Lege Artis Medicinae

[Saluting Semmelweis on the 200th Anniversary of his Birth ]

GAZDA István

DECEMBER 10, 2018

Lege Artis Medicinae - 2018;28(11-12)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The Great Acceleration]

BRYS Zoltán

Lege Artis Medicinae

[The Nobel Prize in Medicine 2018 ]

KOVÁCS Ferenc

Lege Artis Medicinae

[Mastitis and breastfeeding]

UNGVÁRY Renáta, MIKÓ-BARÁTH Eszter, KISS Eleonóra

[Various degrees of mastitis affect a significant percentage of breastfeeding mothers. Prevention and effective treatment are important public health issues due to the severe pain, malaise, high fever, and possible complications. Among other causes for early termination of breastfeeding, the most prominent reasons are the pain, prolonged healing, abscess due to mastitis and the frequent recurrence of the disease. Proper management of mastitis and alleviating the symptoms influence the length of breastfeeding and hence leads to a positive outcome for both the mother’s and her child’s long term health. Nevertheless, there are inconsistencies worldwide regarding the diagnosis, cure and prevention of mastitis. The treatments are done mostly on empirical basis. Even though numerous articles have been published on the subject, the unequivocal results are yet to come. This overview summarizes the current knowledge and the dilemmas about mastitis as well as the prevention opportunities and therapies. It also discusses the new results on breastmilk microbiome research, which might change the approach towards mastitis treatment.]

Lege Artis Medicinae

[Modalities of the therapy of patients with high cardiovascular risk]

FARSANG Csaba

[International and Hungarian guidelines emphasize the need of the combinations in the therapy of hypertension. Single pill combinations (SPC) are preferred. The importance of the treatment reducing cardiovascular risk is underlined by the fact that in most hypertensive patients other cardiovascular risk factors, among them most frequently dyslipidemia is present. In addition to antihypertensive drugs these patients should be treated also with those decreasing plasma lipids. Adherence / persistence to therapy of patients is greatly improved by the use of single pill combinations. Today we also have SPCs decreasing both, blood pressure and plasma lipids. Among them there is the combination containing amlodipine and atorvastatin. Several international and Hungarian clinical studies have been conducted. Results of these investigations have been described in several publications. In this paper I summarise the most important results of some of these studies. ]

Lege Artis Medicinae

[Type 2 diabetes: what is the role of a General Practitioner in the treatment of diabetes?]

TORZSA Péter, KALABAY László, HARGITTAY Csenge, OLÁH Ilona

[The 2017 National Guidelines of the Hun­garian Diabetes Association emphasize the individual treatment of diabetic patients and the strong, goal-oriented regulation of carbohydrate metabolism from recogni­tion on. Beside monotherapy, primary dual or triple combination therapy may be applied in the treatment of patients. In primary care it’s the treatment of patients with type 2 diabetes where there is a lot to be done. We hope that the everyday use of the Professional Guidelines will contribute to a more successful diabetic care by General Practitioners (GPs). The holistic care of the GP’s team plays an important role in the primary, secondary and tertiary prevention of Type 2 diabetes, which accounts for more than 90% of all diabetic cases. ]

All articles in the issue

Related contents

Lege Artis Medicinae

[Dear Reader! Greetings to the 30th anniversary of founding the LAM]

KAPÓCS Gábor

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KÁLMÁN Bernadette, KRABOTH Zoltán

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

ÖKTEM Özdemir Ece, ÇANKAYA Şeyda, UYKUR Burak Abdullah, YULUG Burak, ERDEM Simsek Nazan

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.

Clinical Neuroscience

[A case of destructive cervical spondylarthropathy related to chronic dialysis]

BERTA Balázs, KOMÁROMY Hedvig, SCHWARCZ Attila, KAJTÁR Béla, BÜKI András, KUNCZ Ádám

[A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.]