Lege Artis Medicinae

[End-of-life care]


JUNE 20, 2003

Lege Artis Medicinae - 2003;13(05)

[Recently, physicians and medical literature are more concerned about end-of-life care. A review is given of studies dealing with the rights of the dying patient, with advance directives and with possible treatments in the last days of life. A survey was done in author's department on medical therapy of the terminal period of 103 inpatients, died between 01. 10. 2001. and 31. 03. 2002. Comparing these data with those of American, Finnish etc. authors, the treatments seem to be more generous - probably because in Hungary it is not (yet?) usual to ”declare” endof- life care and to withdraw active therapy. However, indication of antibiotics seems to be more clinical (28.1%, vs. 42%-88% given by similar foreign data). Antibiotics are not palliative means, however, they may be administered in the last days, if the patient is suffering from a terminal infection. Indications and choice of antibiotics are suggested in these cases; medical and ethical problems discussed. Physicians can relieve the physical and mental distressing symptoms of the dying patient and ensure human dignity and peace of the last days.]



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[Indications of palliative radiotherapy]


[Radiotherapy - as a part of complex, multidisciplinary therapy - indicated in 70% of patients with malignant tumors during the natural course of the disease. Unfortunately, around 40-50% of patients can not be cured due to the advanced stage, recurrence or dissemination of the disease. In such cases radiotherapy with palliative intention can be used to resolve symptoms, decrease tumor burden and increase the quality of life for the patient. Urgent radiotherapy can overcome special symptoms causing acute life-threatening conditions. The author reviews the main indications, radiotherapy techniques, dose-fractionation schedules and treatment results of palliative and urgent radiotherapy used in the daily clinical practice.]

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[Easing nausea and vomiting in terminally ill cancer patients]


[Nausea and vomiting are very frequent problems in terminally ill cancer patients, with many causes in the background. Repeated vomiting considerably affects patients' quality of life and may also cause numerous complications requiring hospitalization. In palliative care these symptoms need to be alleviated knowing that triggering causes persist. To provide effective symptom control we need to understand the triggering mechanism of vomiting as well as to have a deep knowledge of most important antiemetics and to give efficient drugs regularly.]

Lege Artis Medicinae

[Therapy of high-intensity cancer pain]


[Although cancer pain is usually a chronic one, in certain cases it needs emergency treatment due to its intensity. By the temporal appearance of pain the author discusses separately the possibilities of treatment of the continuous and the episodic (breakthrough) pain and refers particularly to the neuropathic pain. It is stressed that opiate-responsive continuous severe pain can be diminished most quickly by giving morphine intravenously and a recommendation is drafted how to perform it rapidly but safely. Finally, it is emphasized that the absence of pain analysis and appropriate drug therapy is the most important factor of inadequate pain relief up to now.]

Lege Artis Medicinae

[Palliative chemotherapy of solid tumors]


[Palliative chemotherapy, as defined, a cytotoxic treatment where the expected result is not sufficient enough to cure the patient but it could relieve the cancer related symptoms. In other words, it is such a treatment where the chance of symptomatic improvement means an overall advantage to the patient compared to the possible disadvantages of toxicity. In the 70s and 80s, only the objective response rate, relapse free interval, and overall survival rates were selected as endpoints when the activity of anticancer agents were investigated. In these studies it was observed that a considerable amount of patient showed significant symptomatic improvement even though the treatment was ineffective according to the measured endpoints. Today, the measurement of quality of life is one of the standard endpoint of such studies. Moreover, quality of life is considered as the most important independent factor when palliative chemotherapy is initiated. It should be noted that remission is not the only and final benefit of chemotherapy. The role and options of palliative chemotherapy in certain tumors are discussed.]

Lege Artis Medicinae

[What is personal and what is not]

PÖRCZI Zsuzsanna

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

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

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[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.]

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[A short chronicle of three decades ]


[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]