Lege Artis Medicinae

[The Psychology of Meditation]

FERENCZI Andrea

OCTOBER 18, 2006

Lege Artis Medicinae - 2006;16(10)

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Lege Artis Medicinae

[SIMULTANEOUS PRESENCE OF GIST AND MALT-LYMPHOMA OF THE STOMACH IN A HELICOBACTER PYLORI NEGATIVE PATIENT]

KOVÁCS Ferenc, GYÖKERES Tibor, TAKÁCS Imre Géza, PADÁNYI István, FEKETE Csaba, OROSZ Zsolt, PAP Ákos

[INTRODUCTION - The simultaneous presence of gastric mucosa-associated lymphoid tissue lymphoma (MALT) and a gastrointestinal stromal tumor (GIST) is an extremely rare finding that has not been published until now. CASE REPORT - The authors report on a 78- year-old man who was referred to their department with an emergency upper gastrointestinal bleeding. Urgent gastroscopy revealed a bleeding ulcer in the middle third of the stomach. On the follow-up endoscopy 6 weeks later, an umbilicated polypoid lesion was found proximal to the healed ulcer, which was subsequently removed by elective surgery. Histology and immunohistochemical staining of the specimen for c-Kit confirmed the diagnosis of gastrointestinal stromal tumour. A few weeks later the patient was readmitted because of haematemesis. Upon detailed histological examination of the biopsy specimens taken from the multiple superficial ulcers found near the previous lesion, MALT-lymphoma was diagnosed. The absence of Helicobacter pylori was confirmed by repeated histological examinations, serology and urea breath test. CONCLUSION - This is the first report on a patient with simultaneous presence of a gastrointestinal stromal tumour and gastric mucosaassociated lymphoid tissue lymphoma with H. pylori negativity. Several observations suggest that the development of malignant tumours of the stomach is also associated with H. pylori infection. In view of the reported case, the possibility of a common aetiology of these two neoplasms other than H. pylori infection is discussed.]

Lege Artis Medicinae

[Recommendation for Counselors László Török: The Diagnostic Significance of Skin Symptoms]

NEBENFÜHRER László

Lege Artis Medicinae

[ENTERAL ADMINISTRATION OF N-3 POLYUNSATURATED FATTY ACIDS IN ACUTE PANCREATITIS]

LÁSZTITY Natália, HAMVAS József, BÍRÓ Lajos, NÉMETH Éva, MAROSVÖLGYI Tamás, DECSI Tamás, PAP Ákos, ANTAL Magda

[BACKGROUND - The main determinant of outcome in acute pancreatitis is the extent of inflammation and pancreatic necrosis. Early administration of n-3 polyunsaturated fatty acids (PUFAs) may prevent the development of severe complications through modulation of eicosanoid synthesis and cytokine release. PATIENTS AND METHODS - In the prospective, randomised clinical trial 14 patients with acute pancreatitis received n-3 PUFAs (3.3 g/day for 5- 7 days) as a supplement to their enteral formula in the form of fish oil, and another 14 patients receiving enteral nutrition served as a control group. Measurements of erythrocyte superoxidedysmutase activity, serum total antioxidant status, C-reactive protein and praealbumin concentrations were performed at admission and at day 3, 7 and 14. Beside routine laboratory and imaging examinations, the fatty acid and vitamin A and E concentrations of the serum lipid fractions were also determined at admission and at day 7 of the jejunal nutrition. The endpoints of the study were the duration of hospitalisation, the duration of jejunal nutrition and the frequency of complications. RESULTS - A significantly higher superoxidedysmutase activity was observed in patients receiving n-3 fatty acids at day 3 of the treatment. The n-3 to n-6 long chain PUFA ratio increased significantly in the serum lipids of the patients receiving n-3 PUFA supplementation, whereas remained unchanged in the controls. Supplementation resulted in a significant decrease in the length of hospitalisation (13.1±6.7 vs. 19.3±7.2 days, p<0.05) and jejunal feeding (10.6±6.7 vs. 17.6±10.5, p<0.05). Complications developed in 6/14 (42%) of the treated group and in 9/14 (64%) of the control patients. CONCLUSION - Enteral administration of n-3 PUFAs in acute pancreatitis may promote earlier recovery by moderating inflammation.]

Lege Artis Medicinae

[STUDY OF PARAOXONASE ACTIVITY IN MIXED CONNECTIVE TISSUE DISEASE]

BODOLAY Edit, SERES Ildikó, JAKAB Zsanett, CSÍPŐ István, SZILÁGYI Anna, SZEGEDI Gyula, PARAGH György

[INTRODUCTION - Mixed connective tissue disease (MCTD) is an inflammatory autoimmune disease with multiple organ involvement. Immune- inflammatory processes play a crucial role in the pathogenesis of atherosclerosis. The connection between inflammatory parameters and atherosclerosis in MCTD has not yet been studied. Lipid abnormality is an important risk factor of atherosclerosis. Among the lipids, HDL is protective, which is in part due to the antioxidant effect of paraoxonase. In this paper, the lipid profiles and paraoxonase activities of MCTD patients were studied and the factors causing abnormalities were investigated. PATIENTS AND METHODS - Thirty-seven patients with MCTD, who had not taken any lipid lowering drugs in the past 2 months, were enrolled in the study. Thirty healthy individuals served as controls. At the time of the study the mean age of the MCTD patients was 51.2 ± 9.5 years, and the mean disease duration was 11.0 ± 7.2 years. Paraoxonase activity was determined by spectrophotometry, lipid profiles were determined by a Cobas Integra 700 Analyser, the von Willebrand factor antigen (vWFAg) was measured by turbidimetry in platelet-poor plasma and the thrombomodulin and anti-endothelial cell antibody (AECA) measurements were carried out by ELISA methods. RESULTS - Paraoxonase activity in the MCTD patients was lower than in the control population (118.5 ± 64.6 U/l vs. 188.0 ± 77.6, p<0.001). The arylesterase activity was also significantly lower in the patients (p<0.001). The reduction of paraoxonase activity was in correlation with the age of the patients, the duration of the disease and with vascular (eye, cardiac, cerebral) disorders. The total cholesterol and triglicerid levels of the patients were significantly increased compared to the control group, while in the apoA1 levels a significant reduction was seen. A very strong correlation was observed between the reduction of paraoxonase activity and the increase of endothelial cell activation markers (thrombomodulin, vWFAg, AECA). There was no difference in the values of patients with or without corticosteroid treatment. CONCLUSIONS - The results suggest that in MCTD there is an increased risk for atherosclerosis. Apart from an elevated cholesterol and triglicerid level, a reduced paraoxonase level and activity may also play a role in the development of atherosclerosis,. Therefore, in patients with MCTD, due to the increased oxidative processes and the impaired elimination of free radicals, a sustained damage to the endothelial cells occurs, which is indicated by increased levels of thrombomodulin, vWFAg, and anti-endothelial antibody.]

Lege Artis Medicinae

[Interdisciplinary Issues in Medicine A Discussion with Mária Kopp MD]

FERENCZI Andrea

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[THE PHENOMENON OF BURNOUT IN VIEW OF THE HUNGARIAN AND INTERNATIONAL LITERATURE]

KOVÁCS Mariann

[There is plethora of international publications on the topic of burnout among health professionals. The most comprehensive study in Hungarian on this issue was written fifteen years ago by psychiatrist Sandor Fekete. In the past fifteen years there has been a growing interest among both the scientific community and the public in studies on health psychology, behavioural sciences, sociology of health and quality of life as well as in the harmful effects of work stress. The first part of the study presents clarification of the concept of burnout, its development, course, assessment and treatment, whereas the second part gives a brief overview of the history of burnout research in the past thirty years with special focus on the most recent international and Hungarian literature, as well as on changes in research trends.]

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KAPÓCS Gábor

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SZUMMER Csaba

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[Mirror neurons and interpersonality in the paradigm of embodied mind]

HORVÁTH Lajos, SZABÓ Attila

[In this paper, our aim is to scrutinise the psychology and phenomenology of interpersonal relationships from an interdisciplinary viewpoint. This multi-perspectival examination has a key concept: we critically discuss the interdisciplinary dialogues and philosophical appraisals regarding the issue of mirror neurons. Empathy and resonance phenomena have philosophical, psychological, and biomedical importance. Our paper, by applying certain philosophical and empirical results of the overarching paradigm of embodiment, attempts to shed light on several semantic problems, which could come up with respect to the function of mirror-neurons. In conclusion, we would like to attempt to utilise the results of contemporary phenomenology in order to clear some semantic problems, considering the features of mirroring and resonant behaviour.]

Lege Artis Medicinae

[Meditation of the guest editor-in-chief]

PUREBL György