Lege Artis Medicinae

[The future was brighter in the past]

ANDRÁS László

FEBRUARY 28, 1994

Lege Artis Medicinae - 1994;4(02)

[Master triple, on the final accounts of the social security funds for 1992.]

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Lege Artis Medicinae

[Management of inhibitory haemophilia A and aquired haemophilia]

PFLIEGLER György, RÁK Kálmán, KRÁLL Géza, SAS Géza, HAYNAL Imre

[The authors survey the occurrence and the laboratory and clinical differences of factor VIU antibodies in haemophiliacs (allo) and in non-haemophiliacs (auto) as well as their titer and measurement. The recent therapeutic modalities used in prevention, management of acute bleeds and suppression of antibody development or in duction of immune tolerance are detailed. ]

Lege Artis Medicinae

[Back pain]

ANDREW Frank

[The studies to be presented show that the duration and severity of episodes of low back pain can be reduced, thus reducing the risk of recurrence and the costs of sick leave and absenteeism. Frank reviews differential diagnosis; acute, chronic and intractable pain; and the health services needed. Modern treatment principles emphasise self-care at home, usually with no more than 48 hours bed rest. The importance of regaining physical fitness and resuming other activities, including work, is also stressed. Medication helps to achieve these goals. Two issues are emphasised: the strategy for the management of low back pain should be long-term and preventive; it is the responsibility of the patient, not the doctors, to maintain fitness, exercise regularly, do relaxation exercises and avoid damaging the spine. ]

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[Eating attitudes and eating disorders among secondary school dancers: a high risk group?]

TÚRY Ferenc, WILDMANN Márta, LÁSZLÓ Zsuzsa, JOÓ Mária Nóra

[The authors assessed the morbidity of eating disorders and the frequency of pathological eating attitudes in two secondary school populations in a two-stage study. The first sample consisted of two classes specialized in dancing (n=54), the second was a control group of two age-matched classes without specialization (n=61). In each group one girl met the criteria of bulimia nervosa, which was 2% of the whole population. No anorectic subject was identified while pathological eating attitudes were significantly higher among dancers characterized by an increased slimness ideal. On the basis of the study the risk of eating disorders is higher in this special population. However, this difference can be shown only in the frequency of subclinical, attitudinal disorders, not in that of clinically severe syndromes.]

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[Heart attack primary prevention in hypertension trial]

MATOS Lajos

[Comparison of diuretic versus beta-blocker antihypertensive treatment in men with mild-to-moderate hypertension in terms of nonfatal infarction, coronary mortality and all-cause mortality. ]

Lege Artis Medicinae

[Correspondence]

SELMECZY Kamill

[Reflections on GP (family doctor) reform, training and more]

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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

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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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Rapid changes of stroke management in recent years facilitate the need for accurate and easy-to-use screening methods for early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS). Our aim was to evaluate the ability of various stroke scales to discriminate an LVO in AIS. We have performed a cross-sectional, observational study based on a registry of consecutive patients with first ever AIS admitted up to 4.5 hours after symptom onset to a comprehensive stroke centre. The diagnostic capability of 14 stroke scales were investigated using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) values of NIHSS, modified NIHSS, shortened NIHSS-EMS, sNIHSS-8, sNIHSS-5 and Rapid Arterial Occlusion Evaluation (RACE) scales were among the highest (>0.800 respectively). A total of 6 scales had cut-off values providing at least 80% specificity and 50% sensitivity, and 5 scales had cut-off values with at least 70% specificity and 75% sensitivity. Certain stroke scales may be suitable for discriminating an LVO in AIS. The NIHSS and modified NIHSS are primarily suitable for use in hospital settings. However, sNIHSS-EMS, sNIHSS-8, sNIHSS-5, RACE and 3-Item Stroke Scale (3I-SS) are easier to perform and interpret, hence their use may be more advantageous in the prehospital setting. Prospective (prehospital) validation of these scales could be the scope of future studies.