Lege Artis Medicinae

[The Tragic Death of Gizi Bajor ]

GERLINGER Imre

FEBRUARY 14, 2014

Lege Artis Medicinae - 2014;24(01-02)

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[By the Chronicler’s Eyes]

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[The Eighth Church ]

NAGY Zsuzsanna

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[The real primary prevention - Some thoughts on health and disease, individuals and communities]

KAPÓCS Gábor

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[How to detect it? Dementia screening in primary care]

KÁLMÁN János, PAPP Edina, PÁKÁSKI Magdolna

[The early stage of dementia, the diagnostic and clinical importance of prodromal stages of dementia have been increasingly recognised in the past few years. Nowa - days, simple, rapid, easy to use cognitive screening tests are available, such as the recently developed Early Mental Test and the standardised Mini-Mental State Exami - nation, Clock Drawing Test, which could help general practicioners in the recommended regular dementia screening. The aim of this review is to help general practicioners understand the nature and importance of prodromal and manifest stages of dementia syndromes, and to summarise the characteristics, advantages and disadvantages of dementia screening tests that can be used in primary care. In addition, practical hints are also integrated regarding the diagnosis, screening and referral of persons with high risk for dementia.]

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[Actualities in the epidemiology, diagnostics and therapy of Clostridium difficile infections - a European outlook]

NAGY Erzsébet

[Despite of the facts that Clostridium difficile has been accepted as an enteral pathogen since 1978 and during the past years we have learned a lot about its pathogenic toxins and about diagnostic possibilites, this pathogen has not attracted major interest until the early 2000s. The rapid increase of nosocomial diarrhoea caused by some hypervirulent ribotypes of C. difficile in a number of countries, followed by the increased number of community-acquired cases and the appearance of new risk factors besides antibiotic-related diarrhoeas have put C. difficile infections (CDI) in the focus of research. The rapid and correct diagnosis of the hospital or community acquired diarrhoeas enables clinicians to discontinue - if possible - the usage of the antibiotic therapy responsible for the symptoms, to start treatment early and introduce hospital hygiene measures as soon as possible. The aim of this article is similar to that of the “CDI Europe Report”, an initiative led by European experts: to draw attention on the importance of C. difficile infections in Hungary and in Europe by summarising the latest epidemiological data, the recommended diagnostic algorithm, therapeutic options and the importance of local and national surveillance and infection control measures in hospitals. Clostri]

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[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

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[Treatment of hepatocellular carcinoma - today]

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[The hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death globally, and at the same time, it is the main event leading to death in cirrhotic patients. In the etiology of HCC, the non-alcoholic liver disease may be an important cause besides the viral cirrhosis. The HCC’s staging systems (Child-Pugh scores, Cancer of the Liver Italian Programme/CLIP, Barcelona Clinic Liver Cancer/ BCLC) play an important role in predicting the prognosis and determining the appropriate therapy. In Europe, the treatment strategy is based on the BCLC staging system. Screening of cirrhotic patient is also important because curative therapy is available only for the early-stage HCC. Several therapeutic options exist in the intermediate stage disease; among them the radiofrequency ablation (RFA), the transarterial chemoembolization (TACE) and the percutan ethanol injection (PEI) are most important. For the advanced disease, the only approved systemic therapy is sorafenib, which has been well-tolerated and yielded a substantially relative improvement in overall survival. For patient in end-stage disease with impaired liver function or a poor performance status, only supportive care is recommended.]

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[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.]

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CZURIGA István

[The beneficial effects of treatment with betablockers in patients with chronic heart failure have been demonstrated in several large, prospective, randomised, placebo-controlled clinical trials. In large trials with mortality as the endpoint, the long-term use of bisoprolol, carvedilol, nevibolol and metoprolol succinate have been associated with a reduction in total mortality, cardiovascular mortality, sudden cardiac death and death due to progression of heart failure in patients of functional classes II-IV. These favorable clinical experiences warrant a recommendation that beta-blockers should be used in all haemodynamically stable heart failure patients with reduced left ventricular systolic function who are on standard treatment, unless contraindicated. In this review, the most important data of clinical trials and practical considerations of therapy with beta-blockers in heart failure are summarized.]