Lege Artis Medicinae

[Coronary Angioplasty Versus Excisional Atherectomy Trial]

MATOS Lajos1

DECEMBER 29, 1993

Lege Artis Medicinae - 1993;3(12)

[Atherectomy reduced coronary stenosis 50% or more often (89%) than angioplasty (80%, p<0.001), and the acute increase in vessel diameter was more pronounced (p<0.001). Atherectomy was associated with more early complications (11%) than angioplasty (5%, p<0.001) and hospital costs were also higher ($11 904 vs $10 637, p<0.006). After six months, the restenosis rate was 50% for atherectomy and 57% for angioplasty (p<0.06). However, the probability of infarction or death at six months was higher in the group treated with atherectomy (86%) than after angioplasty (4,6%, p<0,007).]

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Further articles in this publication

Lege Artis Medicinae

[The significance of vasodilator drugs and angiotensin converting enzyme inhibitors in the treatment of congestive heart failure]

JÁNOSI András

[The significance of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure is outlined. The results of multicenter, randomized trials are summarized confirming the beneficial effect on survival of vasodilator therapy and/or angiotensin converting enzyme inhibitors in the treatment of patients with congestive heart failure.]

Lege Artis Medicinae

[Medical management of inland catastrophes]

FARKAS József

[The author details the medical consequences of disasters and mass casualty situations. The concept of disaster is definied and compared with that of mass accident. It is pointed out that in principle there are no essential differences between them since both disasters and mass accidents require the application of compromise medicine princliples at the site of the catastrophe and during the course of the hospital treatment. The main point of medical support at the site is the triage based on a numeric system of classification. In hospital treatment it is of great importance to adopt uniform (doctrinarian) principles and practice in order to prevent or decrease complications occurring in almost every extreme situation. Further co-operation of our medical organizations and development of common disaster plans may improve the effectiveness of coping with a possible emergency in our country.]

Lege Artis Medicinae

[The value of colposcopical and cytological examination in the screening of cervical intraepithelial neoplasia]

PETE Imre, BŐSZE Péter, TÓTH Vera, LEHOCZKY Győző

[ From 1980 to 1991, 1379 women with abnormal colposcopic and/or cytologic findings were examined at the Department of Gynecological Oncology at the National Institute of Oncology, Budapest. The sensitivity and specificity of these screening tests were studied retrospectively. All women underwent either cervical excision or conisation. Cytological and colposcopical findings were compared with the histological findings. Sensitivity and specificity of cytology were 49% and 77%, retrospectively. The corresponding figures for colposcopy were 88% and 12%, and for cytology and colposcopy together, 96% and 14%. 1. The low sensitivity of cytology suggests that as many as 50% of CIN lesions will be missed if cytology alone is used for screening. This finding probably justifies our screening policy (i. e., colposcopy should be used as a primary tool). 2. We found 194 asymptomatic patients with carcinoma in situ, 40 with microinvasive and 8 with frank invasive carcinoma. This finding emphasizes the importance of cervical cancer screening. 3. To decrease the false positive and negative rates, the introduction of new scientific results into the every day screening practice is urgently needed. 4. Our data suggest the superiority of a colposcopical screening method to a cytological one; however histological examination must be done independently of a screening method if the suspicion of cervical dysplasia arises. ]

Lege Artis Medicinae

[Digoxin 2 days a week; Can what is wrong be safe?]

[The last 20-25 years have seen significant advances in the use of medication. Blood levels of drugs can now be measured using available laboratory methods, and many effects can now be accurately measured in addition to general clinical monitoring. This has created the basis for the everyday use of pharmacokinetics and pharmacodynamics and a separate discipline, clinical pharmacology.]

Lege Artis Medicinae

[Correspondence]

CSISZÁR Péter, FEKETE János

[Hospitals and clinics that perform operative laparoscopy do not have a consensus after surgery on whether and which drain should be inserted to drain the pelvis and abdominal cavity. A review of the literature shows that the use of a drain is almost mandatory after surgery for inflammatory diseases (1, 2). The insertion of a drain is also recommended for laparoscopies for ectopic pregnancies, one of the highest risk groups (3, 4, 5).]

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[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]

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[Risk of nonsteroidal antiinflammatory drugs. Focus on aceclofenac]

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[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deterio­rate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]

Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

[Is the implementation of Vojta therapy associated with faster gross motor development in children with cerebral palsy? ]

SANZ-MENGIBAR Jose Manuel , MENENDEZ-PARDIÑAS Monica , SANTONJA-MEDINA Fernando

[Vojta therapy has been reported as clinically beneficial for strength, movement and gross motor activities in individual cases and is being included within the second of three levels of evidence in interventions for cerebral palsy. The goal of this study is to understand the effect of Vojta therapy on the gross motor function. Our clinical trial followed a one group, pre-post design to quantify rates of changes in GMFM-88 after a two-months period undergoing Vojta therapy. A total of 16 patients were recruited. Post-intervention acceleration rates of GMFM-88-items acquisition (0.005; p<0.001) and Locomotor Stages (1.063; p<0.0001) increased significatively following Vojta the­rapy intervention. In this study, Vojta therapy has shown to accelerate the acquisition of GMFM-88-items and Loco­motor Stages in children with cerebral palsy younger than 18 months. Because functional training was not utilised, and other non-Vojta therapy intervention did not influence the outcome, Vojta therapy seems to activate the postural control required to achieve uncompleted GMFM-88-items. ]

Clinical Neuroscience

A variant of Guillain-Barre syndrome after SARS-CoV-2 vaccination: AMSAN

TUTAR Kaya Nurhan, EYIGÜRBÜZ Tuğba, YILDIRIM Zerrin, KALE Nilufer

Introduction - Coronavirus disease 2019 (COVID-19) is a respiratory infection that has rapidly become a global pandemic and vaccines against SARS-CoV-2 have been developed with great success. In this article, we would like to present a patient who developed Guillain-Barré syndrome (GBS), which is a serious complication after receiving the inactive SARS-CoV-2 vaccine (CoronaVac). Case report – A 76-year-old male patient presented to the emergency department with nine days of progressive limb weakness. Two weeks prior to admission, he received the second dose of CoronaVac vaccine. Motor examination revealed decreased extremity strength with 3/5 in the lower extremities versus 4/5 in the upper extremities. Deep tendon reflexes were absent in all four extremities. Nerve conduction studies showed predominantly reduced amplitude in both motor and sensory nerves, consistent with AMSAN (acute motor and sensory axonal neuropathy). Conclusion - Clinicians should be aware of the neuro­logical complications or other side effects associated with COVID-19 vaccination so that early treatment can be an option.