Lege Artis Medicinae

[The Hepatologist’s Dilemma]

WERLING Klára

JANUARY 21, 2004

Lege Artis Medicinae - 2004;14(01)

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Lege Artis Medicinae

[LOCAL INEQUALITIES IN THE UTILIZATION OF SPECIAL HOME NURSING IN THE SOUTH-TRANSDANUBIAN REGION]

BONCZ Imre, SÁNDOR János, OLÁH András, BETLEHEM József, SEBESTYÉN Andor, KISBENEDEKNÉ Gulyás Kinga, DÓZSA Csaba

[INTRODUCTION - The aim of this study is to analyse the local inequalities in the access and utilization of special home nursing within Hungary focusing on the South-Transdanubian Region. DATA AND METHODS - In the first part of the study we compared the indicators of the access and utilizations of special home nursing at national and county level. In the second part of the analyses we made a detailed analyses of utilization data of home nursing in the three counties (Baranya, Somogy, Tolna) of the South- Transdanubian Region of Hungary. Data is derived from the financial database of the National Health Insurance Fund of Hungary for the period 1998-2002. RESULTS - The access of population to the special home nursing increased from 83,8% (1998) to 95,1% (2002). The utilization rate increased from 74,8% (1998) to 84,1% (2002). Within the South-Transdanubian Region we found significant local inequalities in the utilization of services (number of cases, number of visits), which were represented by the tools of geographical information system. CONCLUSIONS - There have been significant differences in the access and utilization of home nursing with remarkable within country inequalities.]

Lege Artis Medicinae

[Cardiovascular aspects of impaired glucose tolerance: A review through the STOP-NIDDM Trial]

BOSNYÁK Zsolt, KERÉNYI ZSUZSA

Lege Artis Medicinae

[A NEW DISCIPLINE IN THE CENTER OF MEDICAL RESEARCH AND CLINICAL PRACTICE - THOUGHTS ON BIOINFORMATICS]

FALUS ANDRÁS, BERKE Tamás, ORTUTAY Csaba Péter, SUHAI György

[Bioinformatics is one of the most important element of genomic research revolutionising biomedical science. This review describes the phenomena of genomic variance and comparative genomics. Briefly, the review summarises the identification procedure of new genes and gene expression patterns highly important in diagnostics. Bioinformatic procedures make possible the rapid detection of pathogens and have principal role in molecular drug design technologies.]

Lege Artis Medicinae

[THE METABOLIC SYNDROME CLINICAL APPEARANCE, DIAGNOSIS, PATHOMECHANISM]

KÉKES Ede, CZURIGA István

[The metabolic syndrome has gone by several names over the past two decades. The diagnostic criteria were proposed by the ATP III of NCEP in 2001 and were accepted by European Society of Cardiology and European Society of Hypertension in 2003. The criteria (abnormal waist rate, HDLcholesterol, triglyceride, blood pressure and fasting glucose) are listed and the presence of any three of these factors is considered sufficient for diagnosis. The prevalence of syndrome affects about a quarter of the Hungarian population with hypertension. The metabolic syndrome is associated with premature cardiovascular morbidity and mortality including an excess of sudden deaths. According to the recent literature data the main component of the syndrome, the obesity, especially with abdominal fat distribution is associated with hypertension, hyperinsulinemia and insulin resistance with related abnormalities of carbohydrate and lipid metabolism. The low HDL cholesterol, high triglyceride level and the small, dense LDL cholesterol particles are the parts of lipid component of syndrome. A variety of environmental (obesity, smoking, physical inactivity) and genetic factors (genetic mutations of lipoprotein lipase, hepatic lipase, CETP and PPA receptors) and the impaired FFA metabolism have all been related to lipid abnormalities. Sympathetic hyperfunction participates in the pathogenesis and complications of metabolic syndrome. Possible factors augmenting sympathetic activation include alterations of insulin, leptin, FFA, cytokines, sleep apnoe. Other important factors as the endocrin concept, the hypothalamus-hypophysis- adrenal axis, endothelial dysfunction are discussed. The impaired muscle insulin stimulated glycogen synthesis (FFA induced GLUT-4 inhibition) is the major cellular factor of insulin resistance. There is a continuous process from the insulin resistance state (with hyperinsulinemia) into the 2T diabetes mellitus (with hypoinsulinemia).]

Lege Artis Medicinae

[CURE]

MATOS Lajos

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[Systemic thrombolysis after the administration of idarucizumab in acute ischemic stroke]

PÁSZTOR Máté, BERECZKI Dániel, SZAKÁCS ZOLTÁN, MAY Zsolt

[Introduction - Expanding indications have resulted in an increasing number of patients taking novel oral anticoagulants, posing a major treatment dilemma in acute ischemic stroke. Case presentation - We present a successful intravenous thrombolysis in a dabigatran-treated patient with acute ischemic stroke after the administration of idarucizumab. Discussion - According to current guidelines, systemic thrombolysis is contraindicated under treatment with novel oral anticoagulants (taken within 48 hours). In this scenario, idarucizumab offers a solution by reversing the anticoagulant effect of dabigatran. Conclusion - Although there have only been case reports published so far, the dabigatran-antidote idarucizumab seems to give new therapeutic opportunities in the treatment of acute ischemic stroke.]

Clinical Neuroscience

Watershed infarction in hypereosinophilic syndrome: a diagnostic dilemma in FIP1L1-PDGFR alpha-associated myeloid neoplasm

IMELDA Marton, PÓSFAI Éva, ANNUS János Kristóf, BORBÉNYI Zita, NEMES Attila, VÉCSEI László, VÖRÖS Erika

Introduction - The FIP1L1-PDGFR alpha-positive, hypereosinophilic syndrome (HES) is a new category of hematological entities. Various clinical symptoms may occur, with no specific characteristics in either the clinical picture or the neuroimaging findings, and this may give rise to a diagnostic dilemma. A report on a long follow-up period (10 years) in a case of HES that presented with neuropsychiatric symptoms appears to be unique. Besides the complexity of the diagnostic process, the successful treatment is discussed. Case report - The HES was diagnosed in a male patient at the age of 33 years, with involvement of the central nervous system and the myocardium. After the onset of the clinical signs, the MRI indicated bilateral cerebral and cerebellar cortico-subcortical lesions involving the watershed areas, mainly in the parieto-occipital regions. High-dose intravenous steroid (methylprednisolone 500 mg/day) alleviated the neurological symptoms within a few weeks, and the administration of imatinib (200 mg/day) resulted in an impressive regression of the hypereosinophilia and splenomegaly within 6 weeks. During the follow-up, the patient has continued to receive imatinib. The molecular remission has persisted, no new complaints have developed and the condition of the patient has remained stable. Conclusion - The timely recognition of the HES and identification of the disease subtype which led to the administration of imatinib may be the key to successful treatment. The long stable follow-up period gives rise to a new dilemma in the treatment of the HES in these special cases: for how long should a patient receive a tyrosine kinase inhibitor, and may the treatment be suspended?

Clinical Neuroscience

[Dilemma of further therapeutic step in RRMS in case of ineffectivity of first line treatment: fingolimod or natalizumab?]

LOVAS Gábor

[Dilemma of further therapeutic step in RRMS in case of ineffectivity of first line treatment: fingolimod or natalizumab? 2014;67(03-04)]

Lege Artis Medicinae

[Dilemma]

FRENKL Róbert

[After the hard and the soft dictatorship, it is understandable that the indoctrination of the past is still alive in the gut; mixed with the mechanisms of a fledgling democracy, it creates its own conflicts, where both the decision and the truth are difficult to pronounce]

Lege Artis Medicinae

[Perioperative management of patients with coronary stent in case of interventions other than cardiac surgery - Part I. - Perioperative treatment of patients with coronary stent]

ZIMA Endre, MEZŐFI Miklós, BECKER Dávid, SZABÓ György, MERKELY Béla, PÉNZES István

[Percutaneous coronary intervention (PCI) is meant to optimalise cardiac status, that is, short-term and long-term outcomes. It is known from large Western databases that stent implantation is performed in 77-85% of coronary interventions, which means hundreds of thousands of new patients with stent every year. The great majority of these patients has to take platelet aggregation inhibitors, namely acetylsalicylic acid and thienopyridin, most often clopidrogel. It presents a major therapeutic dilemma when these patients require noncardiac surgery. First, surgery should be performed with the least possible blood loss, which would be optimal if the platelet aggregation inhibitor therapy - that is indispensable for a certain period because of the stent - was suspended. Second, stent thrombosis has to be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current guidelines and the risk estimation on the basis of our current knowledge in the perioperative management of patients with coronary stent. In the first part, we overview the platelet aggregation inhibitor agents, their mechanisms of effect, stent types and the minimal therapeutic period to be strictly observed, which depends on the type of stent.]