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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[Biliary tract cancer is relatively rare tumour, but the dismal prognosis renders it frightful. Biliary tract cancers which consist of gall bladder cancers and bile duct cancers can be cured only with surgery thus it is exceedingly important that the surgery should take place in dedicated centres. The multidisciplinary approach may involve drug therapy, too, as an adjunct to surgery or for palliation. This publication summarizes present data about systemic treatment with some chronological point of view. Starting from therapeutic nihilism of the past and projecting anticipatory development of the future it shows the present state of medical treatment in this patient population.]

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[A simple method to demonstrate urate crystals in formalin fixed tissue]

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[In our previous study we refuted the thesis that sodium urate crystals are not, or only rarely detectable in formalin-fixed histological samples because they dissolve in the aqueous formalin solution. Our observations indicate that dissolution of urate crystals is primarily caused by haematoxylineosin staining. Undeniably, however, urate crystals are partially dissolved in the aqueous solution of formaldehyde, and thus a small amount of urate deposits may totally dissolve from tissue samples. The aim of the present study was to identify those steps of the staining procedure that are responsible for the dissolution of urate crystals. We found that the dissolution of urate crystals during the course of staining was caused by the combined effects of haematoxylin staining, treatment with 1% aqueous lithium carbonate solution and dehydration with acetone. As the simplest histological method for the detection of urate crystals, we recommend examining unstained sections (mounted with Canada balsam) of formalin-fixed, paraffin-embedded tissue samples in polarised light. According to our previous study, about two thirds of urate crystals remain detectable on unstaied sections, whereas haematoxylin-eosin stained sections of the same tissue samples (derived from patients with gout) did not contain urate crystals. In the samples where urate crystals could be detected in haematoxylin- eosin stained sections using polarised light, the unstained sections contained much more crystals, which shows that dissolution is greatly decreased on unstained sections.]

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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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[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.]