Lege Artis Medicinae

[Some thoughts at the 50th anniversary of my medical graduation]

BOGA Bálint

DECEMBER 18, 2012

Lege Artis Medicinae - 2012;22(12)

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Lege Artis Medicinae

[Is a Good Death Possible? ]

HEGEDÛS Katalin

Lege Artis Medicinae

[Pneumococcal conjugate vaccine for adults: a new paradigm]

LIPTÁK Judit

Lege Artis Medicinae

[The Man who Compiled the First Russian Pharmacopoeia – Keresztély Peken (1730-1779) ]

V. MOLNÁR László

Lege Artis Medicinae

[3rd Congress of the Hungarian Society of Personalized Medicine]

JELINEK Ivett

Lege Artis Medicinae

[The altered role of coagulase-negative staphylococci]

SZALKA András

[Coagulase-negative staphylococci are differentiated from the more virulent Staphylococcus aureus by their inability to produce coagulase enzyme. Currently, more than 40 recognized species of coagulasenegative staphylococci are known. The great majority of these bacteria are normal inhabitants of the human skin and mucous membranes. Therefore, it is very difficult to distinguish isolates that are of clinical significance. Recently, coagulase-negative staphylococci have been increasingly detected to cause clinically significant infections. This is due in most cases to the increasing use of medical devices inserted or implanted in the human body. This overview discusses the various infections caused by these microbes, as well as their pathogenesis, epidemiology, and management.]

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Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

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Simultaneous subdural, subarachnoideal and intracerebral hAemorrhage after rupture of a peripheral middle cerebral artery aneurysm

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The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Lege Artis Medicinae

[THE RESULTS OF MOLECULAR BIOLOGY IN THE MANAGEMENT OF MYELOMA MULTIPLEX]

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[Among heamatological diseases, myeloma multiplex is the disease demanding the greatest attention. This statement could refer to the difficulties in diagnosis through the success or failure of a medical treatment and to the unavoidable deterioration of condition caused by complications. The illness, as it is known, is incurable but can be treated for a long period of time. The results of molecular biology offer new possibilities to secure the collection of instruments facilitating future recovery. These new modalities are targeted radiotherapy, the abundance of new drugs attacking the subcellular organellums of affected cells (thalidomid, Neovastat, oblimersen, bortezomib, etc.) and immunotherapy against myeloma cells. The introduction of new therapies, however, is to be permitted only with the greatest caution because the crossing of roads cannot be calculated and this could bring about deterioration too. The delay in theoretical considerations and experience however, allows the possibility to do a critical analysis. The application would become reality after collecting numerous experiences.]

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[A novel analgesic made from cannabis]

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[Bayer AG has recently announced that it acquired exclusive rights for the marketing of GW Pharmaceuticals´ new medicine Sativex® in Europe and in other regions. Sativex is a sublingual spray on Cannabis extract basis, and is equipped with an electronic tool to facilitate accurate dosing and to prevent misuses. It is standardized for the THC and CBD. The new analgesic is proposed for the treatment of muscle spasticity and pains accompanying multiple sclerosis and as an efficient analgetic for neurogenic pain not responding well to opioids and to other therapies available. The entirely new mechanism of action through the recently discovered cannabinoid receptor system may offer a real therapeutic potential to the drug. Although the Government of Netherlands has authorized the sale of pharmaceutical grade Cannabis herb by pharmacies in the Netherlands, the availability on the pharmaceutical market of the registered preparation may render requests for the authorization of the smoking of Cannabis herb (marihuana) by individuals suffering of multiple sclerosis, neurogenic pain, AIDS wasting syndrome unnecessary. Nevertheless, the ”old chameleon” plant Cannabis appears to gradually regain its previous status in mainstream therapy and pharmacy. As long as the plant Cannabis and its products continue to be classified as narcotic drugs, medical use of the new preparation will need close supervision.]

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[Rituximab in rheumatoid arthritis]

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[The therapy of rheumatoid arthritis (RA) is not always easy. Classical disease-modifying drugs are ineffective in about 10-15% of the cases. Furthermore, biologic agents, mainly tumor necrosis factor- α (TNF-α) inhibitors, may also be ineffective. Rituximab (RTX) is a B cell-inhibitory monoclonal antibody, which has been registered for the treatment of RA patients refractory to classical immunosuppressive agents including a TNF antagonist. Here we summarize the history of RTX therapy in RA including the presentation of the three major randomized clinical trials. We discuss the efficacy, safety of RTX, the practical points of RTX therapy, as well as some special considerations. The presented data suggest that RTX is a highly effective and safe biological, which can be used upon the inefficacy of any TNF inhibitor. RTX suppresses RA-associated inflammation, symptoms and decreases radiological progression. It may improve the functional capacity and quality of life of RA patients.]