Lege Artis Medicinae

[The importance of the control of osmoregulation in modern medical practice]

BODA Domokos

MAY 20, 2002

Lege Artis Medicinae - 2002;12(05)

[The control of the osmoregulation has become of particular interest by progress in the following fields: 1. New research data showed that one of the main function of the cell is the maintenance of constant volume against extracellular and intracellular osmolar perturbations. It is regulated by loss or gain of electrolytes and non-ionic osmolytes mediated by membrane transport processes. 2. The activity of the vasopressin hormone is regulated by the newly discovered aquaporin water channel proteins. 3. Development of modern laboratory osmometers which enable precise determination of osmotic pressures of the fluids in the organism in clinical practice. New data on volume control of the cells and on aquaporin channels in various clinical conditions may provide safer treatment of fluid and electrolyte disturbances, the diagnostics and therapy of congenital and acquired nephrogenic diabetes insipidus and of the serum inappropiate ADH syndrome, as well as other pathologic conditions with water balance disturbances.]



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Lege Artis Medicinae

[Migrating pulmonary infiltrates from the clinican's point of view]

TÓTH Krisztina, RUMSZAUER Ágnes, MESTER Judit

[Authors define pulmonary migrating infiltrates based on four case reports of different etiologies: the concept refers to recurring pulmonary infiltrates appearing at separate localisations and at various times. Listed are those diseases and adverse factors where this phenomenon occurs with various prevalence. A diagnostic algorithm is suggested based on experience for similar cases starting with an accurate case history through non-invasive tests all the way to invasive diagnostics, including surgical intervention where needed. With full knowledge of the diagnosis adequate therapy can be started in time, which can save the patient from unnecessary and in many cases dangerous and incorrect treatment.]

Lege Artis Medicinae

[Prevalence of subtreshold forms of psychiatric disorders in persons making suicide attempts in Hungary]


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[Screening for lung cancer with CT?]


Lege Artis Medicinae

[Changing tendencies in retinal surgery]


[Retinal detachment, a disease caused by pathologic alteration of the vitreoretinal relationship, may decrease vision to blindness without treatment. Although some of the patients with retinal detachment become blind for the time being, last two decades produced significant improvement both in diagnosis and treatment. As a result of new surgical techniques we can perform successful surgery even in cases that were earlier inoperable. Recent methods are significantly less traumatic to the eye than they were 20 years ago. Dramatically reduced bedrest before and after surgery, regional or even topical anaesthesia instead of general anaesthesia, short term hospitalisation or one day surgery, short term restriction of physical activity after surgery are the most important consequences of the new wave of retinal detachment repair. According to recent recommendations of the prophylactic treatment of peripheral retinal lesions we treat only horse tears with sudden retinal complaints.]

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Hypertension and nephrology

[Coexistence of diabetes mellitus and (nephrogenic) diabetes insipidus]

RADÓ János

[In this report we describe a patient with nephrogenic diabetes insipidus associated with diabetes mellitus. The 44-year-old patient was seen by us for the first time when she was 5 years old in 1972, as a member of a family with nephrogenic diabetes insipidus associated with other congenital renal diseases. Surveying five generations by family history we found in four genarations (supported with investigations in three genarations) five patients suffering from the combination of renal tubular acidosis, polycystic kidney disease and nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus was confirmed with blood and urine osmolality measurements performed during water deprivation as well as during administration of synthetic vasopressins. Renal tubular acidosis was confirmed with blood and urine gas analysis and bicarbonate and acid loadings. Polycystic kidney disease was diagnosed with physical findings, imaging and in the case of a deceased patient by necropsy. The autosomal dominant trait was obvious in the family characteristic to the distal renal tubular acidosis and polycystic kidney disease. The clinical picture was dominated by the polydipsia and polyuria. Significant interindividual differences were found in vazopressin resistance responsible for the nephrogenic diabetes insipidus. In our patient metabolic syndrome (diabetes mellitus, hypertension, obesity, abnormal lipid and uric acid levels) and disturbances in calcium metabolism (nephrolithiasis and osteomalacia) were associated with renal disorders. The 39 year long observation period (with some discontinuations) the patient was treated almost without pauses with bicarbonate, desmopressin, thiazide, NSAIDs supplemented with the administration of vitamin D3, antidiabetics etc. Despite of the listed and other diseases the patient’s mood is quite good, her physical condition is relatively satisfactory while she is working regularly physically.]

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.]

Clinical Neuroscience

Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm


The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]