Lege Artis Medicinae

[Tutankhamun’s Mysterious Death]

BECHER Péter, MÁJER Katalin, PATAI Árpád

JANUARY 20, 2013

Lege Artis Medicinae - 2013;23(01)

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Lege Artis Medicinae

[The Private Physician and State Advisor of Tzar Alexander I János Orlay, a Polymath Physician ]

MOLNÁR László

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[Succesful treatment of metastatic breast cancer with fulvestrant]

HERODEK Gabriella

Lege Artis Medicinae

[Weyer and the Crazy Witches ]

MAGYAR László András

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[Management of chronic psychiatry patients in the healthcare and social system]

SZENTES Tamás, KAPÓCS Gábor, KURIMAY Tamás

Lege Artis Medicinae

[Fifty years of the Hungarian congenital abnormality registry and some important results]

MÉTNEKI Júlia, BÉRES Judit, CZEIZEL Endre

[The Hungarian Congenital Abnormality Registry (HCAR) was established in 1962 after the greatest tragedy of human teratology, the thalidomide-Contergan catastrophe. As far as we know HCAR was the first national-based registry in the world based on the mandatory notification of patients with different structural birth defects, i.e. congenital abnormalities (CAs) by medical doctors. The main task of the HCAR has been to determine as reliably as possible the baseline occurrence of different CAs. In addition three other secondary missions of the HCAR were defined: 1) to detect temporal and/or spatial increases (“clusters”) of CA and to evaluate the permanent changing trends of CAs; 2) to help plan medical and social services for cases with different CA; and 3) to estimate the public health importance of different CAs so that resources can be properly allocated. Here some important results of HCAR between 1962 and 2011, i.e. during 50 years are reported.]

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Clinical Neuroscience

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[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.]

Lege Artis Medicinae

[Evidence-based practice guidelines for nursing and rehabilitation of stroke patients]

BALOGH Zoltán

[Stroke is a common problem, being the third most frequent cause of death in the United Kingdom and Hungary, accounting for about 20% of bed occupancy. It is also an important cause of morbidity and disability mainly for those aged over 65. As a result, stroke care constitutes as an important part of health services use. Home care services working in the field of stroke rehabilitation have not used a unified evidence-based approach and well-described professional principles and protocols. There was little cooperation between the teams working in the institutional rehabilitation and home care rehabilitation services. No agreed rehabilitation processes, and standardised scales and documentation, showing the change of quality of life, were in use. There were no quality indicators and efficiency measures of nursing and no provision of services either. The Hungarian Nursing Association played a pioneering role in the introduction and dissemination of Evidence Based Nursing in Hungary and in adopting it into routine clinical practice. The successful implementation of the Association's project could be a good example for another field of care and nursing in Hungary and other countries in Europe. Our projects are supported by the Department For International Development (UK) in the framework of the TUDOR project. The Hungarian Nursing Association (HNA) developed a postgraduate training programme entitled "Evidence based nursing in practice". The participants were required to be members of the HNA, have a degree in the field of nursing (nurse teacher, degree nurse, nurse director). Members of the target group were all working in the field of stroke rehabilitation at hospitals or out-patient clinics and home nursing. The Hungarian Nursing Association's professional group developed an evidence based practice guideline for rehabilitation of stroke patients, which was published in the Bulletin of the Ministry of Health (11/2002, 23rd May, 2002). These evidence-based stroke rehabilitation guidelines focused on bladder management, position therapy and patient information.]

Lege Artis Medicinae

[Importance of statin therapy in stroke prevention]

KÁPOSZTA Zoltán, RÁCZ Klára

[Stroke is the third leading cause of death and a leading cause of major adult disability in developed countries. The annual incidence of hospitalized stroke varies between 400-500 per 100 000 inhabitants every year in Hungary. In the past decade, cholesterol lowering with 3- hydroxy-3-methylglutaryl-coenzyme A (HMGCoA) reductase inhibitors (statins) has proved to reduce risk of stroke in patients with and without coronary disease (CAD). In patients with CAD, statin therapy reduces the risk of first stroke by 25% to 35% versus placebo and, moreover, intensive statin therapy to LDL-C targets below 2.6 mmol/L (100 mg/dL) appears to reduce the risk further. More recently it has also been shown that intensive statin therapy can reduce risk of recurrent stroke in nondiabetic as well as diabetic patients with recent stroke or transient ischaemic attack but no CAD. The overall reduction of stroke and TIA was 23%. Evidence from retrospective studies suggests that in addition to risk reduction statin pretreatment may improve stroke outcome. It may due to their pleiotropic effects that include improvement of endothelium function, anti-inflammatory, antithrombotic, and immunomodulatory effects. As statins have both an excellent safety profile and simple administration, physicians should consider using statins, at dosages shown to have efficacy in clinical trials, in all patients whose cardiovascular risk profile puts them at high risk of stroke.]

Clinical Oncology

[Neoadjuvant treatment of rectal cancer]

PINTÉR Tamás

[Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery - total mesorectal excision (TMA) - are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fl uoropyrimidines (infusional 5-fl uorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so - based on positive results in colon cancer - adjuvant FOLFOX chemotherapy may be recommended.]

Hungarian Radiology

[Rheumatoid arthritis: significance and methodology of cervical spine X-rays in everyday practice]

NÉMETH Ildikó, BUDAY Ilona, MOLNÁR Éva, NYITRAI Márta, SAÁRY Krisztina, TARKOVÁCS Andrea, VARSÁNYI Nóra, FARBAKY Zsófia

[Cervical spine joint destruction in rheumatoid arthritis may lead to progressive vertebral instability. It is a severe risk factor for cord compression, which may even lead to sudden death. Many patients with atlantoaxial subluxation may have no symptoms referable to the neck. True degree of subluxation may occur during anaesthesia when the neck muscles are relaxed and protective spasm is absent. The cervical deformities can be visualised on conventional, transoral and functional lateral view in the flexion and extension positions of the neck. The aim of our study is to demonstrate the usefulness of cervical dynamic X-ray for patients suffering from rheumatoid arthritis. This is the first classical radiological imaging method in the diagnosis and in radiographic follow-up. It is a very important method in the preoperative evaluation to prevent definitive neurologic injury. We describe the method for screening, measuring and grading cervical subluxations and instability in our everyday routine.]