Lege Artis Medicinae

[The 6th conference of the International Coenzyme Q10 Society - Brussels, May 27-30th, 2010]

LIPTÁK Judit

JUNE 20, 2010

Lege Artis Medicinae - 2010;20(06-07)

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[New perspectives of the treatment of hypertensive disease. The triple combination]

BARNA István

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[Significance of the Pleiotropic Effects of Statins]

CSÁSZÁR Albert

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[Future perspectives and health conditions of recently graduated physicians]

PAPP Szidónia, TÚRY Ferenc

[INTRODUCTION - The purpose of our study was to survey the opinion of students graduating in 2008 at the Semmelweis University Faculty of Medicine about university education, future perspectives and physical as well as their mental health conditions. We have considered factors that might cause or might protect against burnout syndrome. METHODS - The electronic questionnaire has been sent to all graduating students and included the Beck Depression Inventory, the Hungarian version of Spielberger’s State-Trait Anxiety Inventory (STAI), which assesses anxiety, the Hungarian adaptation of the Maslach Burnout Inventory for Human Profession modified for students and the CAGE test, which evaluates alcohol consumption. The questionnaire included general questions concerning medical school education, health condition, support from the community, future perspective and livelihood. RESULTS - 31.4% of the graduating class (94 people) answered the questionnaire. These former students felt that the theoretical education at the university was of high quality; however, 61% considered the practical education insufficient. At the beginning of their careers, merely 5% of the young physicians felt well-prepared professionally. 30% of the responders reported a high degree of burnout; 59% would like to work abroad, and 26% were considering leaving the field of healthcare. A quarter of the students had psychosomatic symptoms. CONCLUSIONS - After graduating from medical school, young physicians have to face the difficulties of finding a job, an unstable livelihood and a high risk of burnout syndrome. The high percentage of young medical school graduates leaving the profession as well as the high migration rate might contribute to the growing problems of the healthcare system.]

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ERŐSS Bálint, BENKŐ Tamás, NEMESÁNSZKY Elemér

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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.

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Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

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