Lege Artis Medicinae

[Seasonal airway allergies]

SZALAI Zsuzsanna

SEPTEMBER 20, 2005

Lege Artis Medicinae - 2005;15(08-09)

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Lege Artis Medicinae

[RARE CAUSES OF GASTROINTESTINAL BLEEDING]

TAHIN Balázs, TÓTH Csaba, KOVÁCS Attila, DOBOS András, DÖBRÖNTE Zoltán, NAGY Lajos, TARABÓ Zoltán, MÁRKUS Béla, GARZULY Ferenc

[INTRODUCTION - The efforts to eliminate the source of gastrointestinal bleeding are not always successful, especially in rare diseases. CASE REPORT - In three patients causes and sites of haemorrhages were detected only at autopsy. The first patient underwent upper gastrointestinal endoscopy as well as surgical exploration. The post-mortem examination showed multiple gastric Dieulafoy’s vascular lesion. The second patient was examined by repeated upper gastrointestinal panendoscopy, but the site of haemorrhage remained unknown. Two polyps were removed during colonoscopy. Unexpected haemorrhage caused sudden death. The aortobifemoral graft, which had been implanted two years earlier had destroyed the duodenal wall, a fistula developed and caused haemorrhage. The third patient had had a right hemicolectomy abroad because of angiodysplasia, but the bleeding episodes repeated. The cause was revealed at autopsy as angiodysplasia of the small bowel. CONCLUSION - Dieulafoy’s disease can sometimes be discovered only by repeated endoscopy but sudden death may precede diagnosis. In the presence of an aortic graft we have to keep in mind that this could be the cause of catastrophic bleeding. Therefore, the examinations should be performed immediately - endoscopy has to involve the distal part of the duodenum - and operation is urgent. Angiodysplasia of the small bowel is a rare site of angiodysplasia which requires special diagnostic procedures like capsule endoscopy. The multiplicity of the disease and the age of the patients made the diagnostic difficult.]

Lege Artis Medicinae

[TRAVEL MEDICINE IN GP PRACTICE]

FELKAI Péter, KOVÁCS Erzsébet

[The authors describe the basic ideas of travel medicine, as a newly introduced interdiscipline of the medical science in Hungary. Recently, this segment is considered to be the part of Insurance Medicine, on the other hand the methods and the practice of the travel medicine is based on the other medical specialities’ knowledge. Due to the growing number of travellers in our country as well as the consequences of the joining Hungary to EU, travel medicine could play an important role in the improvement of the Hungarian travellers’ attitude to their health care status, the prevention against the emerged infectious diseases, and in the medical assistance for the international tourism. Travel medicine also a good guideline for the fit-for-travel considerations, made by the GPs. Hungary with its advantageous geographical position appears to be an excellent stopover for any medical evacuation from East European or other surrounding countries. That is why we would like to establish a first travel medicine facility in central Europe. It is expectable that the Hungarian travellers require more and more information regarding to their health care possibilities and prevention during their trip. The first authentic person is being asked by the patients’ are GPs. The GP’s tasks are: diagnosis and the treatment of travel related diseases, the pre-travel advices. All the mentioned factors are a new challenge for the GPs in Hungary.]

Lege Artis Medicinae

[Prostaglandin E1 treatment in patent ductus arteriosus dependent congenital heart defects]

TÁLOSI Gyula, KATONA Márta, RÁCZ Katalin, KERTÉSZ Erzsébet, ONOZÓ Beáta, TÚRI Sándor

Lege Artis Medicinae

[ICARUS]

MATOS Lajos

Lege Artis Medicinae

[Research as “Flow” – a Discussion with Péter Csermely]

GYIMESI Andrea

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Clinical Neuroscience

[Effect of two month positive airway pressure therapy on the structure of sleep, cognitive function and anxiety]

CSÁBI Eszter, VÁRSZEGI Mária, SEFCSIK Tamás, NÉMETH Dezsõ

[Obstructive sleep apnea is a common disorder, characterized by repeated episodes of upper airway obstruction during sleep, resulting intermittent hypoxia and disruption of the normal sleep pattern, which caused cognitive dysfunction in these patients. Nasal continuous positive airway pressure is the treatment of choice for this disorder. The aim of the study is to evaluate the effect of short-term positive airway pressure on sleep pattern (polisomnographic measures), cognitive function and anxiety. Twenty four newly diagnosed and previously untreated patients with obstructive sleep apnea were evaluated a battery of neuropsychological tests before and after 2 and a half months of the treatment. We focused on working memory, short and long-term episodic memory, executive functions, anxiety and subjective sleepiness. Our results showed that the two and half month of treatment improved the respiration during sleep, sleep pattern and the subjective sleepiness. We found improvement in short- and long-term verbal memory, and complex working memory. Despite of treatment we did not find improvement in visuospatial learning. These results reveal that 2 and a half months of positive airway pressure treatment restored not only the normal respiration during sleep and normal sleep pattern, but also the cognitive functions. Our study suggests that cognitive dysfunction is at least partial reversible in obstructive sleep apnea patients after positive airway pressure treatment.]

Lege Artis Medicinae

[The role and scope of screening and diagnosing obstructive sleep apnea syndrome by the family physician]

ANNUS János Kristóf, ÁDÁM Ágnes, BECZE Ádám, CSATLÓS Dalma, LÁSZLÓ Andrea, KALABAY László, SZAKÁCS ZOLTÁN

[Diagnosis and treatment of sleep disorders play an increasingly important role in everyday clinical practice of family physicians. Obstructive sleep apnea syndrome (OSAS) is a significant disorder of this disease group due to its relatively high incidence rate and increasing risk of adverse medical outcomes in the course of time. The prevalence of OSAS is 2-4% in the general population. It is characterized by obstructive apneas and hypopneas mostly with desaturations and/or arousals caused by the repetitive collapse of the upper airway during sleep. Besides impairing sleep efficacy and daytime neurocognitive functions, OSAS increases cardiovascular risk as well. The typical clinical presentation is an excessive daytime sleepiness and loud snoring interrupted by brief pauses of breathing. It can be a risk factor for treatment-resistant and/or non-dipper hypertension, nocturnal cardiac arrhythmias, stroke, cognitive decline and depression. The importance of OSAS is presented by the fact that - according to the latest related Hungarian law reforms - risk evaluation of the disorder is part of the medical assessment of suitability for a driving license. The family physician’s tasks are to recognize the clinical symptoms, identify high-risk patients with potential complications who need adequate treatment and eventually guide them to sleep-diagnostic centers. ]

Lege Artis Medicinae

[Focus on the diagnosis and therapy of chronic cough]

SZILASI Mária

[Cough by itself is not a disease but a part of a complex defense mechanism protecting from harmful materials entering the airways and cleaning the lungs and airways from potentially harmful materials. Normally, cough is accompanied by other defense mechanisms (bronchoconstriction and secretion of sputum) that increase the effectiveness of cough. Cough generally is caused by intrapulmonary disorders, but may be related to extrapulmonary lesions that are not easy to diagnose. In every case, an etiological diagnosis has to be the aim because this is the only way to proper treatment. From the abundance of reasons for cough, upper airway cough syndrome, asthma, chronic obstructive pulmonary disease, and gastro-esophageal reflux disease are discussed in detail.]

Clinical Neuroscience

[CLINICAL ANALYSIS OF PATIENTS WITH PERIPHERAL FACIAL PALSY]

ILNICZKY Sándor

[symptoms. In two thirds of the cases the cause is unknown, this is called “idiopathic peripheral facial palsy or Bell’s palsy”, but several different diseases have to be considered in the differential diagnosis. In this paper we reviewed the case histories of 110 patients treated for “peripheral facial palsy” in the Department of Neurology, Semmelweis University, Budapest in a five year period, 2000-2004. We studied the age, gender distribution, seasonal occurance, comorbidities, sidedness, symptoms, circumstances of referral to the hospital, the initial diagnoses and therapeutic options. We also discuss the probable causes and consequences of diagnostic failures. Results: the proportion of males and females was equal. There was no considerable difference between sexes regarding agedistribution. Of the 110 patients 106 was diagnosed with idiopathic Bell’s palsy, three cases with otic herpes zoster and one patient with Lyme disease. In our material, peripheral facial palsy was significantly more frequent in the cold period of late autumn, winter, and early spring. Diabetes mellitus and hypertension were more frequent than in the general population. 74% of the patients were admitted within two days from the onset of the symptoms. In 37% preliminary diagnosis was unavailable. In 15% cerebrovascular insult was the first, incorrect diagnosis, the correct diagnosis of “Bell’s palsy” was provided only in 16%. The probable causes of diagnostic failures may be the misleading symptoms and accompanying conditions. We examined the different therapies applied and reviewed the literature in this topic. We conclude that intravenous corticosteroid treatment in the early stage of the disease is the therapy of choice.]

Lege Artis Medicinae

[EXERCISE-INDUCED BRONCHOCONSTRICTION]

VIZI Éva, CSOMA Zsuzsanna, HUSZÁR Éva

[Exercise-induced bronchoconstriction describes the transient narrowing of the airways occurring during and most often after vigorous exercise. The mechanism of exercise-induced bronchoconstriction remains elusive, although airway drying and cooling plays a prominent role. The severity of this reaction depends on the temperature and the water content of the inspired air, the type and concentration of air pollutants inspired and the intensity of the exercise. Diagnosis of exercise-induced bronchoconstriction should include baseline spirometry followed by an exercise challenge test. The exercise can be a free-running test or a laboratory based test using a cycle-ergometer or a treadmill. Pre- and post-exercise pulmonary function should be compared, 10%-15% postexercise fall in forced expiratory volume in 1 second (FEV1) is used as a diagnostic criteria (10% in laboratory test, 15% in free-running test). Heat loss, water loss, post exertional airway rewarming and the role of several mediators have been proposed as possible mechanisms responsible for the airway obstruction induced by exercise. Exercise-induced bronchoconstriction can be easily diagnosed and treated in the majority of patients. When properly treated, asthmatic individuals should be able to participate or compete in the majority of sports.]