Lege Artis Medicinae

[What is going to change?]

SINKÓ Eszter

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

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Lege Artis Medicinae

[Rewriting the Story Augustus Y. Napier: The Fragile Bond]

FERENCZI Andrea

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[Pain in the knee - and what’s behind it - The dilemmas of management]

BÁLINT Géza

Lege Artis Medicinae

[MOLECULAR DIAGNOSTICS OF EPIDERMAL GROWTH FACTOR RECEPTOR IN NON-SMALL CELL LUNG CANCER]

TÍMÁR József, OSTOROS Gyula

[One of the most useful markers of non-small cell lung cancer is epidermal growth factor receptor (EGFR) protein expression. Recently it was found that the EGFR gene may be amplified or mutated in non-small cell lung cancer rendering this gene product an ideal target for therapy. The introduction of molecularly targeted therapy into the clinical practice represents a milestone in the management of non-small cell lung cancer. However, our knowledge on the prognostic and predictive factors that will define the efficiency of anti-EGFR therapy is limited. In clinical practice, some common patient and disease features (e. g., smoking habit, gender, histological type) are still more dependable predictors than the fine molecular properties that may directly affect therapeutic response. The indication of anti-EGFR therapy in Hungary is based on the immunohistochemical detection of the EGFR protein, therefore, it is important that these tests are performed as reliably as possible. On the other hand, mutations in the EGFR gene may render the tumour resistant or, in contrary, especially sensitive to EGFR inhibitor therapy. The sequence of the diagnostic steps to define the genotype and phenotype of non-small cell lung cancer has a great importance in terms of cost-efficiency of the therapy.]

Lege Artis Medicinae

[Secondary prevention of patients with ischaemic heart disease - The reduction of LDL cholesterol level and the regression of atherosclerosis]

BÁRCZI György, MERKELY Béla

[The authors review the options of secondary medical prevention in patients with ischaemic heart disease, stressing the need and safety of using statins. The beneficial effect of statin therapy on cardiovascular morbidity and mortality and the clinical benefit of the greatest possible reduction in LDL cholesterol level are presented. The atherosclerotic plaque regression achieved by a high-intensity statin therapy in the ASTEROID trial is also briefly reviewed.]

Lege Artis Medicinae

[Protection of the Environment and Medicine]

VARGA Orsolya

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Clinical Neuroscience

Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid

KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

Lege Artis Medicinae

[SCREENING OF PSYCHIATRIC SIDE EFFECT OF INTERFERON THERAPY WITH QUESTIONNAIRE]

GAZDAG Gábor, SZABÓ Zsuzsa

[INTRODUCTION - Interferon therapy is an effective treatment of several oncological, hematological and viral diseases but it can precipitate serious side effects too. Among others the most frequent are the psychiatric symptoms. These symptoms are also the most frequent reasons of non-compliance and early cessation of treatment which can be avoided with rapid recognition and adequate treatment. Therefore, the early recognition of the psychiatric symptoms is of high importance. METHODS AND RESULTS - Authors report a self-administered questionnaire developed to screen the most frequent psychiatric symptoms precipitated by interferon treatment. They also present the evaluation method for the questionnaire, which makes the evaluation of the data easier for non-psychiatrist doctors as well. Between September 2004 and July 2005 all interferon treated patients who also had psychiatric consultation filled in the questionnaire. The number of patients was 26. Authors set up a decision-making algorhythm for the evaluation, so the non-psychiatrist doctors were able to judge whether a psychiatric consultation was needed as well as its urgency. With the data of 26 interferon treated patients who all went through a psychiatric consultation during a 10 months period, authors discuss their first experience, going into details in the three false positive and the two false negative cases. CONCLUSION - Authors founded the questionnaire helpful in the clinical practice and recommended the use for doctors working in general practice. They also suggest to carry it further research with more patients to strengthen the results.]

Lege Artis Medicinae

[NEW DISORDERS OF EATING AND OF BODY IMAGE]

TÚRY Ferenc, LUKÁCS Liza, RÁCZ Olimpia, HORVÁTH Krisztina

[Eating disorders show an important change in the last few decades concerning their frequency and clinical picture, as well. Besides bulimia nervosa, which was described two decades ago, muscle dysmorphia appeared ten years ago as a special body image disorder of males, regarded as a reverse form of anorexia nervosa in females. Eating disorder, body builder type was described only in 2000, meaning an overconcern about the body composition and muscle mass, accompanied by strict dieting rules. Another type of these disorders was described also in 2000, the nontraditional gender role in women, which is a strong preference for male characteristics and activities, the person being comfortable with her sex, while there is no intersex condition. This overview discusses the proposed diagnostic criteria and the role of some sociocultural factors in these recent disorders.]

Lege Artis Medicinae

[The role and significance of vascular aging in the risk stratification of cardiovascular prevention]

VÉRTES András

[The structure and function of arteries change throughout one’s lifetime. The most important changes include lumenal dilation, diffuse intimal and medial thickening, increased stiffness, reduced compliance of central arteries and endothelial dysfunction. Arterial stiffness, an increased pulse wave velocity (PWV) and an increased carotid intima-media thickness (IMT) are independent predictors of cardiovascular events. The early vascular aging (EVA) could help clinicians to determine the increased cardiovascular risk. EVA can be be determined by noninvasive methods, as arterial stiffness and carotid IMT. EVA can be suitable for the early detection of cardiovascular diseases.]

Clinical Neuroscience

[Assessment of severity and time course of critical illness neuropathy in septic patients: a prospective observational study]

NEMES Réka, FÜLEP Zoltán, LÁSZLÓ István, SÁRKÁNY Péter, FEKETE Klára, MECHLER Ferenc, FÜLESDI Béla

[Objective - In this prospective observational study we investigated electrophysiological alterations in the early phase of critical illness and correlated electrophysiological findings with the clinical picture and outcome. Methods - We enrolled 21 critically ill surgical patients having ≥12 Acute Physiology and Chronic Health Evaluation (APACHE) II scores on admission. Routine non-invasive bilateral electroneurography (ENG) examination of median and ulnar nerves was done on five consecutive days starting in two days after admission. Then weekly follow-up was performed. Motor and sensory nerve conduction indices were calculated and correlated with APACHE II and Simplified Acute Physiology Score II severity scores. Results - On the first examination 18/21 patients had >20% reduction in the motor and sensory nerve conduction indices. Severity score systems showed significant negative correlation with the daily change of CMAP and SNAP amplitudes and calculated nerve conduction indices (Spearman’s correlation, p<0,001). Mortality was higher in the patients with worse admission ENG and/or stagnant electrophysiological status or declining tendency in the first week. Conclusions - Electrophysiological alterations appeared soon after the development of critical illness. Early phase alterations showed a strong correlation with patients’ general condition and more severe electrophysiological alterations predisposed to higher mortality. In several cases early alterations proved to be reversible. ]