Lege Artis Medicinae

[Truth telling in medical practice]

FENYVESI Tamás

NOVEMBER 30, 1994

Lege Artis Medicinae - 1994;4(11)

[Many books and studies have been published on the concept of human autonomy, as well as on the rights of the individual. LAM has also addressed these issues on several occasions with a scientific concern. The subject matter is so much concerned with the subject that a doctor, who is unfortunately no longer quite young, may be allowed to make a few highly subjective comments. The question is usually approached from two quite closely related angles. The 'full' informed consent of the patient in general and the meaning and definition of informed consent in particular. ]

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Lege Artis Medicinae

[The use of in situ hybridization in basic biomedical research and clinical medicine]

MIHÁLY András

[The essential purpose of in situ hybridization is the histochemical and/or autoradiographic detection of specific nucleic acid sequences in cells, tissues or chromosomes. The method is based on the use of artificially manufactured DNA or RNA fragments which are label led with isotope, enzymes, biotin or digoxigenin. The specific attachment of these labelled single-stranded nucleic acid probes to intra nuclear or intracytoplasmic nucleic acids can be used for the study of gene expression, for the establishment of viral infections, for the diagnosis of specific tumours and for the detection of hereditary diseases and chromosomal aberrations. The present review discusses the molecular basis of the method, the possibilities of labelling and detection and various other applications.]

Lege Artis Medicinae

[The role of nutrition in the etiology and prevention of dental caries]

BÁNÓCZY Jolán

[Nutritional factors play an important role in the development of both dental caries and periodontal diseases. Dental caries is a multi factorial disease. The changes in the composition and accumulation of dental plaque, caused by physical and chemical components of the diet, are influenced by quantitative, qualitative and frequency factors of carbohydrate consumption. In the course of bacterial degradation of consumed sugars, acids are formed on the tooth by inherent dental plaque monosaccharides, and enamel demineralization occurs. Due to the multifactorial etiology of dental caries, prevention is a complex activity. In addition to fluoride prevention, appropriate oral hygiene measures, directives for a healthy diet, changes in life-style and behaviour are also important factors. For the elimination of the deleterious influence of carbohydrates, the decrease of between-meal snacks, and the use of non-acidogenic sugar substitutes (xylitol) is recommended, which might contribute to a decrease in the high caries prevalence rates in Hungary. ]

Lege Artis Medicinae

[Activated protein c response: a novel disorder causing thrombophilia]

PÁL András, SAS Géza, HAYNAL Imre, VAJDA Zoltán, KUNCZ Gabriella, MOHAMED A. Lateiwish, RÓNA Tas Ágnes

[In 1993 Dahlbäck described the so-called in vitro activated protein C response phenomena, according to which, the addition of activated protein C to citrated plasma samples prolongs the activated partial thromboplastin times. It was hypothesised that this phenomenon is the result of the action of a new protein C cofactor, and in 1994, Dahlbäck demonstrated that this phenomenon is linked to variations of the factor V, which surprisingly serves as a cofactor for protein C. In this study, forty-one highly selected thrombophilic patients and forty controls were investigated for the activated protein C response phenomenon. The response to activated protein C was expressed as the ratio of two activated partial thromboplastin times, the first in the presence of and the second in the absence of activated protein C. Eighteen patients demonstrated a decreased response, i. e. the ratio of the times was below 2.0 (mean 1.3). The average of the entire group was 1.86. The average ratio of the control group was 3.12, and there were 2 persons with ratios below 2.0. The results of this study correspond with the data in the literature. This newly recognised phenomenon may be responsible for the majority of the formerly unrecognised biochemical defects leading to the clinical picture of thrombophilia. ]

Lege Artis Medicinae

[Treatment for simplex glaucoma, eye drops or early surgery?]

HOLLÓ Gábor

[Primary open-angle glaucoma (simplex) occurs in -0.5-2% of the European population over 40 years of age and is one of the most common causes of blindness in countries with good public health. The visual field and visual impairment that has already developed with glaucoma is irreversible, so diagnosing the disease at an early stage and starting treatment at an early stage is a prerequisite for saving sight. Unfortunately, initiating treatment does not mean that retinal ganglion cell death and the resulting visual field loss will disappear. Although its rate slows down, progression can be detected in a significant proportion of eyes even with treatment. This is why the focus of glaucoma research today is to analyse the long-term efficacy of treatment.]

Lege Artis Medicinae

[News]

[MOTESZ is admitted to the European Union of Medical Specialists (UEMS); Hungarian-French medical education seminar; Smoking in the third trimester hinders foetal development; In Canada, cigarettes will only be sold in plain packaging in the future; Smoking during pregnancy can cause asthma in the unborn child; Smoking or health centre in NEVI; Smoking ban has not reduced restaurant sales in the US; Smoking during pregnancy can cause limb developmental abnormalities in the foetus; Dr. Zoltán Ajkay's five studies on health insurance reform; Diagnostic centre in Pécs; International meeting in Balatonszárszó; New information centre in Budapest;]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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.

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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.]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]