Lege Artis Medicinae

[The lost humanness]

FRENKL Róbert

JANUARY 27, 2009

Lege Artis Medicinae - 2009;19(01)

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[Saving Lives at the Cost of the Physician’s Life?]

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[The Truths of August the Dumb – Clown Doctors]

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[The Adventures of Haydn’s Skull]

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[Importance of statin therapy in stroke prevention]

KÁPOSZTA Zoltán, RÁCZ Klára

[Stroke is the third leading cause of death and a leading cause of major adult disability in developed countries. The annual incidence of hospitalized stroke varies between 400-500 per 100 000 inhabitants every year in Hungary. In the past decade, cholesterol lowering with 3- hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors (statins) has proved to reduce risk of stroke in patients with and without coronary disease (CAD). In patients with CAD, statin therapy reduces the risk of first stroke by 25% to 35% versus placebo and, moreover, intensive statin therapy to LDL-C targets below 2.6 mmol/L (100 mg/dL) appears to reduce the risk further. More recently it has also been shown that intensive statin therapy can reduce risk of recurrent stroke in nondiabetic as well as diabetic patients with recent stroke or transient ischaemic attack but no CAD. The overall reduction of stroke and TIA was 23%. Evidence from retrospective studies suggests that in addition to risk reduction statin pretreatment may improve stroke outcome. It may due to their pleiotropic effects that include improvement of endothelium function, anti-inflammatory, antithrombotic, and immunomodulatory effects. As statins have both an excellent safety profile and simple administration, physicians should consider using statins, at dosages shown to have efficacy in clinical trials, in all patients whose cardiovascular risk profile puts them at high risk of stroke.]

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Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Lege Artis Medicinae

[Manifestations of COVID-19 in pregnancy]

TÖRÖK Marianna, VEZÉR Márton, ZUBEK László, KESZTHELYI Márton, VÁRBÍRÓ Szabolcs

[There are confirmed COVID-19 infections in Hungary since March 2020. This disease caused by SARS-CoV-2 was initially known not to impose special risk on pregnant women, but probably due to the increasing number of cases and the latest mutations, this is no longer true nowadays. Recent outcomes suggest that pregnancy increases the risk of hospital admission, invasive ventilation and death with higher odds of preterm birth and caesarean sec­tion. Seemingly, vertical infection occurs only in a small percentage of all cases. To our best knowledge, 7 expectant mothers lost their life in Hungary thus far due to COVID-19. However, further rigorous studies are needed for a more accurate understanding of pregnancy complica­tions.]

Lege Artis Medicinae

[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]

MORVAY Zita, MAROFKA Ferenc, CSAJBÓK Ernő, SZENOHRADSZKY Pál

[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]

Lege Artis Medicinae

[A CASE OF PRIMARY HEPATIC AMYLOIDOSIS PRESENTING WITH GASTRIC BLEEDING]

STOGICZA Ágnes, GRABER Hedvig, SKALICZKI József, NÁDOR Katalin, MAGYAR Tamás

[INTRODUCTION - Amyloidosis - at an early stage - has no typical clinical findings, but severe weight loss, hepatomegaly and elevated serum alkaline phosphatase level can be clues to the diagnosis. CASE REPORT - We report a 66-year-old woman presenting at our unit with massive gastrointestinal bleeding. Gastroscopy was performed and a haemorragic ulcer was found. Before admission she had lost 20 kg-s in 6 months. The patient had hepatomegaly and markedly elevated serum alkaline phosphatase level. These findings suggested the presence of malignancy, but ultrasound, CT and MR examinations did not support this hypothesis. After liver biopsy the diagnosis of amyloidosis was proven. She had rapid downhill clinical course of gastric bleeding from an ulcer resulting in death. CONCLUSIONS - So far, no specific treatment exists for amyloidosis, but there have been promising results reported about liver transplantation and autologous stem-cell transplantation.]

Lege Artis Medicinae

[To do business or not to do business... Is that the question?]

GYENES Géza

[A wild, stormy night raged along the southwest coast of the New Hebrides. The gloomy cliffs braved the sea's renewed onslaught, sometimes lost among the darkly churning wave crests. Otherwise, the above was of no particular significance for our story, which took place not on the south-western shores of the New Hebrides but in Hungary, although it is true that the weather conditions there were not very good at the time.]