Lege Artis Medicinae

[Chased health]

BÁNFALVI Attila

MARCH 21, 2008

Lege Artis Medicinae - 2008;18(03)

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[Successful treatment of acne]

KÖRMENDY Miklós

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[Cure Without Borders]

FÖLDES Mária Éva

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[Jikei Heart Study]

MATOS Lajos

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[Modern surgical treatment of lung cancer]

AGÓCS László

[Lung cancer is one of the most malignant human cancers because of its high incidence and high mortality rate. The 5-year relative survival rate for lung cancer at the initial diagnosis is 5-15%. Stage I or stage II non-small cell lung cancer (NSCLC) are considered early stage disease. Unfortunately, these two stages combined account for only 25 to 30% of tumours at the initial detection. At present, surgical resection remains the recommended treatment for patients with stage I and II NSCLC. Despite negative preoperative staging studies including mediastinoscopy, as many as one fourth of the patients will be found at surgery to have an occult N2 or one nodal station positive metastatic – stage IIIA – disease. Multimodality therapy is preferred for all subsets of stage IIIA patients. In stage IIIB and IV, surgical resection is possible and indicated only in selected cases, including Pancoast tumours, T4N0,1M0 tumours, the presence of satellite nodules in the same lobe, and certain solitary metastases. Patients with clinical stage T1-2 N0 small cell lung cancer (SCLC) may benefit from surgery for confirmation of diagnosis and improved local control when combined with chemotherapy. The mortality and morbidity rates of surgery in the treatment of lung cancer are reasonably low.]

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[“A Suggestive Force is Needed to Cure” A Discussion with Internist Professor András Leövey]

dr. SZEKANECZ Zoltán

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[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Clinical Neuroscience

Investigation of risk factors, topographic location and stroke mechanisms of unilateral isolated and posterior cerebral ARTERY thalamic infarcts

GÖKCAL Elif, SENGUL Yildizhan, USLU Ilgen Ferda

Aim - In this study, we aimed to examine the risk factors, topographic features and stroke mechanisms of acute ischemic unilateral infarcts of thalamus. Methods - Patient with isolated thalamic infarct and those with posterior cerebral artery (PCA) infarction who were admitted to our hospital between January 2014 and January 2017 with acute unilateral thalamic infarction (TI) were included in this study (isolated thalamic infarction/ isolated TI; thalamic and posterior cerebral artery infarction/PCA+TI). Demographic characteristics and vascular risk factors of the patients were determined. Thalamic infarct areas were recorded topographically as anterior, posteromedial, ventrolateral, posterolateral, more than one area, and variant areas. Stroke mechanism was determined according to the criteria of „Trial of Org 10172 in Acute Stroke Treatment” (TOAST). Patients with isolated TI and PCA TI were compared according to risk factors, stroke mechanism and infarct topography. Results - Forty-three patients with a mean age of 63.3 ± 14.5 years were included in the study. Twenty-eight patients (60.1%) were found to have isolated TI and the remaining 15 patients (34.9%) had PCA+TI. 32.1% of patients with isolated TI had sensory symptoms on presentation, and 60% of patients with PCA-TI had sensorimotor symptoms. The mean age, the mean score on National Institutes of Health Stroke Scale (NIHSS) and the mean frequency of atrial fibrillation were higher in PCA+TI patients than in isolated-TI patients (p: 0.04, p: 0.004, p: 0.02 respectively). 32.6% of the patients had ventrolateral, 30.2% had posteromedial involvement. Ventrolateral topography was seen in 46.7% of the PCA+TI patients, while posteromedial topography was seen in 39.3% of the isolated-TI patients. 53.6% of the isolated-TI had small vessel disease etiology, while 40% of the PCA+TI had cardioembolic etiology, and the other 40% had large artery atherosclerosis. Conclusion - Our study showed that the most ommon stroke mechanism in patients with thalamic infarction is the small vessel disease. Isolated TI and PCA+TI patients differ in terms of etiologic mechanism and infarct topography. Variant territorial involvement and multiple area involvements can be quite common in thalamic infarcts.

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Journal of Nursing Theory and Practice

[The psychological Well-being and Burnout among Ambulance Personnel]

IVÁNKOVITS László

[The aim of the study: The aim of the presented study was to investigate the psychological well-being and burnout among ambulance personnel of the Hungarian National Ambulance Service. Our goal was to identify the ambulance specific stressors that negatively affect the psychological health of personnel and lead to burnout. Material and method: The quantitative, cross-sectional study included 1979 ambulance personnel. Level of burnout was measured by Pines-Aronson Burnout Inventory. SPSS version 17.0 was used for statistical analyses. Types of analyses included Khi square test, ANOVA and correlation analysis. Level of significance was defined at p<0.05. Results: The 40% of ambulance personnel are affected by job-related stressors. The heightened and constant state of readiness does not let time for discussing work-related experiences. There was significant correlation between burnout level, years worked at NAS, and the evaluation of workplace circumstances and climate. Conclusion: Due to the results of the present study we created different possibilities of prevention and intervention that can help handle the symptoms of burnout among ambulance personnel.]

Lege Artis Medicinae

[What worries Hungarian men? - Characteristics of masculine gender role stress]

SUSÁNSZKY Anna, SUSÁNSZKY Éva, KOPP Mária

[INTRODUCTION - The aim of this study was to establish the characteristics of stress associated with male gender role and its relationship to health and to risk behaviours among Hungarian men. SUBJECTS AND METHODS - The present analysis is based on data of the Hungarostudy 2006 survey. Forty-one percent of the participants were men. Eighty nine percent of the male respondents completed the Eisler-Skidmore Masculine Gender Role Stress Scale; data of 1764 persons were analyzed. RESULTS - Anxiety about sexual performance, breadwinner role, and appearance (i.e. tradition factor) causes a much greater burden of stress than anxiety about changing gender relationships (i.e. modernization factor). With the increase of age, stress caused by traditional role expectations significantly decreases; tensions caused by women’s dominance and by situations which demand emotional response and empathy are the highest among middle aged men. Traditional gender role stress is more prevalent among pensioners than among economically active men; stress caused by the modernization of masculine gender role particularly afflicts unemployed men. Married men are to the least extent troubled by female dominance and difficulties in expressing emotions. Of the two dimensions analyzed here (tradition and modernization) only the values on the tradition factor were related to health status, psychological well-being, and frequency of smoking. CONCLUSIONS - Modernization of gender roles represents only a small - if any - stressor in the life of Hungarian men; on the other hand, unsuccessful adaptation to traditional role expectations highly increases the burden of stress and is closely related to smoking.]