Lege Artis Medicinae

[The Nuremberg Doctors' Trial - The forever valid social message of the forced euthanasia programme]

KERPEL-FRONIUS Sándor

FEBRUARY 21, 2008

Lege Artis Medicinae - 2008;18(02)

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[Cardiovascular protection with telmisartan]

NAGY Viktor

Lege Artis Medicinae

[The End of the Story]

MAKÓ János

Lege Artis Medicinae

[Pregnancy and insulin resistance: theoretical and clinical issues]

BARANYI Éva, WINKLER Gábor

[During pregnancy, metabolic changes occur physiologically, which are enhanced by the presence of gestational or praegestational diabetes. The basis of these changes is the increasing insulin resistance throughout pregnancy, which in diabetics may result in hyperglycaemia with undesirable clinical consequences and complications. These complications can be prevented in diabetic pregnant women by maintaining the physiological metabolic state typical of healthy pregnant women. Thus the aim of the treatment is to achieve a normoglycaemic state throughout pregnancy. In most cases this is only possible by the use of insulin, along with appropriate dietary measures. Intensive insulin regimes are successfully used in the metabolic control of pregnant diabetic women, and the use of insulin analogues and insulin pump may also be considered.]

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[Adenoma of the adrenal cortex imitating renal cancer]

SEJBEN István, GÖCZŐ Katalin, SZABÓ Zoltán, CSERNI Gábor

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[Microscopic colitis]

BARTA Zsolt

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The effects of the level of spinal cord injury on life satisfaction and disability

GULSAH Karatas, NESLIHAN Metli, ELIF Yalcin, RAMAZAN Gündüz, FATIH Karatas, MÜFIT Akyuz

Introduction - Spinal Cord Injury (SCI) may often lead to significant disability in affected individuals and reduce life satisfaction. Herein we aimed to investigate the effects of the level of injury on disability and life satisfaction as well as the relation between life satisfaction and disability. Methods - Patients with at least one-year history of SCI were included. Demographic-clinical data of patients were recorded. The Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) was used for quantifying the degree of patients’ disability. Life satisfaction was assessed by the Satisfaction with Life Scale (SWLS). Results - Of the 76 patients, 21 (27.6%) were tetraplegic and 55 (72.4%) were paraplegic. SWLS was found to be similar in tetraplegic vs. paraplegic patients (P=0.59), whereas CHART parameters such as physical independence, mobility, occupation, and total CHART value were significantly higher in paraplegic patients (P=0.04, P=0.04, P=0.001 and P=0.01, respectively). Social integration was found similarly high in both groups. There was a positive correlation between elapsed time after the injury and CHART physical independence, occupation and the level of economic sufficiency (P<0.01, P<0.01, P=0.01). Excluding the economic sufficiency (P=0.02), there was not any other association between the rest of CHART parameters and SWLS. Conclusions - According to our findings, although the level of injury seems to be influential on disability, it seems to have no significant effect on life satisfaction. Since the only thing that positively affects life satisfaction is economic sufficiency, more emphasis should be placed on regulations that increase the return to work in patients.

Clinical Neuroscience

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

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[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

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[The Comprehensive Headache-related Quality of life Questionnaire shows significant improvement after withdrawal treatment in medication overuse headache: a pilot study]

GYÜRE Tamás, CSÉPÁNY Éva, HAJNAL Boglárka, KELLERMANN István, BALOGH Eszter, NAGY Zsolt, MANHALTER Nóra, BOZSIK György, ERTSEY Csaba

[Background and purpose - Medication overuse headache (MOH) is a common form of disabling headache presenting in as much as 30% of the patients seen in headache subspecialty practice. Quality of life (QOL) is frequently used as a secondary endpoint in headache trials. In MOH, previous trials of QOL focused mostly on generic QOL. We report the results of a pilot study that examined the feasibility of using a new QOL questionnaire, the 23-item Comprehensive Headache-related Quality of life Questionnaire (CHQQ), as an indicator of treatment response in MOH. Patients and methods - Fifteen patients (13 women and two men; mean age: 39.7±12.5 years) suffering from MOH were enrolled in a complex treatment programme consisting of acute medication withdrawal, preventive pharmacological treatment, structured advice and lifestyle intervention. The clinical data were collected using a detailed headache diary. CHQQ was completed before and after the treatment programme. Results - MOH patients had low QOL values at baseline which was comparable to the QOL of episodic migraine patients. The treatment programme resulted in significant reductions of the number of headache days and attacks, headache severity and analgesic consumption. The dimensions and total score of CHQQ showed a significant increase after the treatment period. Seventeen of CHQQ’s 23 individual items also improved significantly. Conclusion - In this study the new headache-specific quality of life instrument CHQQ was able to demonstrate significant improvements after adequate treatment of MOH. This result indicates that the CHQQ may be an adequate tool for assessing quality of life in headache treatment trials.]

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[Current questions of quality assurance in diagnostic radiology in the light of a visit to England]

PORUBSZKY Tamás, GICZI Ferenc, BALLAY László, PELLET Sándor

[Physical-technical aspects of quality assurance in diagnostic radiology, because of its dependence on technology are of an extraordinary importance. The intention of Hungary to join EU makes at least the decrease of our lag in this respect unavoidable. Ministerial order 31/2001 (X. 3.) EüM which already came into force requires quality assurance in diagnostic radiology explicitly. This paper starts with definition of basic concepts, then outlooks shortly the history and present international situation of quality assurance in diagnostic radiology. We review preliminaries and the present situation in Hungary, including results of the National Patient Dose Assessment Programme till now. We think that the most efficient help to the initial steps of quality assurance in diagnostic radiology in Hungary may be the appropriate adaptation of experiences of the leading countries. Therefore we review experiences of one of the authors gained during visiting three medical physics centres in England in details. The following topics are discussed: legal requirements, types and levels of measurements, organizational problems, practical evaluation of measurements (including criteria of discarding equipment), patient dosimetry, personal dosimetry, mammography research, instrumentation of the radiology departments, calibration of measuring devices, questions of the so-called type testing and radiation protection training of workers.]