Lege Artis Medicinae

[The Arc of Wine]

NAGY Zsuzsanna

NOVEMBER 20, 2009

Lege Artis Medicinae - 2009;19(11)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Wolf or lamb?]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[In wine, the truth?]

FEHÉR János

Lege Artis Medicinae

[Diabetes mellitus and cancer risk]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past decades, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. On the basis of the latest publications that have created a storm we have to highlight the associations between diabetes mellitus, its treatment protocols and tumours. Analysing the often controversial human results, in the absence of relevant prospective studies, we have to consider preclinical observations to choose a safe treatment method.]

Lege Artis Medicinae

[Cirrhosis and its complications: diagnostic and treatment options]

PÁR Alajos

[During the past two decades, the management of complications of cirrhosis has dramatically changed, which substantially improved the patients’ survival. The present paper provides an overview of the diagnosis, treatment and prevention of cirrhosis and its complications including portal hypertension, variceal bleeding, ascites, hepatorenal and hepatopulmonary syndromes, encephalopathy and bacterial infection. Besides noninvasive diagnostic methods, pharmacological and endoscopic treatment modalities are discussed, with emphasis of the importance of nonselective beta-blockers, vasoactive therapy, antibiotic and albumin medication. Prevention and early diagnosis of cirrhosis as well as new pharmacological agents under development presumbaly result in further development in the management of patients with advanced, chronic liver disease.]

Lege Artis Medicinae

[Treatment of severe infections: principles of therapy and problems of resistance]

LUDWIG Endre

[The basic principles of the treatment of severe infections have recently been delineated : after having samples for microbiological tests, empiric therapy based on local resistance patterns should be introduced immediately, possibly within 1 hour in severe sepsis or in septic shock, the empiric therapy should be simplified according to the results of microbiological tests and/or improvement of the condition of patient , the antibiotics should be applied according to their pharmacodynamic properties, the duration of therapy should be shortened to the minimum time, in case of well responding non-complicated infection to 5-7 days., The most frequent problem pathogens in Hungary are the MRSA and ESBL-producing Gram-negatives. In severe infections with MRSA bacteremia, the therapy sholud be based on the vancomycin MIC of the pathogen. If MIC is below 1,5 mg/l, vancomycin is probably effective with a serum minimum concentration of 15 mg/l, while in case of less sensitive pathogens the administration of an alternative agent, such as linezolid, tigecyclin or daptomycin should be considered. In severe infections due to ESBL-producing pathogens, the carbapenems are the firts line antibiotics, while tigecyclin seems to be a promising alternative agent. The treatment of severe infections requires thorough care of the patient and skillnes in antimicrobial therapy in the period of multiresistant pathogens]

All articles in the issue

Related contents

LAM KID

[The role of diet in the prevention of musculoskeletal diseases]

SPEER Gábor, SPEER Józsefné

[In the European Union, the lowest incidence of osteoporosis and rheumatoid arthritis has been reported in the Mediterranean area. However, for a long time only a few nutrients’ effects have been studied on BMD. Of these, the favourable effects of wine, fermented cheese and fruit and vegetable consumption have been demonstrated in the alleviation of both osteoporosis and rheumatoid arthritis. A number of promising studies are being conducted with analogues of antioxidant components of the mediterranean diet. Some of these components decrease the levels of pathological factors, such as interleukin-1, -6, -17, TNF-α, JAK2/STAT3, which are the targets of a number of efficient drugs. These findings demonstrate the significance of diet in the development of musculoskeletal diseases. In our review article, we present the above mentioned data, illustrated by some of our own recipes.]

Clinical Neuroscience

[Novel strategy in the radiotherapy of metastatic brain tumors: simultaneous whole brain radiotherapy and integrated stereotactic radiosurgery]

KALINCSÁK Judit, LÁSZLÓ Zoltán, SEBESTYÉN Zsolt, KOVÁCS Péter, HORVÁTH Zsolt, DÓCZI Tamás, MAGNEL László

[Background and purpose – Treatment of central nervous system (CNS) tumors has always played an important role in development of radiotherapy techniques. Precise patient immobilisation, non-coplanar field arrangement, conformal treatment, arc therapy, radiosurgery, application of image fusion to radiation planning or re-irradiation were first introduced into clinical routine in the treatment of brain tumors. Methods – A modern multifunctional radiation instrument, Novalis TX has been installed at the University of Pécs two years ago. New methods, such as real time 3D image guided therapy, dynamic arc therapy and ultra-conformity offer further progress in treatment of CNS tumors. Whole brain irradiation and simultaneous fractionated stereotactic radiosurgery or integrated boost seem to be an optimal method in the treatment of not only soliter or oligo, but even a higher number (4-9) and not typically radiosensitive brain metastases. The new treatment strategy is illustrated by presentation of four case histories. Results – Treatment protocol was completed in all cases. Treatment period of 1.5 to 3 weeks, and treatment time of only a few minutes were not stressful for the patients. A quite remarkable clinical improvement as to general condition of the patients was experienced in three cases. Follow-up images confirmed either remission or a stable disease. Conclusions – Simultaneous whole brain radiotherapy and integrated stereotactic radiosurgery is a reproducible, safe method that offers an effective irradiation with delivery of definitive dosage even in cases with radio-insensitive brain metastasis.]

LAM KID

[On the culture of wine]

DÁNIEL Zsolt

Clinical Neuroscience

[Investigation of cerebral autoregulation in Parkinson’s disease]

DEBRECZENI Róbert, AMREIN Ilona, KOLLAI Márk, LÉNÁRD Zsuzsanna, PÁLVÖLGYI László, TAKÁTS Annamária, GERTRÚD Tamás, SZIRMAI Imre

[Background and purpose - The frequent orthostatic intolerance in Parkinson’s disease could be the consequence of cardiovascular autonomic failure and/or a damaged cerebral autoregulation (AR). To clarify this question the regulation of cerebral circulation was investigated by polygraphic method. Methods - On a tilt table simultaneous and continuous registrations were made of MCA velocity (VMCA) by transcranial Doppler, arterial blood pressure by non-invasive method, and end-tidal CO2, in supine and in tilted positions of 10°, 30°, 70° grades. The cerebral autoregulation was characterized by the slope of the curve of the arterial blood pressure at the level of the Willis-circle (BPW, as MCA perfusion pressure) plotted against the MCA velocity, achieved by linear regression (y=ax+b function, a=AR, or index of autoregulation). Patients - The data of 17 parkinsonian patients (PP) and eight age-matched controls (C) were analyzed. Results - The decrease of blood pressure in parkinsonian patients was significantly lower than in the controls when supine position was restored from 70° (ΔABP 70°-0°PP= -3.1±7.5 Hgmm; ΔABP 70°-0C°=-11.1±7.3 Hgmm; p<0.05), which suggests a damage to the sympathetic cardiovascular system. A disturbance of the cerebral autoregulation in patients was suggested by a progressively decreasing MCA average velocity (VMCA) during graded tilt, which was significiant at 70° (ΔVACM=9.8±8.82% cms-1; pCPP <0,05), and by a higher slope of pressure-velocity curve (ARC=0.143±0.125% cms-1/Hgmm; ARPP=0.38±0.25% cms-1/Hgmm; pC-PP<0.05). Conclusions - The results show that the cerebral blood flow of patients is more dependent on perfusion pressure compared to healthy controls. The disturbance of the sympathetic cardiovascular system and of cerebral autoregulation could be the consequence of a damage to the postganglionic structures in Parkinson’s disease. These results could explain the frequent orthostatic intolerance of patients even with normal blood pressure.]

Lege Artis Medicinae

[In wine, the truth?]

FEHÉR János