Lege Artis Medicinae

[RISKS AND BENEFITS OF MEDICATION IN PREGNANT WOMEN]

CZEIZEL Endre

SEPTEMBER 18, 2004

Lege Artis Medicinae - 2004;14(08-09)

[The Hungarian Case-Control Surveillance System of Congenital Abnormalities can provide appropriate data for the evaluation of risk and benefits of drugs and pregnancy supplements in pregnant women. Among the main principles, the importance of time factor (the first trimester concept is outdated) and the explanation of frequent false teratogenic findings (e.g. recall bias, chance effect, etc.) are discussed. The main conclusion is that at present the exaggerated teratogenic risk of drugs is much more harmful for the fetus than the rare teratogenic effect of some drugs themselves. Medical doctors and other experts therefore need more education to know the principles and findings of modern human teratology because it may help us to have a better balance between the risks and benefits of drug use during pregnancy. On the other hand, the primary prevention of neural-tube defects and some other congenital abnormalities is demonstrated by periconceptional folic acid or folic acid-containing multivitamin supplementation. Unfortunately, this new method is used rarely and inappropriately (due to the late onset of supplementation) in Hungary.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Abdominal compartment syndrome: the cause of postinjury multiple organ failure. Summary of the article]

BALOGH Zsolt, MCKINLEY BA, COX CS Jr, ALLENS SJ, COCANOUR CS, KOZAR RA, MOORE EE, MILLER CC, WEISBRODT NW, MOORE FA

Lege Artis Medicinae

[FIXED-COMBINATION THERAPY IN ANTIHYPERTENSIVE TREATMENT]

BARNA István

[Target blood pressure and reduction in cardiovascular morbidity and mortality have to be accomplished always with the consideration of target organ lesion. Fixed-combination antihypertensive therapy has become accepted based on the recommendations of international and Hungarian medical associations that are aware of the results of evidence based medicine. The fix combinational treatment is more favorable for patients’ compliance. The daily dosage of drugs with 24 hour effect improves the patients’ cooperativeness. During fix combinational treatment higher efficiency, smaller dose and fewer side effects were observed. In combination, the effects of the drugs on blood pressure are additive without any increase in adverse effects. Last, but not least the cost of drugs of fixed combination are lower than buying the drugs separately. After careful consideration the fixed combination therapy can be recommended to the everyday practice.]

Lege Artis Medicinae

[The diagnosis and therapy of chronic obstructive pulmonary disease - Recommendation of the 2003 consensus conference]

BÖSZÖRMÉNYI Nagy György

Lege Artis Medicinae

[HPS ]

MATOS Lajos

Lege Artis Medicinae

[BASICS OF MRI MAGNETIC RESONANCE IMAGING]

MARTOS János

[Magnetic resonance imaging (MRI) is a young, developing technology used to create images with extraordinary detail of body tissue or the brain by applying nuclear magnetic resonance phenomena. The MRI technique uses a pulse of radio-frequency energy to excite the hydrogen nuclei, the protons. The distribution of hydrogen nuclei of water and fat in the body depends on the tissue type and whether or not the tissue is healthy or diseased. The image brightness is a complex function of properties in the region of interest, which include parameters of protons density and the relaxation times of the protons. Manipulating these properties is accomplished by varying the experiment (pulse sequence) used at the time of examination to yield images that contains different contrast. Although MRI is normally a noninvasive technique, contrast agents can be administered to a subject to enhance a region of interest. There are now more than 22,000 MR systems in use worldwide. MR is one of the best diagnostic exams for imaging many types of soft-tissue including: the brain, the spine, the heart, aorta and coronary arteries, the organs of the upper abdomen and the pelvis as well as the joints.]

All articles in the issue

Related contents

Lege Artis Medicinae

[POSSIBLE TERATOGENICITY OF VAGINAL METRONIDAZOLE TREATMENT AND ITS EFFECT ON GESTATIONAL AGE AND PREVALENCE OF PRETERM BIRTH - CASE-CONTROL STUDY]

KAZY Zoltán, PUHÓ Erzsébet, CZEIZEL Endre

[INTRODUCTION - The primary aim of the study was to investigate the possibility of a teratogenic effect of vaginal metronidazole treatment during pregnancy. MATERIALS AND METHODS - Various congenital abnormalities and all (1-3) their matched controls were analysed in the population-based database of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. The study group comprised 38 151 pregnant women who had newborns without any congenital abnormalities (control group) and 22 843 pregnant women who had newborns or fetuses with congenital abnormalities. Main outcome measures were analysed in 22 congenital abnormalities groups. The use of metronidazole during the second and third trimesters being common, the secondary objective of the study was to analyse the effect of vaginal metronidazole treatment (500 mg of Klion) on gestational age and birth weight in the control group without congenital abnormalities. RESULTS - The prevalence of vaginal metronidazole treatment during pregnancy was 1.7% in the case group (n=388) and 1.5% in the control group (n=570) (odds ratio (OR), 1.1, 95% confidence interval (CI): 1.0-1.3). Comparisons of cases and their matched controls showed an association between vaginal metronidazole treatment during the second and third months of gestation and congenital hydrocephaly (adjusted OR with 95% CI, 10.7, 1.1-104.5), but this was only based on five cases. The analysis of metronidazole treatment reported by the physicians did not confirm this association. After metronidazole use the mean gestational age was slightly shorter (by 0.1 week) and the mean birth weight was also slightly lower (by 40g) in the treated group. CONCLUSION - This finding should only be regarded as an indication for a possible association between vaginal treatment with metronidazole during pregnancy and congenital hydrocephalus. The results showed that vaginal metronidazole treatment alone was not able to prevent a possible vaginal infection that is associated with preterm birth, and that the prevalence of low birth weight was higher among treated women. The protective effect of metronidazole on preterm birth and low birth weight was not confirmed.]

Hungarian Radiology

[The effect of endovascular intervention in the presence of rare celiac trunk developmental anomalies]

VÁGÓ Andrea, SZENTPÉTERY László, FORRAI Gábor

[INTRODUCTION - The congenital absence of celiac trunk and it’s subtotal stenosis are rare abnormalities and often recognised only during digital substraction angiography (DSA). This anomaly is significant when there is a need to perform local intraarterial chemoperfusion or chemoembolisation of malignant hepatic tumours. In these cases the liver is supplied with arterial blood through the superior mesenteric artery and the gastroduodenal arch. The direction of blood flow in the common hepatic artery is changed ensuring the flow to the splenic and left gastric artery. In such circumstances it is not possible to obtain local chemotherapy. CASE REPORT - Two male patients (61 and 75 years old) are reported. Both patients were candidates for chemotherapy due to hepatocellular carcinoma (HCC). In these two cases the planned therapy was impossible because of a stenosis of the celiac trunk in one, and atresia of the celiac trunk in the other. CONCLUSION - The recognition of vascular anomaly prior to endovascular intervention significantly affects the planning of the therapy.]

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.