Lege Artis Medicinae

[The Great Acceleration]

BRYS Zoltán

DECEMBER 10, 2018

Lege Artis Medicinae - 2018;28(11-12)

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Lege Artis Medicinae

[Type 2 diabetes: what is the role of a General Practitioner in the treatment of diabetes?]

TORZSA Péter, OLÁH Ilona, HARGITTAY Csenge, KALABAY László

[The 2017 National Guidelines of the Hun­garian Diabetes Association emphasize the individual treatment of diabetic patients and the strong, goal-oriented regulation of carbohydrate metabolism from recogni­tion on. Beside monotherapy, primary dual or triple combination therapy may be applied in the treatment of patients. In primary care it’s the treatment of patients with type 2 diabetes where there is a lot to be done. We hope that the everyday use of the Professional Guidelines will contribute to a more successful diabetic care by General Practitioners (GPs). The holistic care of the GP’s team plays an important role in the primary, secondary and tertiary prevention of Type 2 diabetes, which accounts for more than 90% of all diabetic cases. ]

Lege Artis Medicinae

[Editor’s Response to a Reader Correspondence Reflecting the Article “Health Economics in Hungary: Great Potential, Missed Opportunity?” [2018;28(10):431-438.] ]

NÉMETH Bertalan

Lege Artis Medicinae

[IgG4-related gastropathy mimicking malignancy]

NAGY Pál, KASZÁS Ilona, PÁK Gábor, TIBA Imre, FELFÖLDI Éva, HAMVAS József, BAGDI Enikő, KRENÁCS László

[The Immunoglobulin G4-related disease (IgG4-RD) along with its synonyms is recently a popular topic in the medical literature. This illness can affect almost every organ in the body therefore it is frequently discussed in any type of interdisciplinary forums. We presented an instructive case of IgG4-RD with gastric involvement in 2016. Hereby we share our pertinent experiences. We are not dealing with the IgG4-RD in general including its terminology problems, epidemiology, pathogenesis, detailed clinical/pathological appearances, diagnostic criteria and treatment. A 63-year-old male presented with symp­toms of pylorus stenosis. The endoscopic findings and CT images were interpreted as those of a malignant tumour in the antrum of the stomach. So a subtotal resection was performed although the biopsy showed reactive proliferation of plasma cells without evidence of malignancy. Pathological examination of the surgical specimen confirmed an IgG4- associated sclerosing inflammation. The patient had an uneventful recovery. Our case is an example of rare, isolated formof IgG4-RD. ]

Lege Artis Medicinae

[The Nobel Prize in Medicine 2018 ]

KOVÁCS Ferenc

Lege Artis Medicinae

[Modalities of the therapy of patients with high cardiovascular risk]

FARSANG Csaba

[International and Hungarian guidelines emphasize the need of the combinations in the therapy of hypertension. Single pill combinations (SPC) are preferred. The importance of the treatment reducing cardiovascular risk is underlined by the fact that in most hypertensive patients other cardiovascular risk factors, among them most frequently dyslipidemia is present. In addition to antihypertensive drugs these patients should be treated also with those decreasing plasma lipids. Adherence / persistence to therapy of patients is greatly improved by the use of single pill combinations. Today we also have SPCs decreasing both, blood pressure and plasma lipids. Among them there is the combination containing amlodipine and atorvastatin. Several international and Hungarian clinical studies have been conducted. Results of these investigations have been described in several publications. In this paper I summarise the most important results of some of these studies. ]

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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.]

Hypertension and nephrology

[Treatment of high blood pressure in praxis and beyond. Hypertension praxis model]

ÁDÁM Ágnes

[Author presents a hypertension care model in the general praxis. Hypertensive patients and those with diabetes, hyperlipidemia and obesity, OSAS and the therapeutic results with these care model system for three years was analysed. The target blood pressure was achieved in a great rate in all patient’s groups. the elements of therapeutic success was analysed.]

Lege Artis Medicinae

[Endoscopic diagnosis of oesophageal intramural metastasis from an adenocarcinoma of the gastrooesophageal junction]

SZÁNTÓ Imre, VÖRÖS Attila, NAGY Pál, GONDA Gábor, ALTORJAY Áron, BANAI János, GAMAL E. Mohamed, KISS János

[INTRODUCTION - Authors present six cases of intramural oesophageal metastases of adenocarcinomas located in the gastro-oesophageal junction. The tumours and metastases were diagnosed by endoscopic examinations. PATIENTS AND METHODS - Between 01. 01. 1994. and 31. 12. 2000. a total number of 143 patients were examined with the diagnosis of adenocarcinoma of the gastro-oesophageal junction. In six patients (4,19 %), intramural oesophageal metastases were verified. In each case the diagnosis was confirmed by histological examination. TNM stage of the tumours was assessed considering the results of endoscopic ultrasound examination, the findings at initial operation and the pathological data in all cases, where resection was performed. The tumours were localized according to Siewert- Stein’s classification. RESULTS - In six patients who had adenocarcinoma of the gastro-oesophageal junction, the diagnosis of intramural oesophageal metastases was confirmed. The histological structure of the primaer tumours and metastases were the same. Metastases were detected by endoscopic ultrasound examination in three cases of the four examined patients as submucosal masses. All of the cardiac tumours proved to be well advanced: four of them classified as T4N1 by endoscopic ultrasound. Intramural metastases were diagnosed in each Siewert-Stein subgroups. CONCLUSION - Endoscopic examination is of crucial importance in the diagnosis of adenocarcinomas of the gastro-oesophageal junction and in their intramural metastases as well. Beside the endoscopic identification the primary tumour, the thorough examination of the proximal part of the oesophagus seems to be of great importance. These metastatic cancers appeared in the advanced stage of the disease. Endoscopic ultrasound examination is of great help in these cases to identify whether the mass causing oesophageal impression is outside of the wall of the organ, or in which layer it is localized. Endoscopic ultrasound examination also gives the possibility for preoperative assessment of the TNM stage of the disease.]

Hypertension and nephrology

[The 27th Great Assembly of the Hungarian Society of Nephrology]

Lege Artis Medicinae

[Diagnosis and therapy of insect sting allergy]

BÁNKÚTI Beáta

[Over the past 20 years great progress has been made in understanding the pathogenesis, diagnosis and treatment of allergic reactions caused by insect stings. The incidence of insect sting allergy in a general population is about 0.4- 3% but anaphylaxis to Hymenoptera venom can be fatal. The diagnosis of venom allergy is based on the history suggesting an allergic reaction and on the demonstration of the persistence of specific IgE antibody either by skin tests or RAST. Patients who had a severe allergic reaction and has positive venom skin test or RAST result should be advised to receive venom immunotherapy (VIT). The risk for subsequent life-threatening systemic sting reactions can be significantly reduced with VIT. VIT should be continued for at least 3 to 5 years and provides about 90 % protection from insect sting anaphylaxis.]