Lege Artis Medicinae

[SCIENTIFIC DIGEST]

JANUARY 20, 2001

Lege Artis Medicinae - 2001;11(01)

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Lege Artis Medicinae

[Medical ethics in everyday practice]

BODA Domokos

Lege Artis Medicinae

[Pathomechanism, symptoms, differential diagnosis and therapy of fibromyalgia]

KELEMEN Judit

[Fibromyalgia is a chronic, non-inflammatory pain syndrome characterised by diffuse muscle pain and increased tenderness of specific tender points. The exact cause or pathomechanism of the disease is unknown. In the background, nociception and the pain processing pathways of the central nervous system are suspected as dysfunctional. The disease occurs primarily in middle-aged women. Occurence of fibromyalgia is between 1-4%, increasing up to 20% in a rheumatology clinic. In Canada, the cost of treatment of fibromyalgia was 350 million $ in 1993. Unfortunately, in Hungary no similar data is available. It is frequently joined by different vegetative and functional symptoms. One characteristic feature is insomnia, causing typical morning fatigue in patients. Effective therapy has yet to be found, although successful treatment may be achieved with drug therapy (amitryptilin), psychotherapy and aerobics with supplemental electro- and hydrotherapy. Patient education and involvement is also important for good therapeutic results and for the ability to return to work as soon as possible.]

Lege Artis Medicinae

[Current role of thrombolysis in the management of acute coronary syndromes]

RÁK Kálmán

Lege Artis Medicinae

[Salicylates and aspirin]

BÁLINT Péter, WALTER F. Kean, BÁLINT Géza, SZEBENYI Béla, KEMENDY Gábor, WATSON Buchanan

Lege Artis Medicinae

[Clinical importance of the initial symptoms of epileptic seizures]

RAJNA Péter, VERES Judit, CSIBRI Éva

[The evaluation of initial symptoms of epileptic seizures (ISE) and the development of methods of epilepsy therapy through counteracting the seizure spread both support the view that the joint use of localisation and holistic approach is successful. ISE, which were found to occur often, take a prominent place in the organization of seizure, therefore it is considered to have therapeutical potential. An important area of its applications consist of methods based on the interruption of ISE. Beside clinical experience, its efficiency is established neurophisiologically by the experimental model of epileptic neuron network and the possible selfregulation of cortical activity. The psychological effect of these active methods is beneficial, so coping and conservation of social functions are more successful. There is empirical evidence that in a significant portion of epileptic patients the initial symptoms may supplement therapy by the development of behavioral strategies avoiding seizure or counteracting its spread.]

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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

[Legal status and regulation of complementary and alternative medicine in Europe]

HEGYI Gabriella, VINJAR Fønnebø, TORKEL Falkenberg, HÖK Johanna, SOLVEIG Wiesener

[OBJECTIVE - This study aims to review the current legal status of complementary and alternative medicine (CAM) in the 27 member states and 12 associated states of the European Union (EU). METHODS - We contacted national Ministries of Health and educational institutions of all participating countries, international, local and regional CAM associations and members of the EU project CAMbrella. Literature search was performed in governmental, scientific and popular science websites as well as the web sites/databases of health ministries and EU and Hungarian law documents. RESULTS - All 39 nations have different legislative frameworks and different regulations of CAM. CAM activities are regulated by health legislation in 17 member states, 11 of which have created a specific CAM law, and 6 of which include sections related to CAM in their general health laws. Some countries only regulate several CAM treatments. Preparations, agents and herbal products used in CAM are subject to similar authorization requirements in all countries, comparably to other medicinal products. One exception is the requirement for documentation of efficacy studies. The Directives, Regulations and Resolutions of the EU will affect the conditions that might influence CAM treatment(s) in Europe. CONCLUSION - We experienced an extraordinary diversity in EU countries with regard to the regulation and practice of CAM, but did not find differences in the regulation of herbal products and medicines used in CAM. This motivates patients, practitioners as well as researchers when crossing the borders of European countries. In the current legislative environment we think that harmonisation of law is possible within the EU: individual states within culturally similar regions should harmonise their CAM legislation and regulation. This would probably safeguard against inadequately justified, over- or underregulated practice at national levels. In Hungary, modifications of the decree regulating on CAM are currently being prepared following professional recommendations. This outdated decree needs to be reconsidered, as 17 years of practice have shown which practices are worthy to be maintainted, taught and applied within the healthcare system and which should be omitted.]

Lege Artis Medicinae

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Lege Artis Medicinae

[Five nine year results of „Comprehensive Health Screening of Hungary 2010-2020-2030”]

BARNA István, DAIKI Tenno, KÉKES Ede, DANKOVICS Gergely

[2010 a new, complex screening program started in Hungary, named Nationwide Comprehensive Health Protection Screening Program in Hungary 2010-2020-2030. The screening was installed on a specially furnished lorry, which is able and will be able to get anywhere from big cities to the smallest villages. The Program as part of the “Heart and Vascular National Program” works with the support of 74 professional-scientific societies and companies. The screening program took place in a specially furnished lorry. The lorry has an easy access to the disabled, operation was performed with the quality control and permission of ÁNTSZ. Near the lorry there were activities for the preservation of health and prevention of illnesses. Within the framework of the Program in the largest mobile diagnostics center in Hungary 37 comprehensive surveys in free form. This enormous special screening station allows 5,100 tests to be performed at each of the 200 screening stations nationwide. The screening program for over 20 years provides 15 million trials on 3,000 scenes and 1 million adult visitors in free humanitarian. The European National Health Program and the National Program for the Prevention and Treatment of Car­dio­vascular Diseases co-ordinated by the Asso­ciation of Hungarian Medical Asso­ciations (MOTESZ) are implemented by con­sensual cooperation. Based on the results, it was re-confirmed that Hungarian population belonged to the high risk group in several aspects. Authors also outlined solution plans for general risk reduction and disease prevention. ]