Lege Artis Medicinae

[Recent aspects of temporary cardiac pacing the atrial stimulation]

SZÉKELY Ádám1, KISS Róbert1

DECEMBER 25, 1991

Lege Artis Medicinae - 1991;1(18)

[„Pacemaker syndrome" is a deterioration of the cardiac function following sometimes ventricular pacing. Atrial pacing is advantageous, that can be used in temporary pacemaker application. Long term (>2 days) temporary atrial pacing was performed in 11 patiens. The aim was the temporary stimulation before the definitive AAI implantation (4), bradyarrhythmia complicating acute myocardial infarction (3) and suppression of the drug resistant dysrhythmias (4 patients). Haemodynamic parameters of the patients with myocardial infarction complicated with bradyarrhythmia and heart failure improved using atrial pacing compared to the ventricular one. Refractory supraventricular arrhythmias and the „torsade de pointes" ventricular ones could be effectively suppressed by rapid continuous atrial pacing. The atrial position of the temporary electrode could mostly be achieved without X-ray control. The risk of the dislocation seemed to be lower using special „J” shaped electrodes. In selected patients the application of the temporary atrial (or AV sequential) stimulation is possibly advantage ous resembling to definitive physiological pacing. ]


  1. Orvostovábbképző Egyetem Anaesthesiológiai és Intenzív Therápiás Intézet, Budapest



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Lege Artis Medicinae

[Metoprolol treatment in dialated cardiomyopathy]

DÉKÁNY Miklós, NYOLCAS Noémi, FIÓK János, VÁNDOR László, SEREG Mátyás, BALOGH Ildikó

[Authors applied metoprolol for treating heart failure in with dilated cardiomyopathy. Patients were given digitalis, diuretics as well as ACE-inhibitor and vasodilator drugs. The grade of heart failure was according to NYHA classification in the mean 2.5 class. For assessing the effect of metoprolol clinical variables and results of non-invasive tests were evaluated and compared in 3 consecutive periods: 1) before starting metoprolol, 2) 2–4 weeks after reaching its definitive dose (short-term effect), 3) 3-6 months later (medium-term effect). Early intolerance appeared in 3 patients; signi ficant progression of heart failure in 2 and hypotension causing complaints in 1. Evaluating the actually treated 17 patients clinical signs of heart failure (NYHA class) decreased, left ventricular ejection fraction improved, though not significantly in case of every considered variables, left atrial filling pressure decreased, exercise capacity did not alter, rate-pressure product decreased at rest and at low level of exercise as well. The authors stress the significance of "up-regulation" of myocardial beta-1 receptors in the reduction of myocardial toxic catecholamin effect and myocardial oxygen demand as well as in the increase of myocardial blood supply. Referring to the data of the respective literature and to their own experiences the authors suggest metoprolol treatment in cases of dilated cardiomyopathy, where previus therapy did not prove to be efficient.]

Lege Artis Medicinae

[Role of oxygen derived free radicals during myocardial reperfusion]

KÓNYA László , FEHÉR János, JUHÁSZ Nagy Sándor

[Oxygen derived free radicals are now considered to be important contributors to tissue (myocardium) injury associated with ischemia and reperfusion. Normaly the tissue concentration of these toxic intermediate products of oxygen is strietly limited, but production of oxygen free radicals overwhelming the capacity of the tissue elimination may cause serious damage. Thus reperfusion has it's own danger with the extension of the injury produced by the ischemia alone. Several experi mental studies have shown that different free radical scavengers can reduce the post-ischemic tissue injury, however, there are contradictory results and unresolved problems. Further investigation is necessary to establish the relevance of oxygen free radical mediated myocardial injury and the effective antioxidant treatment. ]

Lege Artis Medicinae



[Belfast Metoprolol Study; Helsinki Heart Study]

Lege Artis Medicinae

[Autoimmunity and the network of the antibody-forming cells: the "immunological homunculus"]

UHER Ferenc

[Frank M. Burnet's clonal selection theory declares the deletion and/or anergy of self-reactive clones to be the fundamental mechanism responsible for self tolerance. There is ample evidence, however, that all healthy individuals have lymphocytes and , natural” antibodies that recognize self structures. In the 1970s, Niels K. Jerne postulated the network theory. It is based on the idea that the idiotype, the region of an immunoglobulin that is unique because it comprises the antigen-binding portion of the molecule, can act as both antigen and antibody within the same individual. Network theory views the immune system as a single, highly interconnected system, through idiotypes, a web of V domains. Antonio Coutinho adressed this problem and divided the repertoire of the B lymphocytes into two parts. He suggested that a set of naturally activated cells and the immunoglobulins they secrete, is reflected in the autonomous immune activities of the self-related network as the central immune system. In contrast, immune responses to external antigens are essentially allonomous clonal activities of another set of resting, rapidly turning over lymphocytes that follow the predictions of the clonal selection theory, making up the peripheral part of the system. Finally, Irun R. Cohen suggested that some, perhaps all, major autoantigens are indeed dominant because each one of them is encoded in the organizational structure of the immune system. This picture was termed the immunological homunculus by its analogy to the picture of the body encoded in the central nervous system. ]

Lege Artis Medicinae

[Modern therapy of intracerebral and subarachnoidal hemorrhages]


[The frequency of the intracerebral hemorrhages among the strokes is most commonly quoted around 10 percent. The rupture of an intracranial aneurysm is often complicated with subarachnoideal hemorrhage as well as with intracerebral hematoma therefore this latter type of intraparenchymal hemorrhage may also be discussed in this topic. The modern imaging procedures (Computed to mography, Nuclear magnetic resonance) are of crucial importance in the urgent and exact diagnosis of intracranial hemorrhages. The first essential step in the diagnosis of stroke is to distinguish the ischemic lesion from the hemorrhage by means of CT. When an intra cerebral hemorrhage threatens life and the patient's condition is relatively good there must be an urgent decision considering the choice between medical therapy or surgical intervention. Although clearcut indications for surgery are now available, the clinical and computed tomographic guidelines play indi vidually an important role in the final decision. The individual judgment is always desirable in every case of intracerebral hemorrhage as well as in the surgical intrvention of intracranial aneurysm during the acute phase (two days).]

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[Pacemaker therapy - New indications]


[This article details the classical and newer clinical applications of pacing, i. e. the use of permanent pacing for patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, prevention of atrial fibrillation and pacing in long QT syndrome. The cornerstone of definitive pacemaker therapy is the establishement of correct indication and the optimal selection of pacemaker modality which significantly improve the quality of life of patients. The use of combinations of sensors balancing the strengths and weakness of each represents a logical step toward the optimization of rate responsing pacing. Reliable automatic functions have been incorporated in modern pacemakers to improve the efficiency and quality of life of patients.]

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.

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]


[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

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.]