Lege Artis Medicinae

[Five years of graduate nursing education at the Imre Haynal University of Health Sciences, Faculty of Health Sciences]

HOLLÓS Sándor, MÉSZÁROS Judit

AUGUST 31, 1994

Lege Artis Medicinae - 1994;4(08)

[The authors review the history of the then Postgraduate Medical School, now Imre Haynal University of Health Sciences, the first in Hungary to establish a Diploma in Nursing at the Faculty of Health Sciences. The social conditions, the framework and methods of training are described. They evaluate their activities and outline their ideas for educational development in the light of the changes in the health care system.]

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Lege Artis Medicinae

[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]

MORVAY Zita, MAROFKA Ferenc, CSAJBÓK Ernő, SZENOHRADSZKY Pál

[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]

Lege Artis Medicinae

[Catheter ablation of supraventricular tachycardias]

KEMPLER Pál, LITTMANN László, TÓTH K. Zoltán

[Medical therapy for supraventricular arrhythmias is often ineffective. Arrhythmia surgery is limited by its considerable morbidity and cost. A better understanding of the exact anatomic-electrophysiologic correlations that govern supraventricular arrhythmogenesis and the advances in catheter ablative techniques have led to a new, effectual and costeffective therapy. Catheter ablation techniques result in a high rate of success rates and a low rate of complications. Radiofrequency ablation has become an accepted form of treatment for a variety of supraventricular arrhythmias. This review summarizes current data on catheter ablation of supraventricular arrhythmias.]

Lege Artis Medicinae

[The role of langerhans' cells in the development of cervical cancer]

PETE Imre, SÁPI Sándor, GONDA Gábor

[While the number of deaths from cervical cancer of women over the age of 45, has fallen in the recent years the mortality in women under the age of 35 has increased. The reason for this change is not clear. A large number of analytical studies tried to identify the risk factors for cervical cancer (age, marital status, time of first intercourse, number of sexual partners, coital frequencies, circumcision of partners, menstrual patterns, gravidity, type of contraception, smoking, viral infection, socioeconomic circumstances) but the real con nection between the disease and the varions risk factors remained unclear. The results of these studies suggest that, the 'one hit one tumor' hypothesis can't be proven, and it seems more appropriate to cousider a complex effect of these etiologic factors acting on the altered immunologic status of the cervix uteri. We tried to concentrate on one out of these factors from the literature which may play a cardinal role in the development of CIN or invasive cervix cancer. It is evident from the literature that the macrophages present in the cervix tissue in CIN, or infiltrating the tumor tissue in invasive cancer, could influence either the development of cervical cancer or the prognosis of the disease. It has long been known that in the cervical tissue there are a specific type of dentric cells taking part in the antigen presentation process. The examination of behavior, distribution and activity of these so – called Langerhans cells due to the exogen effect in the cervical tissue may be a which contributes to the understanding of the process leading to the development of CIN. ]

Lege Artis Medicinae

[Morbidity of ischemic heart disease in early breast cancer patients 15-20 years after adjuvant radiotherapy]

GYENES Gábor

[Our aim was to assess the frequency of cardiac side effects, primarily ischemic heart disease, in symptom-free patients with early breast cancer previously treated with radio therapy. Thirty-seven survivors of a previous randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left-sided disease (study group patients) were compared with 17 controls who were either treated for right-sided disease, or were non-irradiated patients. Radiotherapy was randomized in the original study; either tangential field Co-, or electron-therapy was delivered. A bicycle ergometry stress test with 99m Tc Sesta MIBI myocardial perfusion scintigraphy was carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), and none of the 17 controls exhibited some kind of significant defect on scintigraphy, indicating ischemic heart disease (p <0,05). Radiotherapy for left-sided breast cancer with the above-mentioned treatment technique may be an independent risk factor in the long-term development of ischemic heart disease. The need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer, is emphasized. ]

Lege Artis Medicinae

[Recovery from persistent vegetative state of four months or more]

KEITH Andrews

[A retrospective study was carried out on 43 patients admitted to a ward specifically designed for the rehabilitation of patients with persistent vegetative states after another. Of these, 11 regained consciousness four months or more after brain injury. It was reported that the patients' first reaction to being able to follow with their eyes was between the 4th month and the 3rd year of the condition, while the first reaction to being instructed was between the 4th and the 12th month. Only one patient was unable to communicate, six used non-verbal means to express at least yes and no, four could speak. Six patients required full care, while two became independent in their daily activities. Four patients were able to eat independently, three needed assistance, and four patients required maintenance of gastric tube feeding.]

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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.

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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.