Lege Artis Medicinae

[Sports sports medicine medical training]

FRENKL Róbert

OCTOBER 28, 1992

Lege Artis Medicinae - 1992;2(10)

[We who have lived most of our lives in the 20th century must slowly and inevitably face the fact that man, with all the means at his disposal to the contrary, or perhaps because of it, has made this period a terrible century in history. Sadly, despite the glimmer of hope in the late 1980s, there is little likelihood today that the last decade will make a significant difference to the century's balance sheet.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Diagnosis and treatment of acute obstetrical DIC]

RÁKÓCZI István

[Modern management of acut obstetrical diffuse intravascular coagulation (DIC) was evaluated. A large variety of obstetrical conditions are associated with acute DIC such as amniotic fluid embolism, abruptio placentae, intrauterine infection (septic abortion), dead fetus syndrome and prolonged shock of any aetiology. Typically, acute obstetrical DIC is associated with haemorrhage (mainly vaginal bleeding) and shock. The whole blood coagulation time, platelet count and fibrinogen level are the most clinically useful indicators in evaluating the patient with acute DIC. Management of acute DIC includes prompt treatment of precipitating factors (delivery of fetus in placental abruption, evacuation of the uterus in septic abort union plus administration of antibiotics, delivery of a dead fetus by induction of labor). Careful attention to fluid and blood cell replacement is needed to prevent and treat hemorrhagic shock. The coagulation failure is treated with fresh-frozen plazma or cryoprecipitate and platelets. In acute obstetrical DIC complicated by hemorrhage heparin has no use and will only cause the bleeding to worsen. Recently several clinical studies indicate that antithrombin III concentrates are efficacious in DIC.]

Lege Artis Medicinae

[Disseminated intravascular coagulation in the newborn]

GOLDSCHMIDT Béla

[A review is given on disseminated intravascular coagulation in the newborn period. DIC is not a single disease entity, but a complication of several underlying diseases. The author summarizes the physiologic and pathophysiologic conditions which promote the development of this blood coagulation disorder in this age. Further on the clinical symptoms, the difficulties of laboratory analysis as well as of differential diagnosis are discussed. Finally a detailed description of the treatment of the neonatal DIC syndrome is given. ]

Lege Artis Medicinae

[The risk of ischemic heart disease in patients with ischemic cerebrovascular disease]

HORVÁTH Sándor

[A strong association is supported between ichemic cerebrovascular and heart diseases by several studies. Death is more commonly caused by myocardial infarction than by stroke itself in patients with asymptomatic carotid stenosis, amaurosis fugax, transient ischemic attack or ischemic stroke. Signs and symptoms of ischemic cerebrovascular diseases or asymptomatic atherosclerosis of the arteries of the neck are harbinger for both myocardial and cerebrovascular infarction. Patients suffering from ischemic cerebrovascular diseases should be routinely investigated, treated and cared for coronary artery disease in order to prolong survival. ]

Lege Artis Medicinae

[Results and perspective of gene therapy in the treatment of primary immunodeficiency]

SÓFI Gyula, MARÓDI László

[During the last decade research has been directed toward gene-replacement therapy of genetic disorders, including primary immunodeficiencies. Efficient methods for gene transfer were developed to correct the gene defect in adenosine desaminase deficiency, leukocyte adhesion deficiency and chronic granulomatous disease. Somatic gene therapy in a patient with ADA deficiency was performed two years ago. This paper summaries inicial clinical applications of gene transfer and gene therapy in primary immunodeficiency and the future prospects of gene therapy in cohort of patients. ]

Lege Artis Medicinae

[Third International Study of Infarct Survival]

MATOS Lajos

[There was no significant difference in 35-day mortality between the aspirin + heparin and aspirin-only groups. The incidence of re-infarction was slightly lower with aspirin plus heparin (2p <0.09). When patients also received heparin in addition to aspirin, transfusion was needed more often and non-cerebral haemorrhage was more frequent (2p < 0.01) Combining the results of ISIS-3 and GISSI-2, mortality was significantly reduced during the treatment period (p < 0.01). There was no appreciable difference in mortality or re-infarct incidence between the use of streptokinase or APSAC, but there were more allergic events in the APSAC group. There was no difference in 6-month survival between the two groups. There was no difference in the efficacy of streptokinase and tPA treatment at either 0-35 days or 6 months survival. Allergies were less frequent with tPA, but non-cerebral haemorrhage was more frequent. Treatment with tPA led to stroke significantly more often than streptokinase (2p < 0.01). Combining the data from the similar GISSI-2 trial and ISIS-3, no difference was observed between streptokinase and tPA in either mortality between 0-35 days or survival at 6 months. ]

All articles in the issue

Related contents

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Lege Artis Medicinae

[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]