Lege Artis Medicinae

[Hungarian Rheumatologist Meeting]

GÖMÖR Béla

FEBRUARY 21, 2008

Lege Artis Medicinae - 2008;18(02)

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Lege Artis Medicinae

[Errors from a Practicing Surgeon’s Perspective Errors and Complications in Abdominal Surgery]

DÓSA Ágnes

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[Cardiovascular protection with telmisartan]

NAGY Viktor

Lege Artis Medicinae

[Management of bleeding from oesophageal and gastric varices]

JÓZSA Andrea, SZÉKELY Iván, SIMON János, MÁHR Árpád, HORVÁTH László, HORVÁTH Andrea, FEJES Roland, SZÉKELY András, SZABÓ Tamás, MADÁCSY László

[INTRODUCTION – Variceal haemorrhage from the oesophageal or gastric wall is a major cause of death in patients with chronic liver disease. Over the past two decades many new treatment modalities have been introduced in the management of variceal bleeding, such as emergency endoscopy, band ligation and postintervention observation of the bleeding patients in subintensive care units. This study presents the results of state-of-the-art therapy applied in our department, comparing them to published data. PATIENTS AND METHODS – Clinical records of patients with variceal haemorrhage admitted to our department between January 1st 2001 and December 31st 2004 were reviewed. Six-week mortality, incidence of recurrent bleeding, transfusion requirement and length of hospital stay were the main parameters analysed. RESULTS – A total of 228 admissions (191 patients) due to variceal bleeding were recorded in the study period. Cirrhosis was of alcoholic origin in 92% of patients. Upper endoscopy was performed in 94% of patients within 4 hours and endoscopic therapy was also applied in all but 7 patients. Octreotide was administered in 4 patients, and portosystemic shunt was performed in 1 patient. Primary endoscopic haemostasis was achieved in 85% of cases, while rebleeding rate was 31%. The mean length of total hospital stay was 10.6 days, including an average of 2.6 days in subintensive care units. The mean transfusion requirement was 3.75 units of packed red cells. Six-week mortality rate was 14.9%. CONCLUSION – In comparison to international data, the six-week mortality rate among our patients was substantially lower than that in earlier reports, and nearly equals with recent leading results.]

Lege Artis Medicinae

[The End of the Story]

MAKÓ János

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[Adenoma of the adrenal cortex imitating renal cancer]

SEJBEN István, GÖCZŐ Katalin, SZABÓ Zoltán, CSERNI Gábor

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Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

LAM KID

[„HOPE for people with fracture”: Results of the HOPE (Hungarian Osteoporosis Project for Elderly) study]

SPEER Gábor, NÁDAS Katalin, FERENCZ VIKTÓRIA, MÉSZÁROS SZILVIA, HORVÁTH CSABA, BORS Katalin

[We conducted a multicentre, prospective, single cross-sectional, 12-month, open-label study for the assessment of treatment satisfaction using TSQM (Treatment Satisfaction Questionnaire for Medication) for zoledronic acid therapy used in patients with osteoporosis, who suffered minor traumatic fractures. PATIENTS AND METHODS - In total 1736 patients from 94 centers completed the study and filled in the TSQM questionnaire at both visit 1 and visit 2. TSQM is suitable for measuring the patient’s satisfaction with a treatment, by evaluating side-effects, efficacy and convenience of the treatment and the patient’s overall satisfaction rated on a scale of 0 to 100. RESULTS - Patients included in the study previously received a mean of 1.58 other therapies for osteoporosis and their case history included a mean of 1.24 fractures. This real-life study demonstrated that even one year of zoledronate treatment significantly (p<0.0001) improved the satisfaction of patients regarding efficacy (a mean change from a score of 56.15 to 70.89) as well as the occurrence of side-effects on a TSQM score. Regarding the convenience of treatment, the mean score increased from 62.96 to 79.34 (p<0.0001), whereas the overall treatment satisfaction changed from 59.3 to 75.48 by visit 2 (p<0.0001). CONCLUSIONS - Our study demonstrated beneficial TSQM results associated with zoledronic acid treatment, which is a basic requirement for appropriate adherence as well. ]

Hypertension and nephrology

[Dialysis in Hungary: 2003-2009]

KULCSÁR Imre, SZEGEDI János, LADÁNYI Erzsébet, TÖRÖK Marietta, TÚRI Sándor, KISS István

[The authors show the data of Hungarian dialysis statistics from 2003 to 2009. The questionnaire-based data collection was made by the Dialysis Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 45.2% over six years (an average of 7.5% per year) and the number of new ones increased by 51.2% (8.5% per year). The increase in number of patients treated with haemodialysis was 39% (6.5% per year) in this period. The increase in the number of patients in the peritoneal dialysis program was extremely high: 80.6% (an average of 13.4% per year). The population incidence of new dialysed patients was 332/1 million in 2003 and 483/1 million in 2009. The population point prevalence at the end of the year was 437/1 million in 2003, but 607/1 million in 2009. The penetrance of peritoneal dialysis was 12.8% in 2009. Differences exist among the regions of Hungary in the number of patients, the penetrance of peritoneal dialysis and the prevalence of renal replacement therapies. Among patients suffering in conditions which lead to end stage renal disease the proportion of patients with diabetic or hypertensive nephropathies is increasing and the proprtion of patients with glomerular or tubulointerstitial damage is decreasing. The number (and rate) of the elderly people is growing continuously year by year. The rate of patients on waiting list for renal transplantation is decreasing (the rate was 20% in 2003, but only 10.7% in 2009). There is also a slow decrease in the number of the annual renal transplantations. The mortality rate of chronically dialysed patients shows a little increase. Five dialysis centres for paediatric patients and 58 for adults have been functioning in Hungary by the end of 2009. In average 106 patients have been treated by each Hungarian dialysis centre in contrast to the optimal of 60 persons. The number of nephrologists increased between 2003 and 2007, but slightly decreased since then. The case is similar regarding nephrological nurses.]

Ca&Bone

[Relationship of cardiovascular risk factors and bone status in a large adult population of the Balaton Region]

BUDAY BARBARA, IZSÓNÉ KATZ MELITTA, NAGY ELVIRA, PAPP ZSUZSA, KORÁNYI LÁSZLÓ

[BACKROUND - Numerous international studies have investigated the relationship between bone metabolism and type 2 diabetes mellitus. The results are controversial, there are those proving an increasing effect of diabetes on bone density but we know data that prove the opposite results. Our aim was to investigate the relationship between bone density, obesity and carbohydrate metabolism on a large Hungarian population. PATIENTS AND METHODS - The data from a large population screening (n=6287, mean age 56±13 years, men: n=1561, women: n=4726), carried out in the Balaton Region, Hungary, were analyzed (anthropometry, blood glucose and total cholesterol, blood pressure, calcaneus ultrasound T-score). RESULTS - Analyzing the relationship between type 2 diabetes and osteoporosis/osteopenia, we found, that the prevalence of osteopenia is significantly higher in diabetic women between 50-60 years of age than that of normal glucose tolerance, (50 vs. 36.34%, OR: 1.711, 95% CI: 1.076-2.722, p<0.022), however in different age groups and in males there were no significant differences, similar to the metabolic syndrome which did not influence the prevalence of osteoporosis/osteopenia. In normal weight (male and female) diabetic population over 60 years of age, the frequency of osteoporosis/ ostepenia was much higher, than in the normal weight normal glucose tolerance group, which difference was borderline-significant in the case of osteoporosis (63.63 vs. 26.2%, OR: 2.71, 95% CI: 0.969-7.6, p=0.054), and did not reach it with osteopenia (53.38 vs. 43.31%, p=0.359). In the same age group, within the “all glucose intolerant” and “all normal glucose tolerance” groups the prevalence of osteoporosis/osteopenia did not differ. We found significant correlation between BMI and T score only in women and it was strongest in age group of over 70 years (r=+0.23, p<0.001). CONCLUSION - Our data suggest that the increased bone density often measured in type 2 diabetic patients is actually the consequence of the accompanying obesity, and not of diabetes itself, which is rather a risk factor for bone loss.]