Lege Artis Medicinae

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

DECEMBER 29, 1993

Lege Artis Medicinae - 1993;3(12)

[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.]

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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

[Coronary Angioplasty Versus Excisional Atherectomy Trial]

MATOS Lajos

[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).]

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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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

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

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Lege Artis Medicinae

[Focus on Lege Artis Medicinae (LAM)]

VASAS Lívia, GEGES József

[Three decades ago, LAM was launched with the goal of providing scientific information about medicine and its frontiers. From the very beginning, LAM has also concerned a special subject area while connecting medicine with the world of art. In the palette of medical articles, it remained a special feature to this day. The analysis of the history of LAM to date was performed using internationally accepted publication guidelines and scientific databases as a pledge of objectivity. We examined the practice of LAM if it meets the main criteria, the professional expectations of our days, when publishing contents of the traditional printed edition and its electronic version. We explored the visibility of articles in the largest bibliographic and scientific metric databases, and reviewed the LAM's place among the Hun­ga­rian professional journals. Our results show that in recent years LAM has gained international reputation des­pite publishing in Hungarian spoken by a few people. This is due to articles with foreign co-authors as well as references to LAM in articles written exclusively by foreign researchers. The journal is of course full readable in the Hungarian bibliographic databases, and its popularity is among the leading ones. The great virtue of the journal is the wide spectrum of the authors' affiliation, with which they cover almost completely the Hungarian health care institutional sys­tem. The special feature of its columns is enhanced by the publication of writings on art, which may increase Hungarian and foreign interest like that of medical articles.]