[Differential diagnosis of chest pain: point of view of a cardiologist and a rheumatologist]. / A mellkasi fájdalom differenciáldiagnosztikája egy kardiológus és egy reumatológus szemszögébol.

UNLABELLED: The rapid development of therapy necessitates early diagnosis in all clinical spheres because the attainable result of the therapy depends on this. It is especially true in the case of cardial and cerebrovascular events. AIM: Since events in the thoracic cavity--life threatening or not--cause pain, the authors, based on their own experience and on the literature, present a summary of the various differential diagnoses of chest pain. METHOD: The authors discuss the causes of chest pain, grouping them according to their risk, frequency and topography. CONCLUSION: Even in possession of modern and heavy-duty diagnostical and therapeutical possibilities, it is not indispensable, what is more, it is necessary to analyse chest pain as a symptom in detail, with the aim of reaching the most favourable benefit/risk and benefit/cost ratio, respectively.

Motor vehicle accident with complete loss of consciousness due to vasovagal syncope.

Vasovagal syncope (VVS) is one of the most common causes of complete or partial loss of consciousness, thus it might cause harm to the patients themselves or innocent bystanders while driving a car. In our case report we introduce the case of a 60-year-old man who was admitted to hospital after a serious motor vehicle accident due to loss of consciousness. We demonstrate the process and results of complete cardiologic and neurological assessment. Our case report illustrates the importance of recognition of patients with a high risk for incapacitating symptoms due to VVS, and the use of head-up tilt-table tests to determine the diagnosis and to guide therapy with beta-blocking agents. As transient loss of consciousness during driving may cause potentially fatal accident, it has to be taken into consideration during decision making for issue of driving licenses to patients with VVS.

[Acute toxicological cases during a ten-year period in our clinic]. / Akut toxikológiai eseteink klinikánk tízéves beteganyagában.

INTRODUCTION: There's a fact, that Hungary has held the first places in suicidal statstics. METHODS: The authors studied toxicological cases between 1989 and 1998 at the 1st Department of Medicine of the Medical and Health Science Centre, at the University of Debrecen, paying special attention to suicidal poisoning cases. RESULTS: 2% of the patient turnover accounted for acute poisoning cases, the number of which increased during the 10 years in question. 70% of the cases were of suicidal intentions, 20% were unintentional, these poisonings were not committed on purpose, while the proportion of iatrogenic intoxication cases was 10%. Amongst the failed suicide cases there was a higher proportion of women, whereas a higher percentage of men accounted for "successful" suicide cases. When examining auto-intoxication cases it turned out that the medicine most frequently used was meprobamate, besides benzodiazepines. Mortality rate was highest in the glutethimide intoxication cases. Most poisonings with suicidal intentions took place in the 2nd quarter of the year. Most completed suicides were committed on Wednesdays and Thursdays. 81% of the iatrogenic intoxication cases happened to be with digitalis and coumarin overdose. Nearly 50% of the cases turned out to be combined intoxications. 40% of the men took alcoholic drinks during the auto-intoxications. In the case of 135 patients extracorporeal detoxification therapy was applied, which consisted mostly of hemoperfusion. Three quarters of the patients needed psychiatric care and every fourth patient was admitted to the Department of Psychiatry. 6.9% of the poisonings were fatal. CONCLUSIONS: The growing number of toxicological cases--amongst these suicidal poisonings--compels us to pay more attention to the setting up of interdisciplinary based prevention as well as running effective toxicological centres. All physicians have a responsibility to recommend psychiatric care for people suffering from mental problems or depression and for the unsuccessful or potential suicide seeking help for the first time. Family doctors in primary medical care and who meet patients first have an important role in this job.