Lege Artis Medicinae

[Psychiatric disorders associated with childbearing]

PÁLL Irén

MARCH 20, 2002

Lege Artis Medicinae - 2002;12(03)

[The aim of this brief literary review was to draw attention to psychiatric disorders accompanying childbearing and to point out their importance. Authors begin with a historical perspective, the definition of concepts and the presentation of epidemiological data. It is followed by the mapping of multiple entwining etiological factors, then focus on the risc factors. Finally the principles are outlined to be followed in screening, prevention and treatment. Although these conditions develop quite frequently and have serious consequences regarding the individual (“unity of mother and child”) as well as the family and the society, their recognition still present difficulties. Following the establishment of the diagnosis, it is also important to start adequate therapy in time. The solution of the future would be to focus on prevention. This would be realized through the teamwork of would-be parents, health care specialists and researchers.]

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Lege Artis Medicinae

[Cough syncope]

AVRAMOV Katalin, MAYER Péter, KISS Éva, PAPRIKA Dóra, ZÖLLEI Éva, VÉCSEI László, RUDAS László

[Cough syncope is an infrequently diagnosed form of situational syncope. Most of the reported cases occurs among middle-aged or elderly overweight males, suffering from chronic obstructive lung disease. In our report of four cases we demonstrate the underlying mechanism of cough syncope. Hemodynamic recordings at the time of simulated cough attacks demonstrated the equalisation of the arterial and central venous pressures with consequent cerebral hypoperfusion. The first case illustrates the difficulties of the diagnostic work-up and the confounding effects of the co-existing arrhythmia. The second and fourth cases draw attention to the relationship between cough syncope and accidents. All four patients suffered from chronic obstructive pulmonary disease resulting from heavy smoking which seems to be the most important underlying factor of this syndrome.]

Lege Artis Medicinae

[VIIth Debrecen Cardiology Days]

MOHÁCSI Attila

Lege Artis Medicinae

[A case of restrictive cardiomyopathy due to anthracycline treatment]

HELTAI Krisztina, SZABÓKI Ferenc

[INTRODUCTION - A case of restrictive cardiomyopathy with consecutive arrhythmia is presented which developed 20 years after adriablastin treatment CASE REPORT - A 30 years old women has already been treated for 3 years at an outpatient clinic for paroxysmal supraventricular tachycarcia (PSVT) and shortness of breath. All therapeutic interventions were ineffectual, since the patient refused to take the prescribed medicines because of feeling worse after taking them. This lack of compliance was first explained by vegetative neurosis, but later she was examined with the suspicion of dilatative cardiomyopathy and coronary heart disease. The patient was admitted to the Cardiology Intensive Care Unit with cardiogenic shock which developed after injection of propafenon that had been given due to PSVT. On admission sinus rhythm was seen, but later PSVT and non-sustained VT were recorded. Echocardiography showed diffuse hypokinesis, normal diameter of left ventricle and increased right ventricle pressure. Considering the low EF and the recurring high frequency arrhythmia, amiodarone treatment was introduced successfully. From the medical history of the patient it emerged, that in 1977, she underwent surgery due to neuroblastoma with consecutive combined chemotherapy containing adriablastin. CONCLUSION - It is presumed that the recurring arrhythmia was a consequence of restrictive cardiomyopathy resulting from anthracycline treatment. To prove the diagnosis of restrictive cardiomyopathy echocardiography, Swan-Ganz catheter insertion, coronarography and myocardium biopsy were performed to exclude other possible causes of restrictive cardiomyopathy and to verify the toxic effect of anthracycline.]

Lege Artis Medicinae

[TACT]

MATOS Lajos

Lege Artis Medicinae

[Standpoint of the Hungarian College of Obstetrics and Gynaecology on home births]

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Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Lege Artis Medicinae

[Holistic approach to cardiovascular prevention]

VÁLYI Péter

[Cardiovascular diseases, primarily the organic manifestations of atherosclerosis, such as coronary artery disease, ischaemic stroke, and peripheral arterial diseases, represent the largest healthcare problem in the developed countries, since the mortality, disability, and need for hospitalisation caused by them constitute a bigger burden than that caused by all other diseases combined. A modern, holistic approach to cardiovascular prevention should consider the complete cardiovascular continuum, including genetic predisposition, social-economicalcultural background, environmental factors, the integrated effect of atherosclerotic risk factors, the inhibition of progression of functional and morphologic damages that have already developed, and, if possible, the promotion of regression. Besides targeting the individual, prevention at the public and social level is also important.]

Journal of Nursing Theory and Practice

[Awareness of Risk Factors of Falling among the Elderly]

BOROS Edit, BABARCI Ágnes, ERDŐSI Erika, BALOGH Zoltán

[The aim of the study: determining the risk groups of falling among the elderly and measuring the awareness of the elderly of the risk factors of falling. Methods: During the quantitative, cross-section examination, the population consisted of elderly people living in the region of Dél-Alföld (N=379). We used our own questionnaire beside using the STEADI questionnaire determining risk group of falling for data colletion purposes. During the statistical analysis, we used simple descriptive statistics but also used Khi2 and Mann-Whitney tests. Results: The average age of the examined population was 71,96+ 6,8 years old and 45 % of the interviewed person have reported experiencing falling. The risk factors of higher age (p=0.001), dizziness (p=0.021) and polypharmacy (p=0.001) was demonstrable among those who have fallen at least one time. 83% of the population was from a risk group exposed to falling. Respondents were able to better identify the effect of extrinsic factors on the risk of falling than the intrinsic risk factors. Also, those who have fallen before found that there is no significant preventive effect of the orderliness of their home (p=0.009) and the usage of walking assisting equipment (p=0.010). Conclusions: Falling of elderly people is an actual problem, therefore it is recommended to raise the awareness of the elderly of the risk factors of falling.]

Clinical Neuroscience

[EPIDEMIOLOGY OF STROKE IN THE ELDERLY]

POZSEGOVITS Krisztián, KAZUO Suzuki, NAGY Zoltán

[Background - In the industrialized countries the very elderly stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very elderly can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the youngers' one. Subjects and methods - The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. Results - 8,046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged ≥85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of firstever stroke was 222/100,000/year, and 1,085/100,000/year in the very elderly, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the consciousness level at onset. The following in order of predicting value was the SAH stroke subtype. Conclusion - While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a procession, furthermore it raises the importance of prevention, more rather of the acute stroke care and rehabilitation in this high age group.]

Lege Artis Medicinae

[UNSOLVED THERAPY - COMPLEX TREATMENT OF BUERGER’S DISEASE]

SZOMJÁK Edit, DÉR Henrietta, KEREKES György, VERES Katalin, DEZSŐ Balázs, TAKÁCS István, TÓTH Judit, MÓZES Péter, SOLTÉSZ Pál

[INTRODUCTION - Buerger’s disease is a nonatherosclerotic, segmental, inflammatory, progressive obliterative disease of the blood vessels that most commonly affects the small and medium-sized arteries and also the veins of the lower limb. It is strongly associated with tobacco use. CASE REPORT - A 37-year-old heavy smoker forest worker presented with severe gangrenous changes on the fingers as the upper limb manifestations of Buerger’s disease, which required acral amputation. After complex medical treatment, pharmacological sympathectomy on the left side and surgical sympathectomy on the right side, bilateral conserving necrectomy, cessation of smoking and 2 cycles of cyclophosphamid, the patient's status significantly improved, his pain diminished and, although to a limited extent, he could use both hands. CONCLUSIONS - Buerger’s disease is a disorder with unclear aethiology and is difficult to diagnose. Despite of a good prognosis, a causal treatment is not yet possible, so any antithrombotic, haemorheological, vasodilator or immunosuppressive therapy that have been reported to have beneficial effect should be considered for treatment.]