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Lege Artis Medicinae

SEPTEMBER 30, 2020

[Analysis of factors influencing the efficacy of Hungarian acute cardiac care]

BECKER Dávid, SKODA Réka, BOKOR Laura, BÁRCZI György, VÁGÓ Hajnalka, MERKELY Béla, GAJDÁCSI József, BELICZA Éva, NEMES Attila, DINYA Elek, TÖRŐCSIK Klára

[Despite the modern invasive acute cardiac care available for all, as opposed to short-term mortality, the long-term mortality of Hungarian myocardial infarction patients exceeds significantly those of European patients getting similar treatment. In order to change this situation, it is necessary to assess and analyse exactly the factors behind. While analysing retrospectively the data of Hungarian acute myocardial infarction patients, we identified the influencing factors of short- and long-term mortality. This study processed data from 2003 to the present days from a number of registries (Heart- and Vascular Center of Semmelweis University VMAJOR I and VMAJOR II registry, Stent for Life I and II Programs of the European Society of Cardiology, National Public Health Service’s registry about Cardiac Care in Central Hungary, Budapest Modell database). According to our detailed examination, the proportion of primary per­cutaneous coronary intervention in ST-segment elevation myocardial infarction is at Western-European level, however the invasive treatment of acute coronary attack patients with Non-ST segment myocardial infarction is below the required. The so-cal­led hesitation span of Hungarian pa­tients with ST-segment myocardial infarc­tion is substantially longer than that of neighbouring countries thus the average cardiovascular risk of relevant Hungarian patients is significantly higher than those of the GRACE Register’s population. Based on our results a complex strategy can be developed which may have impact also on strategic health­care decisions in order to reduce the long-term mortality of patients surviving myocardial infarction.]

Lege Artis Medicinae

APRIL 18, 2020

[What is worth to know about COVID-19 for (not only) a cardiologist]

HEPP Tamás, CSÉKE Balázs, BENCZÚR Béla

[SARS-CoV-2 virus infection sprang from Wuhan the capital of the Chinese Hubei province, at the end of 2019 and caused a worldwide pandemic with 1.5 million confirmed cases and claimed almost 100 000 victims until the beginning of April, 2020. First analyses of Chinese COVID-patients confirmed that diabetes, hypertension, and cardiovascular diseases were highly prevalent among SARS-CoV2 infected patients, and might be associated with poor outcome. As previously shown for SARS-CoV-1, SARS-CoV-2 similarly utilizes ACE2 as receptor for viral alveolar cell entry. A suspicion has arisen that the widely used ACE-inhibitor/ARB therapy could be potentially harmful for patients suffering from COVID-19 infection as these agents upregulate the ACE2-expressions. From the other point RAAS-blockade might be beneficial due to fact that ACE2 counters the deleterious effects of Angiotensin II. Authors provide a comprehensive over­view of the most recent literature and summarize the link between COVID-19 and car­diovascular disease. It is important to em­phasize that there are no available hu­man evidences confirming if the RAAS-in­hi­bitor therapy were harmful or helpful in pa­tients suffering from COVID-19.]

Clinical Neuroscience

JANUARY 30, 2020

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.

Clinical Oncology

MAY 10, 2018

[Cardiotoxicity caused by fluoropirimides]

PIA Österlund

[One of the most effective traditional anticancer drugs are the fluoropyrimidines. The most challenging problem of the treatment is the cardiotoxicity. This review focuses on cardiotoxicity based on the references as well as personal experiences. The severness of the cardiotoxicity has a rang euptofatal outcome. There for eit is mandatory to monitor heart condition during the treatment with fluoropyrimidines.]

Clinical Oncology

MAY 10, 2018

[Fluid in preformed cavity to malignancy]

SZÖLLŐSI Regő

[The malignancy associated fl uids like pleural effusion, ascites and pericardiac fl uid are a common problems in patients with cancer. Despite the existence of typical types of cancer for these fl uid accumulations, nearly all types of cancer can cause malignancy associated fl uids. The presentation of these fl uids is generally a sign for disease progression, and forecast a poor prognosis. The prognostic factors include the type of cancer, the response to antitumorous therapy and the general condition of the patient, which include age, ECOG status and so on. In most of the cases, the treatment of these fl uid accumulations is supposed to decrease the symptoms, and guarantee an acceptable quality of life, consequently the treatment has a palliative intent. Indeed, there are some exceptions such as cardiac tamponade. From the large scale of available treatments, we have to choose upon careful risk analysis.]

Hypertension and nephrology

APRIL 10, 2017

[Angiotensin-converting enyzme inhibitors before and after myocardial infarction]

TOMCSÁNYI János

[In this review current knowledge related to the coronary atherosclerosis and angiotensin-enzym inhibitor is discussed. The earlier recognition to the effect of ACE inhibitors and ARBs to slow or reverse left ventricular remodelling is well known and accepted but the effect of these drugs on the atherosclerotic process itself may be aqual important. The focus should be now how to treat the early phase of coronary atherosclerosis, how to treat safety the hypertensive patient in the setting of coronary stenosis, how to treat the acute myocardial infarction’s patient with renal failure, and at least how to improve the long-time adherence in the primer and secunder prevention too.]

Lege Artis Medicinae

OCTOBER 20, 2016

[Many faces of thyroid hormone deficiency]

MOLNÁR Ildikó

[The timely detection of thyroid hormone deficiency is crucial to inhibit the dangerous consequences of related diseases, such as obesity, cardiovascular diseases, type 2 diabetes mellitus, breast cancer, bone wasting, menstruation disturbance, and goitrogenesis. Subclinical hypothyroidism (<10 mU/l TSH) can initiate the above mentioned symptoms and diseases, therefore its early detection and treatment is necessary. The manuscript details from a practical point of view the causes leading to thyroid hormone deficiency, their consequences and gives recommendation for starting the treatment. The increased occurrence of breast and colorectal cancers associated with thyroid hormone deficiency is explained, and the attention to concomitantly elevated prolactin levels is called. Finally, the paper gives proposals for the clinical practice, when we should think of thyroid hormone deficiency and reports on the algorithm of the treatment of subclinical hypo­thyroidism recommended by the European Thyroid Association (ETA) in 2013.]

Lege Artis Medicinae

SEPTEMBER 20, 2015

[Causes and pathological appearances of ischemic heart diseases]

MAGYAR Éva, FECSKE Éva, SALAMON Ferenc

[The myocardial ischemia is caused by insufficient offer of oxygen, it can be caused by damage of coronary arteries which is called coronary heart disease, and might be non coronary in origin, this is the relative coronary insufficiency. The reason of coronary heart diesease is the stenosis or occlusion of the lumen of subepicardial main coronary branches as well as intramyocardial small vessels. The type of alterations either of the main or the small vessels are mentioned. The myocardial bridge play an important part in genesis of intimal plaques. The discrepancy occuring between the actual oxygen demand and oxygen offer causes the relative coronary insufficiency, such as myocardial hypertrophy, anemia, shock, fever etc. The myocardial damages, those of caused ischemia can be devided pathologically irreversibile lesions (infarction, coagulative and colliquation myocytolysis) and ischemic heart disease (ischemic cardiomypathy) and clinically angina pectoris and sudden death. The irreversible lesions are detailed in morphological point of view, and differenece between the regional and subendocardial infarction is accentuated.]

Journal of Nursing Theory and Practice

DECEMBER 10, 2012

[Providing ambulance paramedics with more in-depth knowledge relating to the on-site treatment of acute cardiac asthma ]

MOSKOLA Vladimír, HORNYÁK István

[Aim of the study: The authors sought an answer to the questions arising in the course of on-site emergency care, in relation to the treatment of acute cardiac asthma: What is the ratio of men and women developing the disease? How frequently is supplementary, symptomatic treatment applied in the course of on-site emergency care? What is the distribution of the incidence of acute cardiac asthma by age group and time of day? Methodology and sample: The descriptive, retrospective research was conducted at the Nyíregyháza ambulance station of the North Plain Regional Ambulance Service. In the period lasting from 1 January 2006 to 31 December 2007, a total of 13 511 incident sheets were reviewed, from among which a total of 130 were subjected to a more detailed examination, on the strength of the diagnoses of acute cardiac asthma and pulmonary oedema. The data was collated using Microsoft Excel, and the processing of the results thus obtained took place using descriptive statistical methods (frequency, correlative coefficient). Results: With regard to acute cardiac asthma, 51% of the cases took place in the early hours, while 40% occurred in the evening. The remaining cases can be placed in the mid-morning and afternoon periods, which together represented only 9% of all the cases. Of the 130 patients studied, 68 were women and 62 were men. Supplementary treatment was given on-site in the form of Cerucal in 17 cases, and with Theospirex in 13% of cases. Conclusions: The incidence of the disease is increasing from year to year. The rise in the incidence of acute cardiac asthma has been especially notable among the 71-81 age group. In terms of the time of day, acute cardiac asthma tends to occur in the early hours and in the evening. Over the age of sixty incidence increases significantly in both sexes; however, age is not a significant factor in the effectiveness of the treatment. ]

Hypertension and nephrology

DECEMBER 08, 2012

[The history of diuretic treatment in Hungary. Part I. Imre Fodor]

RADÓ János

[The diuretic effect of mercurial compounds was discovered in 1920. However, the term of “mercurial diuresis” was created 36 years earlier by Ernő Jendrassik. Imre Fodor published his experiences with the mercurial diuretic, which has been cited by several authors worldwide. The Hungarian pharmaceutical industry also took its part from the production of the mercurial diuretic with Novurit that proved to be an excellent and worldwide well known preparation in the next 40 years. Even Imre Fodor required the repeated administration of mercurial diuresis because of his severe cardiac oedema in the last period of his life. When the drug became ineffective, i.e. developed refractory oedema, he made a “self-experiment” with the administration of ACTH to restore the sensitiveness to the mercurial diuretic on the basis of most recent American literature at that time. His experience has been published by his colleagues just before his death. Imre Fodor was an eminent clinician, a school creating internist who entered his name into the science dealing with the use of diuretics.]