Lege Artis Medicinae

[Current issues in oral anticoagulation treatment]

SAS Géza1

JANUARY 12, 1991

Lege Artis Medicinae - 1991;1(01)

[Cardiovascular disease is the leading cause of death in civilised countries everywhere. The situation is particularly serious in our country: it is well known that we are one of the countries with the shortest life expectancy in Europe, precisely because of the devastating impact of circulatory diseases. While in the USA, thanks to improvements in living conditions and effective preventive measures, mortality from cardiovascular disease is falling dramatically and is being postponed to later and later years, here at home we can unfortunately expect the situation to deteriorate further in the years ahead.]

AFFILIATIONS

  1. Egyetemi Tanár Orvostovábbképző Egyetem I. sz. Belgyógyászati Klinika

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Lege Artis Medicinae

[The importance of oral symptoms in the early diagnosis of HIV infection (AIDS)]

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[Oral lesions of AIDS might occur in every phase of H/V-infection, their importance in the early diagnosis and treatment is significant. The most frequent oral symptoms are: oral Candidiasis, acute necrotizing ulcerative gingivitis (ANUG) and periodontitis, herpetic infections, resistent to the usual therapy. ,,Hairy leukoplakia " of the tongue is characteristic hyperpigmentation of the oral mucosa, Kaposi's sarcoma are frequent symptoms, latter especially in more developed phases (ARC or AIDS) of the disease. Saliva-containing a factor inhibiting HIV-1 infection of human lymphocytes - has minimal importance in the transmission of the disease. Therefore, professional transmission of HIV-infection -, e. g. dental treatment of infected patients keeping the necessary cautions , - present minimal risk. The appropriate treatment of arai lesions of HIV-infected patients may help in maintaining their general health. ]

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[The molecular genetics of Duchenne and Becker muscular dystrophy]

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[Duchenne muscular dystrophy, an X-linked inherited disease, is the most common among the severe muscular dystrophies, yet untreatable. lts secondary prevention, however, has become possible by the rapidly developing techniques of molecular biology. The authors describe the latest methods of DNA-diagnosis used, as well as the principles of setting up a diagnostic protocol.]

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[The concept of the pathomechanism of ischaemic heart disease]

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Lege Artis Medicinae

[Family medicine, home care, family care]

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[General Practice as an independent speciality of medicine has a very special territory, the family care. The family care is a general wish of the society. This special care is continuously made in every fifth-sixth family. ln the author's practice in the autumn of 1989 113families and 16 lonely persons, in 1990 120 families and 18 lonely persons were controlled regularly at home. The family care, the family medicine needs special knowledge and skill. Minimal addicional technical, personal and financial support is requested, burt due to the special care activity the level of medical work increases and it becomes more humanistic, needs of hospitalization decreases and the plus expenditure refunds. Far the better evaluation of family care a more systematic undergraduate and postgraduate teaching and a special research work would be needed.]

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[The Hungarian ILCO Association]

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

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NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

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Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

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[About the care of patients with hyperuricaemia and gout]

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