Lege Artis Medicinae

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JANUARY 20, 2005

Lege Artis Medicinae - 2005;15(01)

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Lege Artis Medicinae

[DEPRESSION IN SOMATIC ILLNESSES - THE NEED FOR CONSULTATION-LIAISON PSYCHIATRY]

VINCZE Gábor, TÚRY Ferenc, MURÁNYI István, KOVÁCS József

[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]

Lege Artis Medicinae

[ALA (5-aminolevulinic acid)-induced protoporphyrin IX fluorescence in the endoscopic diagnostic and control of pharyngo-laryngeal cancer]

CSANÁDY Miklós, KISS G. József, IVÁN László, JÓRI József, CZIGNER Jenő

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MATOS Lajos

Lege Artis Medicinae

[CARCINOID TUMORS]

RÁCZ Károly

[Carcinoid tumors are rare neoplasms: they are traditionally divided into three subgroups (foregut, midgut and hindgut tumors). Despite their neuroendocrine cell origin and the similarities in their histological structure, the molecular background, pathogenesis, clinical features, diagnostic and therapeutic procedures, as well as the prognosis of carcinoid tumors located at different sites may be highly variable. Although sensitive biochemical markers (serum chromogranin A concentration, urinary 5- hydroxyindoleacetic acid excretion) and localization methods (somatostatin receptor scintigraphy, positron emission tomography) are available, a considerable number of patients are only diagnosed at the late stages of the disease. When surgical cure is not obtainable such as in cases with advanced metastatic disease, surgical procedures to reduce tumoral tissue should be still considered. At present, the most effective drugs for the symptomatic treatment of carcinoid tumors are somatostatin analogues (octreotide, lanreotide). In addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and rarely, tumor regression is produced. Radioisotope-labelled somatostatin analogues are presently under clinical evaluation, which may offer new therapeutic means for patients with carcinoid tumors.]

Lege Artis Medicinae

[What is good and what is bad?]

NAGY Zsuzsa

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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. ]

Clinical Neuroscience

[HANS SELYE AND THE STRESS RESPONSE: FROM “THE FIRST MEDIATOR” TO THE IDENTIFICATION OF THE HYPOTHALAMIC CORTICOTROPIN-RELEASING FACTOR]

TACHÉ Yvette

[Selye pioneered the stress concept that is ingrained in the vocabulary of daily life. This was originally build on experimental observations that divers noxious agents can trigger a similar triad of endocrine (adrenal enlargement), immune (involution of thymus) and gut (gastric erosion formation) responses as reported in a letter to Nature in 1936. Subsequently, he articulated the underlying mechanisms and hypothesized the existence of a “first mediator” in the hypothalamus able to orchestrate this bodily changes. However he took two generations to identify this mediator. The Nobel Laureate, Roger Guillemin, a former Selye’s PhD student, demonstrated in 1955 the existence of a hypothalamic factor that elicited adrenocorticotropic hormone release from the rat pituitary and named it corticotropin releasing factor (CRF). In 1981, Wylie Vale, a former Guillemin’s Ph Student, characterized CRF as 41 amino acid and cloned the CRF1 and CRF2 receptors. This paves the way to experimental studies establishing that the activation of the CRF signaling pathways in the brain plays a key role in mediating the stress-related endocrine, behavioral, autonomic and visceral responses. The unraveling of the biochemical coding of stress is rooted in Selye legacy continues to have increasing impact on the scientific community.]

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Clinical Neuroscience

[Account on the scientific meeting of the Környey Society in 2007]