Lege Artis Medicinae

[SEPSIS AS A NEW DISEASE - PROBLEMS IN HUNGARY]

LUDWIG Endre

DECEMBER 20, 2004

Lege Artis Medicinae - 2004;14(12)

[In our current understanding sepsis is a systemic inflammatory response syndrome to infections mediated by cytokines, an uncontrolled progression which may result in multiorgan failure and in the final stage septic shock. There are no pathognomic clinical signs or laboratory parameters in the early stage of sepsis and the diagnosis can be easily missed if the possibility is overlooked. One of the crucial points of therapy is early diagnosis: the mortality rate of severe sepsis is about 20% and that of septic shock is about 40-50%. The cornerstones of the therapy are the eradication of the focus of sepsis (surgical intervention and antimicrobial treatment), standard intensive care and the intervention in the pathophysiological process of sepsis. For successful treatment a multidisciplinary approach is required: only the early diagnosis and the teamwork of different specialists can decrease the mortality rate that is higher in Hungary than the international average.]

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Lege Artis Medicinae

[ROLE OF TISSUE ANGIOTENSIN CONVERTING ENZYME IN CARDIOVASCULAR DISEASES]

MOHÁCSI Attila, LIZANECZ Erzsébet, ÉDES István, CZURIGA István

[The pathobiological aim of treatment with angiotensin converting enzyme inhibitor is to restore the balance between nitrogen-monoxide and angiotensin II due to inhibition of blood and tissue angiotensin converting enzyme. The clinical consquences of the inhibition of tissue angiotensin converting enzyme in patients with additionally high (HOPE) and low (EUROPA) cardiovascular risk without left ventricular dysfunction has already been demonstrated. Ramipril and the perindopril reduce the risk of combined end-point of these trials such as cardiovascular mortality, reinfarction and resuscitated sudden cardiac death. However, pharmacological and genetic differences in blocking of tissue angiotensin converting enzyme may influence the cardioprotective effect of various angiotensin converting enzyme inhibitors. Thus new, well-designed, controlled clinical trials are needed to determine the role of angiotensin converting enzyme inhibitor with different tissue angiotensin converting enzyme affinity in cardiovascular disease.]

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Lege Artis Medicinae

[LETHAL SEPTIC INFECTION IN RHEUMATOID ARTHRITIS]

BÉLY Miklós, APÁTHY Ágnes

[INTRODUCTION - The lethal septic infection was studied in a randomized (non-selected) autopsy population of 234 in-patients with rheumatoid arthritis. The patients died at the National Institute of Rheumatology between 1970 and 1999. PATIENTS AND METHOD - The aims of this study were to determine the prevalence of lethal septic infection with or without purulent arthritis in rheumatoid arthritis; the relationship between purulent arthritis and lethal septic infection; the clinically missed diagnosis of lethal septic infection and purulent arthritis; the influence of the main complications and associated diseases on lethal septic infection with and without purulent arthritis; the pathogens in lethal septic infection; and the clinico-laboratory parameters associated with lethal septic infection in rheumatoid arthritis. RESULTS - Lethal septic infection was found in 31 (13.24%) of 234 rheumatoid arthritis patients. Purulent arthritis complicated lethal septic infection in 15 (6.4%) of 31 patients. There was a significant association between lethal septic infection and purulent arthritis. Sepsis was detected clinically in 17 of 31 lethal cases and purulent arthritis was detected 9 of 15 septic infection complicated with suppurative articular processes. The coexistent complications (systemic vasculitis, AA amyloidosis), and associated diseases (tuberculosis with or without miliary dissemination, malignant tumors, diabetes mellitus) did not influence the prevalence of septic infection. The most frequent pathogenic agents were: Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella species, Streptococcus species. The patients with septic infection had significantly lower levels of beta-globulin, and higher values of Waaler-Rose or latex fixation test in comparison to patients without septic infection or without complications. CONCLUSION - Lethal septic infection may exist in rheumatoid arthritis without the classical clinical symptoms of sepsis, and clinically latent suppurative processes may be found at autopsy. The missed clinical diagnosis of a fatal complication is explained by the weak immune response and atypical clinical symptoms of elderly patients mainly treated with steroids and immunosuppressive drugs.]

Lege Artis Medicinae

[Hungarian Cannot be Used Indeed? Anglicisms in the Hungarian Medical Language]

NÉMETH Éva

Lege Artis Medicinae

[THE RELATIONSHIP BETWEEN THE DEPRESSIVE MOOD OF PARENTS AND THE BEHAVIOURAL PROBLEMS OF THE CHILD]

HAJNAL Ágnes, SUSÁNSZKY Éva, SZÁNTÓ Zsuzsa, CSOBOTH Csilla

[INTRODUCTION - In this article we analyze the relationships between behavior problems of adolescents and depressed mood of their parents based on literature review and on our own questionnaire surveys. METHODS - We present the data from two surveys conducted among Hungarian adolescents. The first survey was conducted among 1604 young women students, aged of 15-19 years. The second survey included 502 high school students in Budapest. Both surveys were aimed at the lifestyle, health behavior, risk behavior, and emotional state, as well as the social-economic status and family background of the adolescents. Data of both surveys were analyzed using the SPSS 8.0 statistical program package. The association between the mood category of mothers and fathers and the risk factors and emotional state indicators of their children were tested with χ2 tests, as well as the indicators of students whose parents were not treated for depression. RESULTS - Data from both surveys suggest that there are close relationships between the negative mood states of the parents and the behavior problems of their children, especially between the mood of mothers and the behavioral and emotional state of daughters. CONCLUSIONS - Our research data call attention to the phenomenon that girls react explicitly and quite sensitively to the mood state of their mothers while the boys’ behavioral and emotional states are less responsive to their parents’ mood. On the other hand, boys react more intensively to the emotional instability of their fathers than to the instability of their mothers.]

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