Adequacy of hyaluronan binding assay and a new fertility index derived from it for measuring of male fertility potential and the efficacy of supplement therapy.

The aim of the study was to statistically prove that the HBA(®) test is an efficient practical method for andrologists to determine the fertility potential as well as to measure the efficiency of oral supplement therapy in case of male infertility. In the study, 175 patients were involved and it also included the follow-up studies of 39 patients after supplement therapy. Completing the 'classic' spermatological parameters with the results of HBA(®) test, the authors have also determined a new fertility index to be used for practical rating of the measure of fertility potential. After the supplement therapy, both sperm density and hyaluronan binding capacity increased significantly. The authors are convinced that the HBA(®) analysis is an objective, standardisable test, which provides a better approach to fertility potential. This analysis enables us to detect spermatozoa that were previously misjudged as normal by morphological assay and also makes the efficiency of the therapy more measurable.

Patients with difficult-to-treat depression do not exhibit an increased frequency of CYP2D6 allele duplication.

The insufficient response of patients to antidepressant medications may result from several factors, including altered drug metabolism. CYP2D6 genotyping may help assess the possible factors that contribute to difficult-to-treat depression. The aim of our study was to determine the frequency of CYP2D6 allelic variants and the prevalence of predicted CYP2D6 phenotypes in patients who were suffering from difficult-to-treat depression and compare the data with those for the healthy population of Hungary.55 patients who failed to respond to 2 or more adequate trials of different CYP2D6-dependent antidepressants were selected for genotyping.The prevalence of the predicted CYP2D6 phenotypes in the patient population was 1.8% for the UMs, 80.0% for EMs, 3.6% for IMs and 14.5% for PMs compared with 1.9% for UMs, 83.3% for EMs, 6.5% for IMs and 8.3% for PMs in the Hungarian population.The CYP2D6 allele frequencies and the predicted phenotype distributions in patients with difficult-to-treat depression were not significantly different to those found in the healthy population of Hungary. The cumulative frequency of the CYP2D6*1XN, *2XN and *35XN alleles was 0.9% in the patient population -suggesting that CYP2D6 duplication or multiplication does not play a significant role in antidepressant pharmacotherapy failure in this patient sample. The cumulative frequency of the non-functional alleles (33.5%) and the prevalence of the genetically determined PM phenotype (14.5%) were relatively high in the patient group. These figures draw attention to the possibility of unrecognised and non-reported side effects and non-adherence to drug treatment.

Physical and physiological performances in 10-year-old obese boys.

Fatness generally has a negative influence on the performance of a variety of motor and cardiorespiratory fitness tests. The aim of this comparison was to analyse the effects of three grades of obesity on somatic growth, physical performance and oxygen consumption during exercise. Volunteer boys with definitely different grades of obesity were recruited for the comparison. In the group of mildly obese children (G1; n=23) BMI ranged between 24 kg.m -2 and 26 kg.m -2 ; and individual percent body fat was between 33% and 33.5%. In the case of moderate obesity (G2; n=23) BMI ranged between 26.5 kg.m -2 and 28.5 kg.m -2 ; and percent body fat was between 35% and 36%. In the extremely obese group (G3; n=20) BMI was greater than 31 kg.m -2 ; percent body fat was greater than 37.5%. Oxygen consumption during the 1,200 m run-test was measured by VIMEX-ST-type (USA) telemetric equipment.The greatest absolute aerobic power referred to the G3 boys, and the lowest oxygen consumption was characteristic of the mildly obese group. The very high differences between the body mass means resulted in a more marked inter-group variability in mean relative oxygen uptake.The predicted relative fat and high body fat content observed on the trunk, and the elevated level of resting blood pressure may indicate serious risks for the development of cardio-respiratory and metabolic disease. The very low oxygen consumption relative to body mass and poor physical performance are expected consequences of physiologic and environmental influences on the obese population.

Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania.

BACKGROUND: This study compared the safety, tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular (IM) olanzapine or other IM antipsychotics for the treatment of acute agitation. METHODS: Patients (N = 2011) from 15 countries participated in this prospective, observational, non-interventional study. Inpatients requiring treatment with at least one IM injection of a short-acting antipsychotic were assessed at baseline and within 7 days after the first IM injection. Treatment groups comprised: (i) patients prescribed IM olanzapine at baseline; and (ii) patients prescribed any other IM antipsychotic medication at baseline. Outcome measures included: treatment-emergent adverse events, concomitant psychotropic medication and the time taken to switch to oral medication. RESULTS: Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group (34.4% vs. 46.2%, p < 0.001). The most frequently reported adverse events in both groups were: sedation, Parkinsonism, disturbance in attention, akathisia, dystonia and orthostatic hypotension. Fewer patients in the IM olanzapine group used anticholinergics (13.9% vs. 42.5%, p < 0.001) or anxiolytics/hypnotics (47.6% vs. 51.6%, p = 0.023). Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group (median time = 46.5 vs. 48.0 h, p = 0.009). CONCLUSIONS: These findings suggest that IM olanzapine may have a favourable impact on individual patients. However, the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone.

Urinary steroid measurements in some endocrine and psychiatric diseases.

In 1990, the worldwide accepted Shackleton method, which provides a possibility of determining the steroid metabolites from urine, was adopted in our laboratory. The procedure is very useful in the diagnosis of different endocrine diseases and in the recognition of dysfunction or absence of enzymes with an important role in steroid metabolism, and it gives possibility to control the treatment in patients with these diseases. Besides the proximate clinical application, the method gives a convenient tool to study the steroid background of these disorders, helping us understand the mechanism of their development. In the last few years, we have examined the steroid profile of patients with hair (androgen alopecia /AA/, effluvium /E/), psychiatric problems (major depression /MD/, eating disorders /EDS/, especially anorexia nervosa and bulimia) and osteoporosis (OP). In all of the examined hair loss diseases, the levels of main androgen metabolites were increased, and elevated 5alpha-reductase activity were found. We could observe the alteration of the activity of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme and marked gender differences in the changes of the steroid metabolism in patients with major depression (MD). In women with OP, the significantly decreased level of certain metabolites points to the role of testosterone, androstenedione and DHEA in postmenopausal bone loss in women. Our experiences contribute to the knowledge of the nature and steroid background of some endocrine and psychiatric diseases.

Sexual dysfunction among patients treated with antidepressants--a Hungarian retrospective study.

The authors have investigated the incidence and several aspects of sexual problems in Hungarian outpatients (N = 637) treated by antidepressive medication. In this multicentre epidemiological survey the sexual dysfunctions (SD) was assessed by psychiatrists using structured interviews. Seventy-eight of the sample has sexual problems, more than half of them mentioned SD after starting antidepressive medication. Comparing various groups of antidepressants, patients taking a RIMA compound reported the occurrence of SD not so often as in TCA or SSRI groups, where the rate of SD was very high. Authors pointed out that physicians have to pay special attention to this problem in everyday clinical practice, since the recognition and treatment of sexual dysfunction is critical for the patient's satisfaction, medication compliance and the quality of life.

Attitudes of Hungarian students and nurses to physician assisted suicide.

In Hungary, which has one of the highest rates of suicide in the world, physician assisted suicide (PAS) and euthanasia are punishable criminal acts. Attitudes towards self destruction and assisted suicide are, however, very controversial. We investigated the attitudes of medical students, nurses and social science students in Hungary towards PAS, using a twelve item scale: the total number of participants was 242. Our results indicate a particular and controversial relationship between attitudes towards assisted suicide in Hungary and experience with terminally ill people. The social science students, who had the fewest personal experiences with terminally ill patients, are characterised by the most permissive attitudes towards assisted suicide. Nurses, who had everyday contact and experience with these patients, were the most conservative, being least supportive of assisted suicide. The attitudes of medical students, the would be physicians, are somewhere between those of nurses and social science students.

[Suicidal behavior in the elderly. Review of results at the Pécs Center of the WHO/EURO Multicenter Study on Suicide]. / Idóskor és öngyilkosság. Attekintés a WHO/EURO multicentrikus európai szuicidiumkutatas pécsi centrumának adatai alapján.

The authors examined the characteristics of old suicide attempters (over 65 years) with special regard to organic and depressive disorders and sociodemographic features. Within the framework of the WHO/EURO Multicentre Study on Parasuicide data of 849 suicide attempts were collected during three years. Comparing old age group (n = 54) to younger suicide attempters (n = 795) were found that over 65 years the proportion of female was much higher, repeaters rate was lower. In aged group were more widowed persons, while was not substantial difference in the rate of living alone. Regarding methods of parasuicide there were fewer poisoning (but higher rate of sedatohipnotics intoxication), while hard methods were more frequent. Over 65 years the proportion of depression, and organic disorders was higher. It seems that, in spite of the fact, that many old parasuicidal patients have depressive symptoms, they could get treatment only for symptoms of anxiety and sleep disturbance, while the affective problems remain undiagnosed and untreated. Another important factor, that high proportion of elderly sample was living in the family, with other relatives or in nursing home. In spite of this most of cases family members or caretakers in nursing home could not recognise the psychic problems and could not give sufficient emotional or social support to the patients to prevent suicide attempt. Authors pointed out, that the recognition and treatment of depression plays very important role in the suicide prevention in elderly population, and the adequate emotional and psychosocial support by family and health care systems seems to be essential.

Echocardiographic characteristics of male athletes of different age.

Two dimensionally guided M mode and Doppler echocardiographic data for 578 male subjects (106 non-athletic and 472 athletes) were analysed from two aspects: (a) in the young adult category (19--30 years of age), competitors in different groups of sports were studied; (b) in the different age groups (children, 10--14 years; adolescent juniors, 15--18 years; young adults, 19--30 years; adults, 31--44 years; older adults 45--60 years), data for athletes and non-athletes were compared. Morphological variables were related to body size by indices in which the exponents of the numerator and denominator were matched. Morphological signs of athletic heart were most consistently evident in the left ventricular muscle mass: in the young adult group, the highest values were seen in the endurance athletes, followed by the ball game players, sprinters/jumpers, and power athletes. A thicker muscular wall was the main reason for this hypertrophy. Internal diameter was only increased in the endurance athletes, and this increase was more evident in the younger groups. The E/A quotient (ratio of peak velocity during early and late diastole) indicated more effective diastolic function in the endurance athletes. The values for E/A quotient also suggested that regular physical activity at an older age may protect against age dependent impairment of diastolic function.

[Physical illness and suicidal behavior. Review of results at the Pécs Center of the WHO/EURO Multicenter Study of Parasuicide]. / Testi betegségek és öngyilkos viselkedés. Attekintés a WHO/EURO Multicentrikus Európai Szuicidium-kutatás Pécsi Centrumának adatai alapján.

The authors examined the relation of physical illness, suicidal behaviour and help-seeking patterns among suicide attempters within the framework of the WHO/EURO Multicentre Study on Parasuicide. Until now 700 monitored suicidal events have been collected; 101 structured interviews and 50 follow-up cases have been conducted in this three years period. Physical and mental problems proved to be very frequent among suicide attempters and many of them took somatic and psychiatric drugs. It was shown that patients with acute or chronic physical and mental illness more often had been in contact with GPs. Authors pointed out that in addition to mental problems the somatic diseases are significant risk factors in suicidal behaviour. In many cases these factors were not recognised and thus patients could not get help. Authors emphasised the importance of training GPs, since complex diagnostic and therapeutic approach is essential to prevent suicide.

Mass media, cultural attitudes, and suicide. Results of an international comparative study.

Many studies indicate that the suicidal behavior in a society is affected by the suicide stories publicized. Cultural valuations appear in the way media present self-destruction. The reflection of sociocultural attitudes toward suicide can be observed and analyzed in these texts. In this research, reports about suicide (n = 2203) in the years from 1981 and 1991 taken from daily newspapers were gathered--three central and regional papers in each country. A content analysis was performed of the suicide reports in Hungary (n = 244), Japan (n = 684), the United States (n = 265), Germany (former West n = 458, former East n = 60), Austria (n = 405), and Finland (n = 81), on the basis of the following variables: mentioning of the name, personal data, prominence of the suicidal person, qualification of the suicide, methods, motives, positive or negative consequences, alternatives, and the expression(s) used to refer to the act. After a coding process, an analysis was conducted as to whether any significant differences existed in the rate of the several characteristics in the countries from the point of view of the possible imitation-identification and of the cultural differences are the most important findings interpreted.

[Diagnostic and preventive factors in the background of attempted suicide--review of two-years results of the Pécs Center in the WHO/EURO Multicenter Study of Attempted Suicide]. / A szuicid kísérletek diagnosztikus és prevenciós háttere--áttekintés a WHO/EURO Multicentrikus Európai Szuicidiumkutatas pécsi centrumának kétéves adatai alapján.

Since parasuicides are not being systematically recorded in Hungary, a monitoring project within the framework of the WHO/Euro Multicentre Study on Parasuicide was started in Pecs catchment area. The study is aimed both to monitor the medically treated parasuicides and to predicts future acts (repetition prediction study) through a follow-up investigation. Pecs centre has been participated for two years in this study. The recent results of this survey are presented and analysed: 553 monitored suicidal events has been collected; 101 structured interview and 37 follow-up cases has been conducted in this period. The most important epidemiologic sociodemographic and psychosocial factors are discussed. Authors paid special attention to the presuicidal psychological characteristics especially the cry for help of the patients, emphasizing the specific diagnostic and preventive possibilities.

[Comparative study of the attitudes of students and nurses to physician-assisted suicide--first results]. / Egyetemi hallgatók és nóvérek az orvosi közremúködéssel elkövetett öngyilkossággal kapcsolatos attitúdjének összehasonlító vizsgálata--elsó eredmények.

While the popular media and the professional literature deal with the topic of euthanasia intensively, the problems of physician-assisted suicide received insufficient attention in Hungary. The authors review the most important details of the physician-assisted suicide. A twelve-item scale to measure attitude toward PAS (constructed and validated by G. Domino) was administered to the samples of Hungarian social science, medical students and nurses. The distributions of responses for the 12 items for the social and medical samples are compared and discussed. Also a cross-cultural comparison was made with an American student sample examined by Domino. The social science students who have the fewest personal experiences with serious, or terminally ill patients are the most liberal group, characterised by the most permissive attitudes toward PAS. Nurses who have everyday contact and experience with these patients are the most conservative; they show more or less conclusively the lowest acceptability rate of PAS. The attitudes of medical student's group, of the would-be physicians are between them, and they are the most controversial and ambivalent. Future research is necessary to get more information about attitudes toward physician-assisted suicide.

[A case of datura stramonium poisoning--general problems of differential diagnosis]. / Csattanómaszlag-mérgezés esete--a differenciáldiagnózis gyakorlati kérdései.

In past year drug abuse becomes more and more general in Hungary. In addition to consume traditional drugs, other substances are used frequently too. One of them is the Datura stramonium, which contains alkaloids (mostly atropine), and can result in hallucinations. Therefore Datura stramonium is seemingly becoming popular as a hallucinogenic drug. The consumption of any part of the plant causes atropine intoxication, thus anticholinergic delirium. Differential diagnosis of Datura intoxication can be difficult in the everyday medical practise. In our paper the symptomatology, diagnosis, differential diagnosis, and therapy of Datura intoxication are discussed and we report one of our cases.

Genital retraction syndrome in Korean woman. A case of Koro in Hungary.

Koro is a culture-specific psychiatric disorder occurring primarily in Southeast Asian cultures. It is manifested by acute anxiety associated with the fear of genital retraction, accompanied by fear of death induced by the thought that complete disappearance of the genital organ will result in death. Koro has been described in non-Asian patients as well, leading to a debate concerning the culture-specific nature of the syndrome. Giving a psychopathological, nosological definition of this peculiar syndrome is also problematic. In this paper, we report a case of koro in a young, Korean female patient. We briefly present the etiological factors related to the development of the syndrome and the most significant psychopathological characteristics.

[Senile depression in everyday medical practice]. / Idöskori depressziók a mindennapi orvosi gyakorlatban.

The authors suggest that though the prevalence of depressive disorders among people over 65 is high, it is not diagnosed in many cases. They give different rating scales and symptom-lists, which can help the diagnostic procedure. It is pointed out that, according to the etiologic factors, the mood disorders of elderly people form together the clinical picture. The modern pharmaco- and physiotherapeutic treatments of depression are briefly discussed, too. The authors emphasize, that the depression of the elderly can be treated efficiently.

[Management of childhood pseudocroup with budesonide inhalation]. / Gyermekkori pseudocroup kezelése inhalativ budesoniddal.

The authors examined 85 children who had serious recurrent pseudogroup syndrome, and re-examined them 1-3 years later. 1/3 of the patients was also allergic, mostly to mites and grasspollens. The patients got either regular, daily two inhalation, or their parents were taught to inspire the drug in the case of stenotic cough of hoarseness. Half of the patients did not answer to our letter. The parents of 43 patients answered and described their observations according to the inquiry letter. 2/3 of treated children either amolioreted definitely of became symptom free. 12 patients had 30 laryngeal attacks before the budesonide treatment whereas only 3 attacks, needing hospitalisation, occurred after the budesonide treatment. 6 patients experienced definite amelioration and two children's state worsened. Budesonide therapy seemed to be useful in the prevention and therapy of recurrent laryngitic children. Further experiences using turbo-inhaler and placebo would be important for more definite statement. Nevertheless inhalative budesonide is the first drug promising fast remission of laryngeal edema.

[Allergologic study of the pathogenesis of atopic dermatitis in infancy and childhood]. / A csecsemö- és gyermekkori atópiás dermatitis kóreredetének allergológiai vizsgálata.

The authors present the results of allergologic investigations in 54 infants and children with atopic dermatitis. To demonstrate the food and inhalative allergies, which are most important etiologic factors in this disease, different methods have been administered. Besides these in vitro and in vivo methods oral food challenges were done to verify the real causative role of the food in question. Food allergy only was verified in 16 cases, 12 patients were suffering in inhalative allergy. Both kind of allergens produced reaction in 19 cases. Among the foods hen egg caused sensibilization most frequently, among the inhalants the house dust mite. In analysing the results the authors want to demonstrate the combined allergic etiology, of atopic dermatitis.

Study of mold allergy in asthmatic children in Hungary.

We studied the change in sensitivity to propagating aerogenic fungi (spores, conidia) in extrinsic asthmatic children living in an urban environment from 1977 to 1988. According to the skin test, 10.6% of those examined in 1977 were sensitive to the fungi, the proportion being 30.4% in 1985 and 38.5% in 1987/88. The increase may be explained by the increasing frequency of sensitivity to Alternaria alternata and Phoma betae. In skin tests with Bencard allergens, reaction to both types was frequently observed. Of those sensitive to P. betae, 83% were also sensitive to A. alternata, and 87.5% of those sensitive to A. alternata were also sensitive to P. betae. The frequency of cross-reactions observed both with skin tests and specific IgE determinations suggests the presence of a common allergen, or epitope. The effect of environmental factors was analyzed with computer techniques. P. betae allergy was not related to detectable mold, humidity or number of pot plants in the home. The living conditions changed during the study period as follows: 1) housing conditions improved; 2) energy-saving building technologies were generally accepted; and 3) air pollution increased, also affecting the vegetation. The sensitizing masses of spores and conidia originated most likely from molds living on plants weakened and diseased by environmental pollution.