Lege Artis Medicinae

[The Hungarian Fate of a Discovery – Diuretic Renography]

RADÓ János

FEBRUARY 20, 2009

Lege Artis Medicinae - 2009;19(02)

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Lege Artis Medicinae

[I planted a ginkgo biloba]

NAGY Viktor

Lege Artis Medicinae

[Treatment of acute pancreatitis, with special regard to pharmaceutical therapy]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]

Lege Artis Medicinae

[Sudden cardiac death in athletes - cardiac electrophysiology point of view]

VARRÓ András

[Sudden cardiac death of athletes is very rare (1/50 000 to 1/100 000 annually) but it is still 2 to 4 times more frequent than that of the agematched normal population. In addition, it attracts peculiar media attention. Sudden cardiac death in athletes is supposed to not primarily have an ischemic origin but most likely relates to repolarization abnormalities. These may be caused by several independent and/or dependent factors such as benign cardiac hypertrophy developing normally in athletes (athlete’s heart), hypertrophic cardiomyopathy, increased sympathetic activity, genetic defects, seemingly harmless drugs, doping agents, food, and dietary supplements. These factors together can increase inhomogeneities in myocardial repolarization (“substrate”). In this case, an otherwise harmless extrasystole (“trigger”) occurring with unlucky timing may - although very seldomly - elicit fatal arrhythmias. Thus, effective prevention of sudden cardiac death may include new types of cost-effective cardiac electrophysiological screening methods (ECG or echocardiography) and, in case of a high level of suspicion, more costly genetic tests can be considered.]

Lege Artis Medicinae

[Labiolingual lesions - important symptoms of a rare endocrine syndrome]

SALLAI Ágnes, HOSSZÚ ÉVA, GERGICS Péter, RÁCZ Károly, FEKETE György

Lege Artis Medicinae

[Practical considerations in the state-of-the-art management of ankylosing spondylitis]

SZÁNTÓ Sándor, SZEKANECZ Zoltán

[Ankylosing spondylitis is an inflammatory rheumatic disease characterized by inflammation of the spinal and sacroiliacal joints, which causes chronic back pain and ultimately spinal stiffness, impaired motility, and deformity. Until the last decade, treatment mainly consisted of a combination of physical therapy and non-steroidal anti-inflammatory drugs, but recently tumor necrosis factor-α inhibitors revolutionized therapy and improved clinical outcomes. Tumor necrosis factor-α inhibitors effectively control inflammation of the sacroiliacal and spinal joints as shown by improved signs symptoms, and functions, magnetic resonance imaging findings, and reduction of acute phase reactants. Whether these drugs are capable of preventing radiographic progression and structural damage has, however, to be clarified in future studies. This review aims to highlight recent progress in the treatment of ankylosing spondylitis, and to provide recommendations for its management.]

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[The Comprehensive Aphasia Test in Hungarian]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

KAPÓCS Gábor

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]