Lege Artis Medicinae

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JULY 10, 2001

Lege Artis Medicinae - 2001;11(06-07)

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Lege Artis Medicinae

[Abstracts of Hungarian authors’ articles published abroad]

Lege Artis Medicinae

[Embracing the national spa project]

JOBST Ágnes

Lege Artis Medicinae

[Endoscopic diagnosis of oesophageal intramural metastasis from an adenocarcinoma of the gastrooesophageal junction]

SZÁNTÓ Imre, VÖRÖS Attila, NAGY Pál, GONDA Gábor, ALTORJAY Áron, BANAI János, GAMAL E. Mohamed, KISS János

[INTRODUCTION - Authors present six cases of intramural oesophageal metastases of adenocarcinomas located in the gastro-oesophageal junction. The tumours and metastases were diagnosed by endoscopic examinations. PATIENTS AND METHODS - Between 01. 01. 1994. and 31. 12. 2000. a total number of 143 patients were examined with the diagnosis of adenocarcinoma of the gastro-oesophageal junction. In six patients (4,19 %), intramural oesophageal metastases were verified. In each case the diagnosis was confirmed by histological examination. TNM stage of the tumours was assessed considering the results of endoscopic ultrasound examination, the findings at initial operation and the pathological data in all cases, where resection was performed. The tumours were localized according to Siewert- Stein’s classification. RESULTS - In six patients who had adenocarcinoma of the gastro-oesophageal junction, the diagnosis of intramural oesophageal metastases was confirmed. The histological structure of the primaer tumours and metastases were the same. Metastases were detected by endoscopic ultrasound examination in three cases of the four examined patients as submucosal masses. All of the cardiac tumours proved to be well advanced: four of them classified as T4N1 by endoscopic ultrasound. Intramural metastases were diagnosed in each Siewert-Stein subgroups. CONCLUSION - Endoscopic examination is of crucial importance in the diagnosis of adenocarcinomas of the gastro-oesophageal junction and in their intramural metastases as well. Beside the endoscopic identification the primary tumour, the thorough examination of the proximal part of the oesophagus seems to be of great importance. These metastatic cancers appeared in the advanced stage of the disease. Endoscopic ultrasound examination is of great help in these cases to identify whether the mass causing oesophageal impression is outside of the wall of the organ, or in which layer it is localized. Endoscopic ultrasound examination also gives the possibility for preoperative assessment of the TNM stage of the disease.]

Lege Artis Medicinae

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MATOS Lajos

Lege Artis Medicinae

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[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.]

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

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[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

[SIGNIFICANCE OF MICROCIRCULATION IN ARTERIAL DISEASES]

FARKAS Katalin

[The microvascular bed is an anatomical entity, which constitutes of blood vessels smaller than 50 μm (i.e. arterioles, capillaries and venules), and its major function is the nutritive perfusion of organs and tissues. In search of cardiovascular diseases, there are growing evidences that impaired microcirculation plays an important role in the patophysiology of arterial diseases. Beside the well known consequence of diabetic microangiopathy in the development of diabetic complications, new data support the role of microcirculation in the pathogenesis of hypertension and atherosclerosis, as well. There are different non-invasive methods for the investigation of the microcirculation. Capillarmicroscopy, laser doppler flowmetry and transcutaneous oxygen pressure measurement are used not only in the scientific research, but also in the clinical practice. Laser doppler flowmetry gives us the possibility to assess microvascular endothelial function and other early microcirculatory disturbances. Capillarmicroscopy is particularly useful in the diagnosis of different autoimmune diseases. Transcutaneous oxygen pressure measurement is mostly used in the diagnosis of critical limb ischemia, because it has proven prognostic relevance. Vascular specialist should prescribe all investigations. General practitioners play key role in the early diagnosis of vascular diseases that can be achieved through the screening of patients at risk for vascular disease. In case of suspected vascular disease, the patient should refer to angiology outpatient clinic, to decide further investigations and prescribe therapy. The conservative treatment includes the complex cardiovascular risk management supplemented with medication, acting on the microcirculation.]

Lege Artis Medicinae

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Hypertension and nephrology

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