Hungarian Radiology

[Hungarian radiologists in Sweden]

KARLINGER Kinga

APRIL 20, 2002

Hungarian Radiology - 2002;76(02)

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Hungarian Radiology

[Errors and mistakes II.]

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[Scientific presentations of pediatric radiology sections of ECR 2002]

KIS Éva

Hungarian Radiology

[Atypical diaphragmatic herniation causing bowel obstruction]

ERDŐSI Éva, MÉSZÁROS Anikó, GREXA Erzsébet

[INTRODUCTION - A 21-year-old woman presented with iatrogenic diaphragmatic hernia causing bowel obstruction. CASE REPORT - Plain abdominal X-ray and barium swallow examinations showed a diaphragmatic hernia causing partial gastric obstruction. Surgery confirmed the radiological diagnosis. The hernia was located atypically at the centre of the diaphragm. CONCLUSION - The cause of the hernia was probably related to a pyogenic necrosis due to subphrenic abscess after cholecystectomy performed 2 years earlier, treated by drainage and repeated surgical interventions.]

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[Our place in Europe]

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[CALENDAR OF RADIOLOGICAL EVENTS, 2002]

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Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

LAM KID

[The EFEZUS study: Estimation oF the Effectiveness of Zoledronic acid in Use in Steroid-induced osteoporosis in real life]

KISS Csaba György, SURMANN Ágnes, DRESCHER Edit

[The Hungarian EFEZUS study (Estimation oF the Effectiveness of Zoledronic acid in Use in Steroid-induced osteoporosis in real life) was a multicentre, prospective, non-interventional, open-label, one-year-long study, in which we assessed the effect of zoledronic acid on bone mineral density and on the markers of bone turnover in osteoporosis developing after treatment with glucocorticoids. The mean baseline lumbar BMD was 0.762 g/cm2 and by the end of 12 month it increased to 0.818 g/cm2 (p<0.0001). The mean BMD measured at the femoral neck during visit 1 was 0.675 g/cm2, and it increased to 0.711 g/cm2 by visit 2 (end of study) (p<0.0005). The levels of bone turnover markers (cTX, nTX) significantly decreased between visits 1 and 2 (p<0.05). The mean cTX level at visit 1 was 421.2 ng/l (SD: 309 ng/l), which decreased to 253.3 ng/l (SD: 188.1 ng/l) by visit 2. The mean change in the levels of nTX was 0.65 µg/l (SD: 0.36 µg/l) and 0.39 µg/l (SD: 0.28 µg/l), respectively. There was no major change in serum and urine calcium levels. Five adverse events were reported by 4 patients during the study. ]

Lege Artis Medicinae

[Advance directive]

KŐMÜVES Sándor

[In the first step the work defines the institution of advance directive, places advance directive in the context of advance care planning, and demonstrates the advantages of advance care planning. Then the forms of the advance directive are presented and related Hungarian health care sections are interepreted in the context of these back-ground conditions. In the third step decision making capacity is defined, its standards are set out, the role of substituted decision maker is delineated. In the fourth step accumulated experience with living will is demonstrated and the possible alternatives concerning the future of living will are provided: the elimination of the living will part of the institution from health care or its continued application after substantial revision. METHODS - Analytic presentation after systematic review of the literature on the topic. RESULTS - Significant experience has been accumulated since the implementation of advance directive. In light of experience two attitudes have been chrystallized regarding the future of the institution: one takes the side of the elimination of the living will part of the institution from health care, the other recommends its revised application. CONCLUSION - The American and Hungarian experiences with advance directive recommend the review of the Hungarian institution of advance directive. ]

Hypertension and nephrology

[Management of patients with chronic renal disease]

KULCSÁR Imre, SZEGEDI János, KISS István

[The number of patients with chronic renal disease is increasing in our country and they are about one million people nowadays. The main causes of this phenomenon are increased number of diabetic, hypertonic, overweight and elderly people, as well as the presenting of calculated GFR results. The care of patients with renal diseases is an interdisciplinary work. Most of them are under care of general practitioners, but those, who are belonging to the high-risk groups, are treated by nephrological outpatients clinics. The capacity of Hungarian nephrological outpatients departments is insufficient, and the dispersion of them is uneven. For better nephrological care, the capacity of these outpatients clinics - including the human resources - must be increased.]