Lege Artis Medicinae



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.]



Further articles in this publication

Lege Artis Medicinae


Lege Artis Medicinae


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]


Lege Artis Medicinae



[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.]

Lege Artis Medicinae



[INTRODUCTION - Gallstone ileus is a rare disorder among elderly population. The gallstone coming through a bilioenteral fistula into the gastrointestinal tract is stuck into the duodenal lumen causing ileus in approximately 0,5% of all cases. The syndrome is named after Bouveret, the first describer. CASE REPORT - Author present the case of 72 year old female patient with known cholelithiasis. Investigations proved existing cholelithiasis causing the patient abdominal pain one year before admission but she gave no consent to surgical intervention. An emergency admission to our department occurred after four days of abdominal pain and vomiting. The clinical status of the patient and abdominal X-ray examination suggested stomach evacuation disturbance. Double contrast barium swallow test and gastroscopy proved bowel obstruction caused by a gallstone. During surgery gastrotomy and the removal of gallstone was carried out. There were no postoperative complications and the patient was discharged home. CONCLUSION - Cholelithiasis should be resolved at any chosen time well before complications may occur. The simultaneous appearance of stomach evacuation problems and cholelithiasis should draw attention to this rare disease.]

All articles in the issue

Related contents

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

LAM Extra for General Practicioners



[In the first part of their review about chronic pain syndromes the authors summarize our knowledge about the etiopathogenesis, pathology, clinical features, diagnosis and treatment of myofascial pain syndromes. It is emphasized that also pain of the internal organs, as well as musculoskeletal and connective tissue diseases may generate myofascial pain syndromes. The correct diagnosis of these syndromes is very important, for they respond poorly to simple analgesics, steroids or non-steroid anti-inflammatory drugs. Exercise, physiotherapy, behavioral treatment, local injections, muscle relaxants, tricyclic antidepressants, serotonin reuptake inhibitors are successful modalities of treatment.]

Lege Artis Medicinae

[Epidemilogy of hepatitis C virus and possibilities of transmission]

HAGYMÁSI Krisztina, LENGYEL Gabriella

[The medical impact of hepatitis C (HCV) is significant worldwide. The main consequences are chronic hepatic injury, cirrhosis, and hepatocellular carcinoma formation. The estimated global prevalence is 3% with 180 million infected people worldwide. The prevalence <1% in Hungary. The prevalence increased between 1990 and 2005 in East Asia, Western Europe, and West sub-Saharan Africa. There is characteristic geographical distribution of the main HCV genotypes. The mode of transmission can not be identified of 40% of cases. The most frequent transmission is the intravénás drug injection in the developed countries, and unsafe health procedures in developing countries. The sensitive, nucleic acid amplification testing, identification of high-risk groups, development of vaccination would help the HCV prevalence in the future. ]

Hungarian Immunology

[Adalimumab in the treatment of Crohn’s disease]

LAKATOS Péter László

[Crohn’s disease (CD) is a chronic inflammatory disorder which may involve any part of gastrointestinal tract. The pathogenesis is only partially understood; various environmental and host (e.g. genetic-, epithelial-, immune and non-immune) factors are involved resulting in chronic uncontrolled inflammation, and among pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) seems to play a central role in CD. The last few years have witnessed a significant change in the management of Crohn’s disease. The role of and indications for conventional therapy (aminosalicylates, steroids and immunomodulators) have been reassessed. Over the past decade the increasing knowledge on the pathogenesis of CD led to the development of a number of biological agents targeting specific molecules involved in gut inflammation, first of all TNF-α and its receptors. The aim of this paper is to review the rationale for the use one of the new anti TNF-inhibitors, adalimumab in the treatment of CD.]

Hypertension and nephrology

[New data about adolescent hypertension]


[The new recommendation of management of high blood pressure in children and adolescents was published at Journal of Hypertension, September 2009. The aim of this review is - based on this guideline - to summarize the newest knowledge of epidemiology, pathomechanism, diagnosis and treatment of adolescent hypertension.]