Lege Artis Medicinae

[SCIENTIFIC DIGEST]

FEBRUARY 20, 2002

Lege Artis Medicinae - 2002;12(02)

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Lege Artis Medicinae

[Recurrent meningitis caused by spontaneous liquorrhoea]

TÓTH Géza, FŰTŐ László, SASHALMI Sándor, KISSÍK Imre, HOMONNAI Andrea, KIS Zsuzsanna, KORDÁS Marianna, CZIRJÁK Sándor

[INTRODUCTION - The most common and most important cause of recurrent meningitis is bacterial infection. In the majority of cases, recurrent episodes of bacterial meningitis are associated with certain anatomical abnormalities that enable bacteria to penetrate subarachnoideal space. Nasal liquorrhoea can arise via traumatic or non-traumatic way. Non-traumatic nasal liquorrhoea with normal pressure is either of congenital origin or "idiopathic" and is frequently called spontaneous liquorrhoea. Spontaneous liquorrhoea is a rare entity making up 3-4 % of nasal liquorrhoea. CASE REPORT - The patient presented in this study was initially treated with purulent meningitis. A diagnosis of Streptococcus pneumoniae infection was established by bacterial culture tests. After being discharged, the patient was free from complaints for a considerable period of time. Her recurrent symptoms of a running nose were diagnosed later as allergic rhinitis at an ambulatory examination. A year later the patient was readmitted to hospital with bacterial meningitis. Due to the noticeable rhinorrhea on admission, the initially suspected liquorrhoea was confirmed by an otorhinolaryngological examination. A CT scan of the cranium verified external and internal pneumocephalus. Through a nuclear medicine examination a liquor fistula communicating with the sphenoidal sinus was diagnosed. After recovering from the meningitis caused by ascending bacterial infection the patient successfully underwent a neurosurgical operation for a reconstruction of the cerebral base via frontal craniotomy. CONCLUSION - With this case presentation we wish to bring attention to the rare disorder of spontaneous cerebrospinal fluid rhinorrhea when treating recurrent meningitis.]

Lege Artis Medicinae

[9th Congress of the Hungarian Society for Hypertension and 11th Symposium on ABPM]

NAGY Viktor, SALLAI György

Lege Artis Medicinae

[Transplantation in Hungary]

GÖRÖG Dénes

Lege Artis Medicinae

[The importance of hormone replacement therapy in primary and secondary cardiovascular prevention]

KANCZ Sándor

[There has been increasing expectation in hormone replacement therapy (HRT) as a potentially useful preventive intervention. Observational studies indicated 50% relative risk reduction on ischaemic heart disease among current HRT users. Unfortunately, this has not been justified by the results of the large scale, prospective, placebo controlled, double blind secondary prevention trials. Even these trials underscored the potential adverse effects of hormone replacement therapy (thromboembolic complications, gall bladder disease). No results of completed primary prevention trials are available for the moment. Based on these data the AHA/ACC Science Advisory of 2001 recommends: HRT should not be recommended for secondary prevention There are insufficient data to suggest that HRT should be initiated for the sole purpose of primary prevention of cardiovascular diseases.]

Lege Artis Medicinae

[Aether]

KAPÓCS Gábor

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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. ]

Lege Artis Medicinae

[ACTUAL OBJECTIVES OF CARDIAC REHABILITATION]

VERESS Gábor, BERÉNYI István, SIMON Attila

[Cardiac rehabilitation programs are performed to decrease the physiologic and psychological effects of cardiac illness, reduce the risk of reinfarction and cardiac symptoms, stabilize the arteriosclerotic process and enhance the psychosocial status of selected cardiac patients. The cardiac rehabilitation intervention should be integrated into multifactorial secondary prevention program involving hospital phase, medical evaluation and adequate oral and interventional treatment, risk factor modification, prescription of exercise training, education and psychosocial counseling. These rehabilitation programs should be followed by long term risk reduction and secondary prevention program directed by the family physicians. On the basis of the review of scientific literature, the authors present the important components of cardiac rehabilitation and address actual objectives like new indications, selection of a professional rehabilitation team, appropriate training programs, counseling and education.]

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Hypertension and nephrology

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