lege Artis Medicinae

[Pathomechanism, symptoms, differential diagnosis and therapy of fibromyalgia]

KELEMEN Judit

JANUARY 20, 2001

Lege Artis Medicinae - 2001;11(01)

[Fibromyalgia is a chronic, non-inflammatory pain syndrome characterised by diffuse muscle pain and increased tenderness of specific tender points. The exact cause or pathomechanism of the disease is unknown. In the background, nociception and the pain processing pathways of the central nervous system are suspected as dysfunctional. The disease occurs primarily in middle-aged women. Occurence of fibromyalgia is between 1-4%, increasing up to 20% in a rheumatology clinic. In Canada, the cost of treatment of fibromyalgia was 350 million $ in 1993. Unfortunately, in Hungary no similar data is available. It is frequently joined by different vegetative and functional symptoms. One characteristic feature is insomnia, causing typical morning fatigue in patients. Effective therapy has yet to be found, although successful treatment may be achieved with drug therapy (amitryptilin), psychotherapy and aerobics with supplemental electro- and hydrotherapy. Patient education and involvement is also important for good therapeutic results and for the ability to return to work as soon as possible.]

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[The authors review the orthopaedic surgical treatment possibilities of the hip joint affected by rheumatoid arthritis. In the first part, they draw the attention to the characteristic features of the disease. They describe a possible pathological interpretation of rheumatoid arthritis and emphasize the specific features of the rheumatoid hip joint. Different surgical interventions and treatment possibilities are analyzed. Because of the multiple joint involvement in these patients, the possibility of sequential operations has to be considered. The importance of close cooperation between rheumatologists and orthopaedic surgeons is emphasized. According to the authors, one of the most effective long term treatment possibility of the rheumatoid hip is the total hip arthroplasty.]

Lege Artis Medicinae

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Lege Artis Medicinae

[Salicylates and aspirin]

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Lege Artis Medicinae

[Abstracts of Hungarian authors’ articles published abroad]

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Clinical Neuroscience

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Background - Cerebral vasomotor reactivity, defined as the cerebral vasculature response to hypoxia, is not wellunderstood in fibromyalgia (FM) patients. This study investigated the difference in the cerebrovascular reactivity (i.e., responsiveness to hypercapnia was evaluated by use of breath- holding index) to the breath-holding index (BHI) between patients with fibromyalgia and a group of normal controls. Methods - The study included 40 FM patients and 40 healthy subjects. Cerebrovascular reactivity was evaluated using the BHI, which is a nonaggressive, well-tolerated, real-time, reproducible screening method to study cerebral haemodynamics. Insonation depth and basal velocity were symmetrical and not significantly different between the two groups (p>0.05). All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), and the somatization subscale of the SCL-90-R symptom checklist. Results - The BHI ranged from 0.30 to 2.20 (mean 1.11±0.45) in the FM patients and 1.10 to 2.80 (mean 1.90±0.35) in the control group (p<0.001). Disease duration and right BHIaverage and left BHIaverage values exhibited a significant negative correlation (r=-0.877; p<0.001, r=-0.842; p<0.001, respectively). As pain and fatigue scores increased, the right BHIaverage and left BHIaverage values decreased (r=-0.431; p=0.005, r=-0.544; p<0.001, r=-0.341; p=0.031, r=-0.644; p<0.001, respectively). Conclusions - BHI values showed that cerebrovascular reactivity in FM patients decreased in comparison to healthy individuals. BHI decreased as disease duration and severity increased. Cerebrovascular reactivity decreased in FM patients, and this phenomenon should be accepted as an abnormality. Additionally, this outcome may have been the result of a mechanism responsible for central neuropathic pain.

Lege Artis Medicinae

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[The aim of the study: Studies underline the increasing burden of dementia people. Hungarian social care system is also facing dementia care challenge. In case of developing of social sector, it is beneficial to research the psychosocial status of nurses working in dementia care. Material and method: N=130 professional caregivers in dementia care filled out self- administered questionnaires. Standardized health-psychological scales were evaluated: SWLS, Rahe’s Life Meaning, Beck’s Inventory of Measuring Depression, Maastricht Vital Exhaustion, Freudenberger’s Burn Out Inventory. Results: Caregivers have fatigue, dissatisfaction and tendency of quitting profession. Scales show high burn-out, exhaustion and depression and show correlations. Depression correlates with vital exhaustion (r=0.549), depression moves with burn out r=0,528. SWLS correlates opposite with Vital Exhaustion: r = - 366. Coherence and SWLS shows statistically significance correlation: r=0,455. Conclusion: Indicators apply nurses are in risk conditions. More focus on workplace satisfaction, psychosocial care and stress management training is essential. .]

Lege Artis Medicinae

[DEPRESSION IN SOMATIC ILLNESSES - THE NEED FOR CONSULTATION-LIAISON PSYCHIATRY]

VINCZE Gábor, TÚRY Ferenc, MURÁNYI István, KOVÁCS József

[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]