Lege Artis Medicinae

[The Anatomic Theater – The Publicity of the Opened Body ]

CZIGLÉNYI Boglárka

MAY 20, 2017

Lege Artis Medicinae - 2017;27(04-05)

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[Deadly Caress, or the Apotheosis of Cosmic Pain ]

GEREVICH József

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[The World and I are One – On the Photographs of Rinko Kawauchi ]

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[Mazes and compass in prognostic value of cardiovascular risk factors]

KÉKES Ede, KISS István

[The risk assessment of cardiovascular disease is dispensable in everyday practice, because this disease-group gives the high-est death rates all over the world - in developed countries, in Central European Region, including Hungary. Based on reliable surveys world side, we need in addition to coronary heart disease, stroke has been reckoned today to peripheral vascular disease, type-2 diabetes, and chronic kidney diseases as well. It seems useful to the new name i.e., atherosclerotic cardiovascular diseases. It stands as smoking, hypertension, dyslipidemia risk factors among this group of diseases in the background, but more and more importance is given to visceral obesity, physical inactivity, alcohol consumption and psycho-social status. It has to count with the fact that the individual factors together and appear further worsen to mortality rate. The greatest interference arises because the cardiovascular risk estimation proposed by embodiments of non-uniform principles. Undoubtedly, the resolution of ACC/AHA 2010 was the first correct compass, because the classification and utility values of the factors precisely regulated. But in addition, it is essential that in the risk assessment not only the “global estimation” (tables, other forms) will be conducted, but also other important parameters characterizing the extended factors (vascular structure, obesity, psycho-social status, etc.) - set schedule and regulations - acting on to be carried out. We presented in cardiovascular risk assessment methodology and the most profitable methods of estimation based on the preventive guidelines, extern opinions generally accepted now and own experiences. We propose to modify the risk assessment me-thod.]

Lege Artis Medicinae

[Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]

KOVÁCS Ákos, KULCSÁR Andrea, KALABAY László, TORZSA Péter

[In this article, based on a short case report, the authors summarise what you must do and must not do as a primary care physician when suddenly meeting a young patient suspected of having meningococcus infection. Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopha-rynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially de­vastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006 and 2015 every year there were 34 to 70 cases of the registered invasive disease caused by Neisseria meningitidis, the morbidity rate being 0.02-0.07‱. Half of the diseases (50.7%) were caused by serotype B N. meningitidis, 23.2% were serotype C. ]

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[Osteoporosis is one of the most under-diagnosed and under-treated health conditions. In recent decades, several risk indices have been developed to identify women at risk for low bone mineral density (BMD) who require a BMD test. This study aimed to demonstrate that quantitative ultrasound bone density measurement can indeed be performed simply by nurses working in primary care, which can significantly facilitate early detection of osteopenic and osteoporotic conditions. Method: The medical records of all patients who had an ultrasound of the left heel using the quantitative heel ultrasound machine between March 2021 through December 2021 were reviewed retrospectively. The subjects were 20-64-year-old adults (N=1032). Calcaneal quantitative ultra­sound parameters were registered with Sonost-2000 bone densitometer. The body composition was measured using a multi-frequency segmental body composition analyzer. The measurement results were evaluated with SPSS 22.0 statistical program and descriptive statistics. The mean age of the population studied was 43.12±9.6 years; 29.7% were men and 70.3% were women. Of the women in our study, 2.4% were osteoporotic (T ≤ −2.5), and 49.86% were classified as osteopenic according to the WHO operational definition. Osteopenic values were measured in 32.35% of men. A total of 273 subjects (26.45%) in the study sample were in the 50-64 age group (223 women and 50 men). 4% of women over the age of 50 had osteoporosis and 63.7% had osteopenia. Rating of the OST score no one was placed in the high-risk group. Of the 9 women with osteoporosis, 8 were classified as low-risk and 1 as medium based on OST. Nurses in primary care are able to identify key risk factors for osteoporosis, examine the measurement with quantitative ultrasound, and identify individuals with the disease. ]

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Psychoneuroimmunology and the embodied mind

SZABÓ Attila

One of the major philosophical aspirations in contemporary consciousness research is to find a framework of explanation that could successfully address the problem of mind-body relations. Descartes is often regarded as the father of dualism in modern philosophy of mind. Phenomenology and embodiment may dissolve the problem of dualism in the waters of the experiential features of the life-world and the subject. Recent findings in psychoneuroimmunology have shown that somato-psychic mechanisms exist through which bodily stimuli are translated into neuropsychological events resulting in alterations in certain behavioral patterns. These may as well include changes in the qualitative features of the lived body (Leib) resulting in an overall change in the subjective experience. The application of modern embodiment theories in life sciences has the potential to create a novel, fruitful and heuristic approach, which may help us unveil features of the “mind-body phenomenon” that have been hidden so far. In this paper, I will try to briefly outline a possible analytical framework on the grounds of classic - Husserlian and Merleau-Pontian - phenomenology and biomedical sciences.

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[A case of a 61-year-old male patient suffered chronic renal failure and dialysed for 23 years with destructive cervical spondylarthropathy is presented. The patient presented with sudden onset of cervical pain radiating into his shoulders without neurological deficits. CT and MRI of the cervical and thoracic spine revealed severe destructive changes and compressive fractures of C6 and C7 vertebrae which caused the narrowing of the nerve root canals at these levels. A 360-degree fixation was performed to treat the unstable fracture and the patient’s pain (C6 and C7 corpectomy, autolog bone graft replacement of the two vertebral bodies, anterior plate fixation and posterior instrumentation with screws and rods). Postoperatively the patient had no significant pain, no neurological deficit and he was able to manage independent life himself. During the immediate follow-up CT of the neck showed the satisfactory position of the bone graft and the metal implantations. The 6 months follow-up CT revealed the anterior migration of the two screws from the Th1 vertebral body and 2 mm ventral elevation of the caudal end of the plate from the anterior surface of the Th1 vertebral body. The 1-year follow-up could not be performed because the patient died due to cardio-pulmonary insufficiency. This is the second Hungarian report of a chronic dialysis related severe spondylarthropathy which may cause pathologic fractures of the vertebral bodies. The typical radiological and histological findings are discussed. This disease affect patients’ quality of life and the conservative treatment alone seems to be ineffective in most cases. Based on the literature and personal experiences, the authors suggest 360-degree fixation of the spine to provide sufficient stability for the vertebrae of ”bad bone quality”, and early mobilisation of the patient can be achieved.]

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