Lege Artis Medicinae

[The Janus-faced Princess, or the Secret of Ghosts Emerging from the Depth of the Soul ]

GEREVICH József

SEPTEMBER 20, 2018

Lege Artis Medicinae - 2018;28(08-09)

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Lege Artis Medicinae

[Medical aid in dying or physician assisted suicide]

KŐMÜVES Sándor

[The paper reflects upon the process in which physician assisted suicide, as it is traditionally called, is being reinterpreted. First, changes in word usage shall be demonstrated by examples taken form the relevant US laws and statements of prestigious US organisations. Then the interpretive possibilities of suicide, as it is traditionally called, and their consequencies are discussed. In this context the present state of art of the Hungarian criminal law is briefly presented. Finally some remarks on the normative element of the practice are made. ]

Lege Artis Medicinae

[Differential diagnosis and treatment of hyponatraemia]

NÉMETH Zsófia, DEÁK György

[Hyponatraemia (serum sodium concentration < 136 mmol/l) is the most frequent electrolyte abnormality that inceases the risk of both in-hospital, and outpatient mortality. Antidiuretic hormone action or low glomerular fitration rate or low excretable osmoles or their combination are involved in its pathogenesis. Differential diagnosis is based on medical and medication histories, serum- and urine osmolality and urine sodium concentration. Measurement of fractional excretions of urea and uric acid help identifying low effective circulting volume, renal hypoperfusion. Symptomatic hyponatraemia or an acute decrease of serum sodium concentration exceeding 10 mmol/l should be treated with 3% NaCl to avoid impending threat to life. The principles of the treatment of chronic hyponatraemia are restriction of water intake and elimination of etiologic factor(s) (eg. medications - most often thiazides). In case of contracted axtracellular volume, isotonic saline should be given. In case of euvolaemia, restriciton of water intake is fundamental. In case of expanded extracellular volume, (heart failure, liver cirrhosis, nephrosis), water and NaCl intake should be restricted along with aldosteron antagonist and loop diuretic therapy. In chronic hyponatraemia, the rise of serum sodium concentration should not exceed 10 mmol/l during the first 24 hours and 8 mmol/l/day thereafter. ]

Lege Artis Medicinae

[„Is it worth the while to be further occupied with the history of medicine? - letter by Gyula Magyary-Kossa to Bódog Csajkás]

PERJÁMOSI Sándor

[In 1941 Bódog Csajkás, a young historian of medicine at the beginning of his career, wrote a letter to Gyula Magyary-Kossa, the most outstanding character of Hungarian medical historiography and sent him some of his works. In this letter he asked if there was a point in further devoting himself to the history of medicine. In a short and encouraging answer Magyary-Kossa urged the young man to continue with his efforts. ]

Lege Artis Medicinae

[Depression in medical practice - the possibilities of diagnosis and treatment]

OSVÁTH Péter

[Nowadays, there is an increasing incidence of depressive mood disorders, so we have more and more depressed patients in everyday clinical practice. Unfortunately, in many cases, this is not recognized and thus the treatment of depressed patients is not adequately addressed. Untreated depression not only increases the burden of the patient and his environment, but leads to serious and dangerous psychic and somatic complications. However, with modern and complex psychopharmacological, psychotherapeutic and sociotherapeutic methods, depressive mood disorders can be effectively treated. In this paper I review the etiologic background, the characteristics of depressive mood disorders and the most important steps of making diagnosis, as well as the state of the art therapeutic options. Rapid recognition and effective treatment of depressive symptoms has important therapeutic and preventive significance, so today, besides psychiatrists, there is an increasing role for general practitioners and other specialists (internists, neurologists, etc.).]

Lege Artis Medicinae

[The First Mindfulness Conference in Hungary ]

BRYS Zoltán, KIS János Tibor, SIMONCSICS Eszter

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[The pain-trigger role of cytokines in the nervous system – the direct analgesic effect of anti-cytokine therapy ]

HODINKA László, VERECKEI Edit

[Nociceptive, neuropathic and central me­chanisms are involved in the perception, transmission and processing of chronic pain and shaping of cerebral pain image. Alar­mins – molecules alarming defence and signing the presence of pathogens and tissue damage - trigger a series of pathogenic events resulting in inflammatory pain stimuli. Proinflammatory cytokines play a determining role in the pain perception at the level of the nervous system. Continuous inflammatory stimuli while sensitizing the periferic and central neurons activate the pain-related cerebral areas and develop the complex pain image, the pain matrix. Ce­reb­ral functional connections are operating in networks and can be visualized by functional MRI. Cytokines activate the neurons directly or indirectly by other neuromediators. Cytokine receptors are expressed on no­ciceptors and even on higher-level neurons and on various non-neural cells, such as microglia and astrocytes. The most ubiquitous cytokines are the Tumour Necrosis Factor and Interleukin 6 in the nervous sys­tem. The signaling pathways are the Nuclear Factor κB and the Janus-kinase enzyme system. The proinflammatory cytokines and the Janus-kinase are therefore primary therapeutic targets. Anti-cytokine biologicals and small molecular kinase inhibitors decrease the pain and improve functional activity in rheumatoid arthritis. Decrease of pain was more pronounced than expected only from the decrease of the clinical biomarkers of inflammation. The early and ra­pid painkiller effect of targeted biological and chemical-biological response modifiers is attributed to their direct analgesic effect on the brain.]

Clinical Neuroscience

[Unusually located metastatic tumors of the spine]

BAZSÓ Péter, NAGY László

[Metastatic spine tumors are representing a growing number of oncological patients. In this paper the authors would like to focus on a rare type of metastatic spine tumors, the unusually located ones. Since the advent of MRI and with the progress in general oncology this formerly rare tumors became more frequently recognized. Consequently these tumors are causing a new challenge for the oncologists, neurologists and neurosurgeons as well. The aim of the authors with this paper was to raise, especially the neurologists' attention to this emerging problem.]

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[Big blind spot syndrome (papillophlebitis) with unusual visual field defect]

RÓZSA Anikó, KOVÁCS Krisztina, BOÓR Krisztina, VAGYÓCZKY Ágnes, SZILVÁSSY Ildikó, GÁCS Gyula

[We present three cases, where young patients had unilateral disc edema with normal optic nerve function. We diagnosed their disease as big blind spot syndrome (BBSS). What is remarkable, however, is that in two of the three cases the extent of the visual field defect considerably exceeded the one regularly emerging in BBSS, which caused us some difficulty in differential diagnosis. The characteristics and the differential diagnostic questions of the big blind spot syndrome are summarised and we would like to draw attention to this unusual, but probably not very rare, form of it.]

Lege Artis Medicinae

[How can the specialists be contacted? Ways of communication in the specialist-patient consultation]

MOLNÁR Regina, PAULIK Edit, SÁGI Zoltán, KÖVES Béla

[Consulting the specia­list means face-to-face meetings traditionally. Nowadays patients do not need to go to the outpatient clinic to see the doctor since many new communication options have already been available. The aim of our study was to explore how typically doctors and patients use other options (as phone call or e-mail) beside face-to-face appointments in the outpatient clinic. We conducted a focus group interview with specialists and health workers and an in-depth interview with the chief nurse of an outpatient clinic in Budapest. The specialist-patient consultation is mostly face-to-face in the specialist’s office in the presence of the nurse, whose role is complex and pivotal. Fur­ther­more, the landline phone is an essential device, as the patients can reach the specialist or nurse in their office hours. The application of e-mail or mobile phone is incidental. The website of the outpatient clinic provides practical information to patients. Traditional postal letters, leaflets, and publications are also typical for providing information. The doctors’ opinion was rather heterogeneous about the pa­tients’ Internet usage and about the on­line contact with patients. Beside increasing the capacities the deliberate and organized introduction and application of technical de­vices, may reduce the overburdening of health professionals.]

Lege Artis Medicinae

[The significance of the identification of SARS-CoV-2 virus and the possible errors of the sampling method]

NOSZEK László

[The COVID-19 pandemic caused by SARS-CoV-2 virus while emerging suddenly and spreading throughout the globe challenged seriously also the modern medicine. Diag­nostic methods recognising viral infections of the upper airways developed essentially in the last 20 years, and it was specifically progressing during the SARS and MERS epidemics thus facilitating the recognition and identifica­tion of infections by influenza, RS- and adenoviruses as well. Nevertheless the present novel coronavirus (SARS-CoV-2) also de­mon­strated that the relatively simple procedures of naso- and oropharyngeal sampling are fallible too. Thus they may have a relatively high risk of false-negative outcomes. However the correct sampling prior the RT-PCR tests provides reliable diagnosis by high sensitivity and specificity. Thus improving the quality of sampling and avoiding failures by correct training and education of the personnel make more reliable the detection of viral infection or indicate recovery after the infection. Finally, this is a key issue while overcoming the present pan­demic.]