Lege Artis Medicinae

[From Medical Anthropology to Cultural Medicine ]

PIKÓ Bettina

FEBRUARY 22, 2013

Lege Artis Medicinae - 2013;23(02)

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[Informal Payment for Physicians: What Lies Beneath our Opportunism? ]

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[Operated patient with benign retroperitoneal tumour Case report in pictures]

MASSZI István, TOPERCZER Zsolt, MÉSZÁROS Péter, SZELI Dóra, BÉLY Miklós, FARBAKY Zsófia, KIS János Tibor

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[LETTER OF THE EDITORS IN CHIEF]

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[Economic relations of laparoscopic colorectal surgery in hopitals]

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[In this review, we compared economic and physiological observations reported in the literature that are related to laparoscopic versus conventional colorectal surgery. Our study group has modeled the patient journey of those with colorectal disease, and analysed the accounting and controlling data of an impatient institution in Budapest for various types of colorectal interventions. We compared the costs determined for laparoscopic and conventional colorectal surgery and the actual costs spent by the inpatient care institution with financing data of the National Health Insurance Fund. On the basis of our study, we conclude that in Hungary colorectal surgery performed by laparoscopy is much more expensive that conventional surgery as the cost of the operating room - in particular, the disposable tools - is high and currently it is not financed as a separate intervention type. In case of colorectal diseases, laparoscopic and traditional interventions have not been differentiated, observed and compared yet.]

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[Infectious diseases associated with biological therapy]

KÁDÁR János

[The use of biological therapeutic agents increases the risk of certain infectious diseases. The greatest hazards are the reactivation of tuberculosis or hepatitis B infection and the development of sepsis. The degree of risk is comparable to that experienced with the use of routine DMARD therapy: in case of an adequate choice of treatment the risk is equal to or slightly higher than that of conventional treatment. However, this hazard is definitely smaller than that associated with the use of corticosteroids at doses necessary to reach the required immunosuppressive effect. This article provides a brief summary of potential infectious illnesses on the basis of the literature.]

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Simultaneous subdural, subarachnoideal and intracerebral hAemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

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[This summarizing paper demonstrates the main elements and tasks of severe dementia care of patients. Dementia care is provided on three levels of competence: level of specialist’s, that of physician’s and of caregiver’s/supporter’s. Because of increasing gravity of tasks during the progression of dementia the caregivers become(s) risk-persons from psychopathological points of views. The most important tasks of the everyday care are summarized in tables and the main factors of predominantly emotional character, which can limit the results are also demonstrated. Application of some up-to-date institutional solutions, which can optimize the patients’ care is also listed. Supposing an ever increasing burden of dementia care, author delivers an important message also for members of the younger generations. ]

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[We have read several publications of great authority on the neurological profession in the last two years in which were expressed assessments of the current situation combined with opinions about neurology and the necessity to reorganize neurological patient care. These articles took up the question of neurorehabilitation too. The authors, who on a daily basis, deal with the rehabilitation of people with disabilities as a consequence of neurological conditions, summarize some important definitions of rehabilitation medicine and the present system of neurological rehabilitation, as it is defined by the rehabilitation profession.]

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[Ferenc Keresztúri, Professor of Medicine at the Moscow University ]

V. MOLNÁR László