Lege Artis Medicinae

[TISSUE HORMONAL SHOCK: INTRACRINOLOGY - THE IMPORTANCE OF LOCALLY PRODUCED HORMONES IN THE PATHOGENESIS OF VARIOUS DISEASES]

SPEER Gábor, LAKATOS Péter

JANUARY 22, 2008

Lege Artis Medicinae - 2008;18(01)

[This review describes the function and tissuespecific expression of the 11- and 17-beta-hydroxysteroid- dehydrogenase enzyme families as well as the aromatase and 1-alpha-hydroxylase enzymes. Recently, in situ formation of active steroids by these enzymes at the sites of their actions from biologically inactive precursors in the circulation have been demonstrated to play an important role in sex steroid-dependent neoplasms (such as breast and prostate cancer), and in some metabolic diseases (such as obesity, osteoporosis and insulin resistance). Tissuespecific Cushing syndrome (local hypercortisolism) may contribute to the pathogenesis of the latter group of diseases, suggesting that obesity may be considered the Cushing-syndrome of the omentum and that osteoporosis is the obesity of bone. Intracrinology is the science of alterations in tissue hormone synthesis catalysed by enzymes such as those mentioned above, which cannot be detected by measuring circulating hormone levels. The effects of local hormone production differ from those of the well-described autocrine, paracrine and endocrine actions. Based on the hormonal changes within various tissues, the pathogenesis of a number of diseases may be interpreted in a novel way.]

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Lege Artis Medicinae

[THE EPIDEMIOLOGY OF CEREBROVASCULAR DISEASES IN HUNGARY AFTER THE MILLENNIUM]

VOKÓ Zoltán, SZÉLES György, KARDOS László, NÉMETH Renáta, ÁDÁNY Róza

[INTRODUCTION - Here we present the descriptive epidemiology of stroke in Hungary including mortality, morbidity, functional limitation and inpatient care based on the most recent health statistical data. METHODS - Mortality data were analysed by direct and indirect standardisation, and geographical mapping based on empirical Bayesian smoothing. Morbidity data were obtained from the General Practitioners’ Morbidity Sentinel Station Program and the National Health Surveys. The latter also provided data on functional limitation. Data on inpatient service were taken from the European Hospital Morbidity Database of WHO. RESULTS - Hungarian stroke mortality continued to decrease in recent years, and the slope of the decrease was larger than in Western Europe. Stroke mortality was highest in the Northern- Hungarian Region, and in Somogy and Zala counties. The incidence of stroke was 1.5-2 times higher than in the developed countries in most age groups. Over 64 years of age, a decline of stroke incidence was observed, especially in men. In this age group approximately 10% of men and 7% of women had already had a stroke. Of these patients more than 10% needed assistance to get out of the bed, dress up, or eat. Hospitals reported more than 60 000 stroke cases in 2005. CONCLUSION - Despite the promising trends in stroke mortality and now also in morbidity, both indices are still rather high in Hungary compared to those in Western-Europe. The relatively favourable epidemiological changes, however, may be overridden by the increased stroke burden resulting from the aging of the population.]

Lege Artis Medicinae

[Call for the LAM Awards]

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[PAIN AND PAIN CONTROL IN RHEUMATOLOGY]

GAÁL János

[In developed industrial countries the overall population prevalence of chronic rheumatic pain is around 35%. A classification that is useful in everyday practice is based on the origin of musculoskeletal pain and lists pain associated with degenerative joint diseases, pain related to metabolic bone diseases, non-articular and soft tissue rheumatism, and pain due to inflammation. In chronic pain syndrome pain itself has lost its adaptive biological role, and presents as a pathogenetic factor in its own right, accompanied by significant vegetative and psychological symptoms. Therapeutic exercise is of basic importance in the management of rheumatic pain. It is supplemented by various pharmacologic and nonpharmacologic methods. The latter include, among others, fomentations, packs, balneo- and hydrotherapeutic methods, electro-, mechanoand thermotherapeutic approaches. Pharmacological therapy usually means the use of simple analgesics, non-steroidal antiinflammatory drugs, steroids, minor opiates, and, lately, also major opiates, which may be supplemented by adjuvant agents such as tricyclic antidepressants and anticonvulsive drugs. When indicating the most often used non-steroidal antiinflammatory drugs, their potential side effects should carefully be considered. Invasive pain-killing methods on the border area between anaesthesiology and rheumatology (epidural steroid administration, ganglionic blockade, intravenous regional blockade) are applied in cases that do not respond to conventional therapy, and sometimes also as successful first-line intervention.]

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[“Everyone Will Account Once with their Talents Received...” An Interview with Pathologist Professor Gábor Kendrey by Elemér Nemesánszky]

NEMESÁNSZKY Elemér

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HEGYI Péter, TAKÁCS Tamás, RAKONCZAY Zoltán

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