Lege Artis Medicinae

[The results of Study for Monitoring Antimicrobial Trends]

URBÁN Edit

MAY 20, 2011

Lege Artis Medicinae - 2011;21(05)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Specialists’ mobility in surgery and gynaecology-obstetrics in Hungary]

BALÁZS Péter

[The new government inaugurated in 2006, started a most comprehensive professional and territorial restructuring of the hospital network in the recent decades. While performing it, the health administration took in account also the considerable re-allocation of the domestic medical workforce. The joint mobility program launched by the Ministry of Health and the Ministry of Social Affairs and Labour supported doctors and nurses changing their habitation provided they had lost their working place by reorganisations. The obvious failure of this program indicated very clearly the lack of mobility of involved physicians (only 24 physicians and 11 nurses applied to be supported). The present study based on data of registered specialists in December 2009 analyses the graduate training and professional mobility patterns of surgeons and gynaecologist-obstetricians born in Hungary and abroad as well. Among surgeons (N=1469) there is 13.5% and among gynaecologist-obstetricians (N=1377) 10.6% the proportion of those born abroad. Results obtained show a very strong adherence of domestic professionals to the regional community, however this adherence exists parallel with the crossnational migration of the same workforce both indicating the essential role of immigrant specialists while providing health care in this country.]

Lege Artis Medicinae

[To fight for our self-esteem as well]

PAPP Magor

Lege Artis Medicinae

[Increasing importance of invasive fungal diseases]

PRINZ Gyula, SINKÓ János

[INTRODUCTION - Invasive mycoses are life-threatening fungal infections affecting patients with severe underlying conditions or impaired immune system. According to epidemiological studies, the incidence of invasive mycosis is increasing in several patient groups. CASE REPORT - In patients who require ICU care, the majority of invasive mycoses are caused by Candida species. A shift has been observed within the spectrum of pathogenic species. In patients undergoing chemotherapy for acute leukemia and in recipients of allogenic stem cell transplantation, however, an increased morbidity and mortality of invasive aspergillosis have been observed. The authors discuss current issues regarding the diagnosis and treatment of invasive fungal diseases on the basis of case reports. CONCLUSION - Invasive mycoses are lifethreatening infections affecting patients with severe underlying conditions. While the opportunities of state-of-the-art medicine are expanding, the incidence and significance of these infections increases. If detected and treated in time with appropriate antifungal agents, these infections can be efficiently treated.]

Lege Artis Medicinae

[Development of anticoagulation in the past two decades]

SAS Géza

[In the past two decades we have witnessed a gradually increasing significance of both prophylactic and therapeutic anticoagulation. The importance of thromboprophylaxis has become widely accepted in the course of surgical interventions and in various other fields of medicine, too. The introduction of low molecular weight heparins was a milestone in this respect. The need for long-term anticoagulation has become a common problem. The various recent aspects and topics of anticoagulation have been described in the current Hungarian medical literature, therefore, I focus on two general problems of medicine of our days from the aspects of our subject. The evaluation of information on the new, direct-acting inhibitors (anti-IIa and anti- Xa),and their high price present great difficulies, especially in the case of long-term anticoagulation therapy. Clinical data and experiences have been collected from patients who are greatly different from the majority of patients in the real world. The lack of antidote may also be a serious problem in case of these new drugs, as urgent neutralization might be necessary, for example in case of serious bleeding, accidents etc. Today, cost-effectiveness of medical interventions and drugs has become a major aspect, therefore, the high price of new anticoagulants might prevent their use in the clinical practice. Despite the optimistic expectations regarding new anticoagulants, at present we have to strive to treat our patients with the currently available, effective but affordable drugs, widening and improving their use.]

Lege Artis Medicinae

[Successful treatment with fulvestrant - case report and some considerations]

RUBOVSZKY Gábor

All articles in the issue

Related contents

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Lege Artis Medicinae

[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

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

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]