Lege Artis Medicinae

[Dániel Fischer on Madness (1716) ]

MAGYAR László András1

JUNE 20, 2013

Lege Artis Medicinae - 2013;23(05-06)

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  1. Semmelweis Orvostörténeti Múzeum, Könyvtár és Levéltár

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[Aims of the study: The local community nurses can use their present abilities between given conditions and how these abilities could be extended. Sample and methods: 137 evaluable questionnaires were returned from 14 family doctors’ patients and 12 questionnaires were from community nurses. The questionnaires consisted of open and closed questions. The data was processed by SPSS and Excel software. Statistics were made by descriptive statistic means and Fischer exact tests. Results: During my survey it turned out that patients don’t utilize basic adult health care means such as measuring blood pressure and blood-sugar and lab examinations. Conclusions: Most of the community nurses can’t utilize most of their abilities and knowledge. They don’t have the opportunity to perform health education or just to talk to the patients face-to-face. My thesis surfaces the fact that community workers and doctors should work coordinate. It’s not true in relation of all the general practitioners and nurses.]

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[INTRODUCTION - Present work aimed to identify some predictors of success or failure (gender, age, number and size of stones, presence of periampullary diverticula and jaundice) in mechanical lithotripsy. PATIENTS AND METHODS - 7998 endoscopic retrograde cholangio-pancreatographies, 2430 endoscopic sphincterotomies and 1205 bile duct stone extractions were performed between 1981 and 2000 years. In 159 patients - because of failure of standard techniques - mechanical lithotripsy was attempted for crushing of large bile duct stones. There were 39 men (mean age 70.5 years) and 120 women (mean age 67.7 years). 65 patients had single stone, 31 had 2 stones and 63 had multiple stones. 80 patients had larger stones than 20 mm in diameter. 23 patients had periampullary diverticula and 98 were jaundiced. Mechanical lithotripsy was accomplished with Olympus BML 2Q and BML 4Q intraendoscopic systems. When the first attempt failed, repeated treatment was performed or a Wilson-Cook extraendoscopic system was used. Data of predictors were processed using univariate analysis, Chi-square test and Fischer’s exact test. P<0.05 was regarded as statistically significant. RESULTS - Clearance of common bile duct was obtained in 130 patients (81.8%). Procedure related cholangitis occured in 16 patients. 8 pancreatitis developed, 7 of them subsided with conservative therapy, 1 of them required surgical treatment. On univariate analysis, the stone size was the only variable to differentiate the success from failure of procedure (p<0.05). Other variables had not any role in determining the outcome. CONCLUSION - Mechanical lithotripsy is a useful method with a high success rate and with an acceptable complication rate for treatment of ”difficult” bile duct stones. Stone size is the single outcome predictor.]

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[INTRODUCTION -The pathomechanism of hepatic osteopathy is not fully understood.We investigated how bone parameters change in growing rats with experimentally induced fatty liver, liver cirrhosis and hepatocellular carcinoma. METHODS - Liver disease was induced by administration of CCl4 and phenobarbital (PB) following a single injection of diethylnitrosamine (DEN) in 55 Fischer 344 rats.Animals were sacrificed and their femur removed at week 8 or 16. Bone mineral content (BMC), femoral length, cortical index (ratio of cortical thickness and total diameter at the diaphysis) and ultimate bending load (Fmax) of femora were determined. Results of animals treated with DEN+PB+CCl4 (group DPC, n=21) were compared to untreated animals (n=14) and to a second control group treated only with DEN+PB (group DP, n=20). RESULTS - Fatty liver and cirrhosis developed in each animal in the DPC group (n=21) at week 8 and in a subgroup of these animals (n=11) hepatocellular carcinoma also appeared by week 16. No changes in bone parameters were observed in this group at week 8, but lower BMD, femoral length, cortical index and Fmax values were found at week 16 compared to the untreated controls or to the DP group (p<0.05 for both). In the DP group no fatty liver or cirrhosis was observed at any time. Femoral length and Fmax values were higher in the DP group at week 8 compared to the untreated controls (p<0.05 for both).At week 16, however, no difference could be detected. CONCLUSION - Experimentally induced liver cirrhosis and hepatocellular carcinoma are associated with growth inhibition and reduced bone mineral content, cortical index and mechanical resistance in growing rats.]

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