Lege Artis Medicinae

[CHARM-Alternative ]

MATOS Lajos

JUNE 22, 2004

Lege Artis Medicinae - 2004;14(06)

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Lege Artis Medicinae

[Elevation of IgG antibodies against tissue transglutaminase as a diagnostic tool for coeliac disease in selective IgA deficiency]

KORPONAY-SZABÓ Ilma, DAHLBOM I, LAURILA K, KOSKINEN S, WOOLEY N, PARTANEN J, KOVÁCS JB, MÄKI M, HANSSON T

Lege Artis Medicinae

[A CASE OF PRIMARY HEPATIC AMYLOIDOSIS PRESENTING WITH GASTRIC BLEEDING]

STOGICZA Ágnes, GRABER Hedvig, SKALICZKI József, NÁDOR Katalin, MAGYAR Tamás

[INTRODUCTION - Amyloidosis - at an early stage - has no typical clinical findings, but severe weight loss, hepatomegaly and elevated serum alkaline phosphatase level can be clues to the diagnosis. CASE REPORT - We report a 66-year-old woman presenting at our unit with massive gastrointestinal bleeding. Gastroscopy was performed and a haemorragic ulcer was found. Before admission she had lost 20 kg-s in 6 months. The patient had hepatomegaly and markedly elevated serum alkaline phosphatase level. These findings suggested the presence of malignancy, but ultrasound, CT and MR examinations did not support this hypothesis. After liver biopsy the diagnosis of amyloidosis was proven. She had rapid downhill clinical course of gastric bleeding from an ulcer resulting in death. CONCLUSIONS - So far, no specific treatment exists for amyloidosis, but there have been promising results reported about liver transplantation and autologous stem-cell transplantation.]

Lege Artis Medicinae

[MEDICAL ANTHROPOLOGICAL APPROACH TO CHILDREN'S SURMISES ON SMOKING]

BAK Judit, PIKÓ Bettina

[INTRODUCTION - The aim of our study was to explore school children'’s surmises on smoking. The following questions were in the focus of our analysis: what concepts children have about smoking and smoking-related diseases before adolescence? Have they already tried smoking? METHODS - The study was conducted among 3rd, 4th and 5th year school children (N=128) in two towns of Békés County, namely in Békés and Köröstarcsa. The sample consisted of 57% males and 43% females. Regarding sampling we followed international studies with similar aims where samples of 9-11-year-old average children were thought to be ideal for such study purpose using the draw-and-write technique. RESULTS - Most respondents from the study have not tried smoking yet. On the other hand, there are great number of adults who smoke in children’s environments, in many times, both parents do. Despite these facts, children’s attitudes toward smoking is rather negative. Children'’ s opinions reflect many negative aspects of smoking: the health-damaging effect, the financial aspects, the negative effects for social and physical environment. CONCLUSIONS - Similar to previous international studies, children of our sample possess correct and comprehensive knowledge of the smoking-related health problems. Findings of our study provides a support to the need of a smoking prevention program for children in the age of their negative opinions of smoking and well before the peer group effect is getting significant.]

Lege Artis Medicinae

[On teaching, with personal overtones]

BODA Domokos

Lege Artis Medicinae

[Postgraduate conference on hepatology]

TELEGDY László

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[Practice of the Hepatitis B vaccination with non-responder patients in our Centre]

GÓZ Lászlóné, KÖRTVÉLYESINÉ Bari Krisztina, BECS Gergely, SZABÓ P. Réka, BALLA József, KÁRPÁTI István, MÁTYUS János, UJHELYI László, BEN Thomas

[Introduction: End-stage renal disease patients under dialysis have impaired immune system and are more susceptible to infection, even those infections that can be prevented by vaccination (e.g. hepatitis B). If the antibody titer (anti-HBs) remains <10 IU/ml after two consecutive vaccinations, patients are classified as non-responders. Reasons for unsuccessful vaccinations include technical, immunological (e.g. multigene haplotypes) reasons. They are often also associated with chronic diseases. Aim of the research: To re-vaccinate patients after unsuccessful intramuscular vaccination to achieve immunity. Research and sampling methods: Intracutaneous vaccination can be a viable alternative for successful immunity. 6 months after re-immunisation, anti-HBs titer>10 IU/mL indicate a successful immune response. Results: 22 haemodialysed patients received intracutaneous hepatitis B vaccination with the total dosage of 6 μg. An anti-HBs titer elevation (21-100 IU/ml) was observed in 15 cases (68.18%). In those cases, where we failed to achieve successful immunity, we identified malignancies, immunosuppression, amyloidosis, psoriasis diabetes mellitus, or coeliac disease as a possible reason. Conclusions: The rate of successful immunisations against HBV infections can be improved by means of intracutaneous vaccination. ]

LAM Extra for General Practicioners

[Insertion of percutaneous peritoneal dialysis catheter using Seldinger technic with assistance of image amplifier ]

PETHŐ Ákos Géza, SZABÓ Réka, SZŰCS Attila, BALLA József

[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

Lege Artis Medicinae

[Alternative Medicine in the View of Scientific Evidence]

NAGY Zsuzsanna

Journal of Nursing Theory and Practice

[Application of external circulatory assist device in cases of cardiac failure]

TAMÁS Csilla, BARATI Zoltán

[The Heart and Vascular Centre of Semmelweis University was the first institution in Hungary to routinely apply external mechanical circulatory support (Extracorporal Membrane Oxigenation, Ventricular Assist Device) as a new alternative to treat cardiogenic shock cases. The objective of our study was to assess how frequently certain therapeutic methods were applied, and to evaluate the demographic characteristics, the case historic and the mortality data of the patients treated, as well as to demonstrate the incidence rate of the most frequent complications. Our study was based on the data of patients suffering cardiogenic shocks treated with external circulatory assist devices between 1. June, 2012 and 31. January, 2016. The study has been carried out analytically and retrospectively after data collection from written and electronic patient documentation. Data analysis has been executed by SPSS software. The results revealed uneven gender distribution, over 60% of incidence in case of four examined complications, and an elevated mortality rate of patients over 60 years old. We found that there is a higher risk for complications if mechanical circulatory support is applied, and we made a suggestion to reconsider the application of this support for patients over certain ages. The study demonstrated that our results match the statistical data found in international medical literature. ]

Lege Artis Medicinae

[About stem cells]

PAPP Csaba

[Stem cells are special cells of an organism that are capable to continuously renew themselves and, triggered by environmental effects, to differentiate and produce cells suitable for various functions. Due to their special characteristics, stem cells have an exciting potential to fulfil an old dream of physicians: to replace and regenerate damaged cells and tissues. Regenerative medicine has undoubtedly opened new vistas in medicine and provides hope for those with yet uncurable diseases. Here, we briefly describe different kinds of stem cells and their sources and discuss some of their experimental or clinical applications. Besides the bone marrow, which is now considered a traditional stem cell source, we present alternative sources. Among these, we pay special attention to the two stemcell sources that are important for obstetricians and gynaecologists: the umbilical cord (Wharton’s jelly) and the characteristics of the umbilical cord blood. We discuss some aspects of the storage of cord blood (”stem cell banking“) its potential use. Obstetricians and gynaecologists have an important role and a great responsibility in promoting the collection and, if necessary, the use of these stem cells. Communicating with patients and informing them about the their possible therapeutic applications stem cells is a part of this process as well as obtaining cord blood and preserving a segment of the cord. Obstetricians and gynaecologists should help to save as much as possible the umbilical cord and cord blood, which become ”redundant“ after birth but are a great source of multipotent mesenchymal and haemopoietic stem cells, which can be used in various fields of 21st-century medicine.]