Lege Artis Medicinae

[The Patent System: is it For or Against Us? ]

VARGA Orsolya, MOLNÁR Péter

APRIL 21, 2006

Lege Artis Medicinae - 2006;16(04)



Further articles in this publication

Lege Artis Medicinae

[The True Salieri]


Lege Artis Medicinae


MAJOR János, RESS Katalin, HULESCH Bors, TÚRY Ferenc

[Burnout, a physical, emotional and spiritual exhaustion, is caused by chronic emotional stress, and is considered to be the end-state of a multistep process. It is most frequently observed among professionals who work with people and are faced with people's negative emotions every day. Apart from emotional stress, certain personality traits as well as high workload have also been linked to the development of burnout. Burnout symptoms include physical exhaustion (depleted energy, tiredness, illnesses), emotional exhaustion (hopelessness, depression, suicide), and spiritual exhaustion (pessimism, negative attitudes, dehumanization of patients). Approximately 20% of all medical practitioners in several European countries, as well as in the United States, have been demonstrated to show burnout symptoms. Its prevalence appears to be similar across countries, but shows differences according to medical specialty. Doctors mostly seeing patients with easily curable diseases or with good prognosis have a lower risk of burnout, whereas those seeing chronic or dying patients on a daily basis are at a much higher risk. The prevention is possible in a number of ways, such as ensuring proper work environment, providing personality development and soft skills trainings, and participation in clinical case study workshops. The Humania Professional Socialization Workshop was set up with prevention in mind at Semmelweis University in 2002 to formally provide medical students, as part of their vocational training, with skills and techniques that later will help them cope with hard emotional situations and thus reduce the risk of burnout.]

Lege Artis Medicinae

[The Scientific Rationale of Balneology]


Lege Artis Medicinae



[Bronchial asthma is a chronic disease with symptoms that significantly influence the daily life of patients causing difficulties in almost every area of life. The author reviews his own results and those published by others on the impact of asthma on the quality of life. The patients' quality of life was assessed using the general quality of life questionnaire EuroQol as well as the disease-specific St. George's Respiratory Questionnaire. Asthma was classified by severity according to GINA, an international classification system. The results of the study provide numerical proof of the concept that due to their disease, patients with asthma have lower quality of life indices than the non-asthmatic population. On examining the effect of age, sex and respiratory functions as factors that influence quality of life, the results indicate that the quality of life of women with asthma is lower compared to men, which is a warning that more attention should be paid on the care of women with bronchial asthma. Since there is only a moderate correlation between respiratory functions and quality of life (r=0.37), the extent of respiratory tract obstruction assessed by objective measurements is not indicative of how the patient is doing. Despite of having normal values, some patients are commonly anxious, are subjects to many real or pseudo-attacks, which in turn leads to greater drug consumption, and judge their state more severe in the symptom diary than actually it is. The findings indicate that beside considering clinical state, symptoms and laboratory results, asthma care should place greater emphasis on the patients’ self-judged quality of life and their own view on their disease.]

Lege Artis Medicinae



[Gastroduodenal peptic ulcer disease accounts for nearly 50% of the cases of acute upper gastrointestinal tract bleeding. Despite early endoscopic diagnosis and treatment, bleeding recurs in 15-20% of the cases within 72 hours. Mortality of recurrent bleeding is high (25-30%), therefore, the main goal of the treatment of patients with bleeding peptic ulcer is not only to stop the bleeding but also to prevent recurrence. The most effective way of the endoscopic therapy is the combination of injection (epinephrine) and thermal coagulation, with supplemental clip placement in spurting arterial bleeding. Overlying adherent clot should be removed after epinephrine has been injected into the ulcer base and the exposed vessel lesion should be coagulated. Proton pump inhibitors promote platelet aggregation and inhibit the proteolytic digestion of clots by raising the pH of gastric juice. The nearly neutral pH necessary for clot stability can be achieved by an intravenous bolus injection of the proton pump inhibitor followed by continuous infusion for 72 hours, after which an oral proton pump inhibitor should be used to prevent late recurrence of bleeding. Proton pump inhibitors can thus contribute significantly to the maintenance of primary haemostasis in patients with bleeding peptic ulcer. Beside omeprazole and pantoprazole that have been available as intravenous proton pump inhibitors, intravenous esomeprazole is a promising new product for the treatment of bleeding peptic ulcer since it ensures a faster and more pronounced intragastric pH increase.]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

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.

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.