Lege Artis Medicinae

[SCIENTIFIC DIGEST]

NOVEMBER 20, 2005

Lege Artis Medicinae - 2005;15(11)

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[A Masterpiece or a Forgery? Morelli’s Method]

NÉMETH István

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[Peptic ulcer disease - facts and questions]

PAPP János

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[Hemingway and the Caesarean Section]

SZABÓ András

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[Effects of tiotropium on lung hyperinflation, dyspnoe and exercise tolerance in COPD]

NAGY László Béla

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[SELECTIVE α1-ADRENORECEPTOR ANTAGONISTS IN CARDIOVASCULAR MEDICINE]

RÓNASZÉKI Aladár

[A hypertonia korszerű kezelésében a szelektív α1-adrenoreceptor-antagonisták ma is jelentős szerepet játszanak. A hatékony vérnyomáscsökkentés mellett számos előnyös, járulékos hatásuk révén sok társbetegséget (diabetes mellitus, atherogen dyslipidaemia, obliteratív érbetegség, prostatahypertrophia, erectilis diszfunkció) is kedvezően befolyásolnak. A hypertoniához társuló szívelégtelenségben, illetve annak elkerülése érdekében monoterápiában nem alkalmazhatók. Az α1-adrenoreceptor-antagonisták kombinációja diuretikummal mindig javasolt.]

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

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[Platelet aggregation inhibitors in the prevention of coronary coronary artery disease. „Handle with care!"]

NAGY Viktor

[Platelets play pivotal role in the pathophysiology of unstable angina, acute myocardial infarction and in complications following percutaneous coronary intervention. Three classes of platelet-inhibiting drugs, aspirin, thienopyridines and platelet glycoprotein IIb/IIIa inhibitors are now commonly used for the prevention and treatment of the disorders of coronary artery thrombosis. For the last several decades, aspirin has been the sole option for antiplatelet therapy in the treatment and prevention of the manifestations of cardiovascular disease. However, a wider selection of antiplatelet agents, including the thienopyridines (ticlopidine and clopidogrel) and the platelet glycoprotein IIb/IIIa receptor antagonists are available today. This review summarizes these drugs and scientific data that have led to their use in primary and secundary prevention, unstable angina, myocardial infarction and percutaneous coronary intervention.]

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[Basics of the medical use of ayahuasca: physiology of dimethyltryptamine]

FRECSKA Ede, KOVÁCS Attila, SZABÓ Attila, FERENCZ Csaba, MÓRÉ Csaba

[Ayahuasca is a brew made of two admixture plants containing dimethyltryptamine (DMT) and b-carbolines (harmine and tetrahydroharmine). The indigenous groups of the Amazonas basin have been using it for centuries as an ethnomedical substance in healing and spiritual-religious rituals. During the last two decades the brew has raised increased scientific and public interest worldwide about its healing effects. Present paper addresses the therapeutic potentials of ayahuasca use and outlines the cellular mechanisms behind - in focus of the s-1 receptor mediated action of DMT. The scientific investigation of ayahuasca is complicated by methodical problems, legal issues, and sociocultural preconceptions.]