Lege Artis Medicinae

[Von Willebrand meets Alzheimer's]

JANUARY 29, 1992

Lege Artis Medicinae - 1992;2(01)

[I. Congress of the Hungarian Society of Thrombosis and Haemostasis]

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Lege Artis Medicinae

[Biological and Pathological Significance of Apoptosis (Programmed Cell Death)]

SZENDE Béla

[Programmed cell death (apoptosis) basically differs from necrosis regarding its biological significance, the morphological signs and biochemical events. Apoptosis is the result of an active cell function, so-called cell-suicide and it is observable in several biological as well as pathological processes. Enhancement of apoptosis can be achieved in malignant tumors by hormonal treatment. This explains the mode of action of hormones in tumor therapy and also contributes to the alterations in gene regulation leading to apoptosis.]

Lege Artis Medicinae

[The use of BCG immunotherapeutic for the treatment of superficial bladder cancer (carcinoma in situ and papillary tumor)]

CSIZÉR Zoltán

[BCG Immunotherapeutic (BCG IT) is the first immunomodulator to be licenced in Canada, Germany and the United States for the use in the treatment of carcinoma of the urinary bladder. The product licence was granted following the conduct of a well designed efficacy study. The study was multicente red, independent and controlled with well defined end points and a long follow up period. The results clearly shows that BCG immunotherapy is significantly more effective than Adriamycin chemotherapy. There is no evidence to suggest a difference in severity of toxicities between BCG and Adriamycin treatment groups.]

Lege Artis Medicinae

[Transesophageal and transthoracic echocardiography in aortic dissection]

LENGYEL Mária

[ The severe prognosis of aortic dissection can only be improved by early diagnosis. The role of echocardiography was assessed. Echocardiographic findings were analysed in 32 patients in whom aortic dissection was confirmed by other methods between September 1984 and July 1991. In 19 of them only transthoracic echo (TTE), in 13 patients both TTE and transesophageal echo (TEE) was performed. Control group consisted of 21 patients in whom the clinical suspicion of dissection was ruled out. The DeBakey classification was used. Among 14 acute and 18 chronic cases type I was confirmed in 9, type II in 15 and type III in 8. The sensitivity of clinical suspicion, TTE, TEE and angiography was 34, 72, 92, 94% resp. TEE correctly identified the types, entry and reentry sites, false lumen and left coronary ostium. TTE was valuable in the detection of complications and of etiologic factors of dissection. Hypertension (12) and Marfan's syndrome (7) were the leading etiologic factors. As previously has been reported in the diagnosis of aortic dissection TEE was a safe and reliable technique. It was superior to TTE and was as correct as angiography. The combined use of TTE and TEE is recommended in each case of clinically suspected dissection. The importance of the echocardiographic detection of cardiac complications and etiologic factors is emphasized in the management and prevention.]

Lege Artis Medicinae

[Oral symptoms in the early diagnosis of leukaemias]

GYURKOVICS Csilla, BÁNÓCZY Jolán

[Diseases of the haemopoetic system are often preceeded and/or accompanied by clinical changes in the oral cavity, which, as first signs of the disease, might be of important diagnostic value. Primary oral findings are characteristic mainly of acute leukaemias, such as haemorrhagies, petechias, ecchymoses, ulcera, gingival hy pertrophy, painful gingiva, tooth mobility, candidiasis, herpes simplex infection, lymph node enlargements. Oral manifestations of chronic leukaemia may also arouse the suspicion of a haemopoetic disease. Applied cytostatic therapy might aggravate the condition of oral manifestations. ]

Lege Artis Medicinae

[Peritoneal dyalisis in hungary]

KARÁTSON András, MAKÓ János

[Traditional intermittent peritoneal dialysis in patients with chronic uremia lasts for 8 to 10 hours three times a week. In 1976 Popovich et al. outlined the principle of CAPD (Continu ous Ambulatory Peritoneal Dialysis), a technique giving good results in the removal of water and toxic substances. The procedure is used in 19 000 patients in US and in 9600 patients in Europe. In early 1991 the technical conditions and the number of patients receiving peritoneal dialysis were surveyed in the Hungarian nephrological and dialysing units. Not only the number of patients with chronic uraemia (those undergoing dialysis + transplantation) is lower in this country as compared to the European average (106 versus, 236 per million people, respectively) but the distribution of patients according to the type of treatment they receive is also different. In Hungary intermittent peritoneal dialysis has been used in more than 10% of the cases for several years whereas the number of those receiving continuous peritoneal dialysis has been under 2%. (In Europe < 2% and 4–43%, respectively). The survey also included the types of solution, desinfection and connecting devices used in peritoneal dialysis, as well as the incidence of peritonitis and the administration of antibiotics . The principles of biocompatibility, the function of interleukin as well as the effectiveness and the conditions of home treatment are summarized. ]

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Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]

Clinical Neuroscience

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Clinical Neuroscience

[The applicability of 123I-FP-CIT SPECT dopamine transporter imaging in clinical practice]

PERLAKI Gábor, SZEKERES Sarolta, JANSZKY József, DEZSŐ Dániel, ASCHERMANN Zsuzsanna, ZÁMBÓ Katalin, KOVÁCS Norbert

[The 123I-FP-CIT dopamine transporter SPECT imaging is a sensitive method to assess functional dopaminergic neuron terminals in the striatum. The method has also been available in Hungary for years. There are two main indications: (i) to help differentiate essential tremor from clinically uncertain Parkinsonism, including patients with early symptoms and (ii) to help differentiate dementia with Lewy bodies from Alzheimer’s disease. The aim of this paper is to review 123I-FP-CIT SPECT imaging based on international data/guidelines and our own experiences, thereby assisting nuclear medicine practitioners and neurologists.]

Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part II. - Breastfeeding, complementary feeding and weaning in the Large-sample of the “For Healthy Offspring” project]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[INTRODUCTION - Complementary feed-ing is the transitional period from exclusive breastfeeding to family foods, while breastfeeding is continued. It should be started, when breastmilk itself no longer meets the infant’s nutritional requirements, ideally at the age of around 6 months. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Comple­mentary feeding practices and issues of weaning were analyzed. RESULTS - In our sample complementary feeding was started at the age of 5.5±1.8 months. 6% of infants younger than 4 months and about two third of infants at the age between 4 and 6 months were started on complementary feeding. 32% of the 7-12 month old infants were continued on breastfeeding. The proportion of breastfed infants and young children in the 12-24 and 25-36 month age group was 24% and 5.5% respectively. The daily feeding frequency of breastfed infants was 6.7±1.6. The infants and young children, who were breastfed along with complementary feeding were feeding 5.6±1.5 times/day. After completed weaning the range of feeding frequency was limited to 4.9±0.9 occasions/day. 60.4% of mothers regarded their feeding style on demand, while 39.6% on set schedule. 16% of mothers reported that their child had feeding difficulties. CONCLUSIONS - Complementary feeding indicators should be part of infant feeding data collection, such as time of introduction of complementary food, feeding frequency, food consistency, energy density of food and safe preparation. Responsive feeding is part of responsive parenting and should be promoted, along with continuing breastfeeding at least till one year of age, and for as long as mother and infant wish to continue. ]