Lege Artis Medicinae

[It is Hard to Scoop out the Sea with a Net]

FERENCZI Andrea

NOVEMBER 20, 2010

Lege Artis Medicinae - 2010;20(11)

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Lege Artis Medicinae

[Robert Schumann, the Romantic Composer ]

KÖVES Péter

Lege Artis Medicinae

[Renal care - possibilities of complex organ protection]

WAGNER Gyula, AMMA Zoltán, JUHÁSZ László, KULCSÁR Katalin

[The authors analyse data of the last ten years of renal care. According to the principles of care they prefer to have contact at least once to all patients with an estimated clearance less than 60 ml/min, and on a regular basis to those with less than 30 ml/min. Their fundamental ambition is to develop the most favourable therapy for the patients together with general practitioners and with representatives of other specialities. The most important aim is to reduce cardio-renal morbidity and mortality. Early detection and effective treatment of target organ damage are the tools for this. It is clear from their previous work that it was not successful in the first period of care (2000-2005) especially in patients with diabetic nephropathy. Before the initiation of renal replacement therapy only half of the patients have been seen by a nephrologist. One-year-mortality after initiating dialysis was significant among patients who did not receive such care. Their medication was also not up-to-date. Through regular continuing medical education for general practitioners and in close collaboration with diabetologist colleagues the number of patients taken care of has doubled. Furthermore, the proportion of patients with hypertension or diabetes as an underlying disease among the patients receiving renal care increased to 68%. These findings may contribute to that their patients receive effective treatment taking the actual therapeutic recommendations into account. Hopefully it will be apparent in the hard end-points at the time of the analysis of the second period.]

Lege Artis Medicinae

[Diabetes mellitus and the liver]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[In the past years, the prevention of micro- and macrovascular complications has been the main target of diabetes treatment. Its unfavourable effects on the liver have been forgotten: the accelerated progression of the liver diseaeses and the increased risk of hepatocellular carcinoma. The multimetabolic syndrome leads to non-alcoholic fatty liver diseases (steatosis, steatohepatitis, cirrhosis). On he other hand some types of liver cirrhosis (for example the common alcoholic form) are worsening the insulin resistance, so they may due to a hepatogenous diabetes mellitus, that’s treatment is different and needs more regard, than type 2 diabetes.]

Lege Artis Medicinae

[Clinical outcome 16 years after the IFN-beta-1b trial]

CSÉPÁNY Tünde

Lege Artis Medicinae

[Treating breast cancer patients with fulvestrant - could it be more efficacious?]

NAGY Zsuzsanna

[Fulvestrant, as an estrogen-receptor antagonist, effectively decreases the estrogen effect, which is a key factor in the development, growth and progression of the breast cancer. Its clinical advantage can appear even after several lines of unsuccessful chemo- or hormonal therapy. In our invasive ductal carcinoma cases, the clinical benefit was obvious over 40%. According to recent data using a higher dose better results can be obtained. The same is expected if the drug would be applied at an earlier stage of the disease.]

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[Faces from the Hungarian Nursing Hall of Fame: the exemplary careers of two Hungarian recipients of the Florence Nightingale Medal Part 2]

SÖVÉNYI Ferencné, PERKÓ Magdolna, FEDINECZNÉ VITTAY Katalin, BOROS Károlyné

[This part of the series of articles on Hungarian recipients of the Florence Nightingale Medal is dedicated to the life and work of Ms Vera Józsefné Marosi. Two of the authors of the article had the privilege and honor not only to know Ms. Vera Marosi personally, but also to have been her students and co-workers at the Vocational Secondary School of Nursing, Postgraduate Medical School, Budapest. The other awardee whose life is presented is Ms. Anci Jánosné Faragó who was the last nurse in the Hungarian nursing community to be awarded the Medal in 2003. What connects the two outstanding nursing personalities is that both of them started out as teachers and educators and turned towards nursing spurred by historical circumstances, the cruelties of World War II and last but not least their humanity and desire to help others. ]

Lege Artis Medicinae

[Hungarian health care professionals’ attitudes and habits regarding blood donation in different professional groups]

RAJKI Veronika, HIRDI Henriett Éva, BALOGH Zoltán, MÉSZÁROS Judit

[INTRODUCTION - We carried out a survey in Hungary among health care workers, we surveyed their habits in blood donation and their knowledge about the blood donation. METHODS - A cross-sectional study happened between 15th July and 15th Sep-tember in 2012 among the Adult nursing care-, Emergency care-, Surgical care-, and Maternity care professional groups, with convenience sampling statistical method (n=312). The data collection happened with a web-based, anonymous, self-administered questionnaire. For the edited electronic questionnaire we used some question from the “Eurobarometer 41.0 (1995): Europeans and the blood” survey. We analyzed the collected data with IBM SPSS Statistics 20 software and Kingsoft Office Spreadsheet (2012) program, using by descriptive statistical methods. RESULTS - The survey has occured with the participation of 312 health care workers. The blood donation activity of the health care workers in every professional groups was higher than the national average in a EU survey stated in 2009. 61.86% of the health care professionals give blood at least twice a year at different locations. The most common causes of the non-appearance from blood donation were the “other reasons”, “earlier forbidden from blood donation” and “lack of time”. We found differences in their view in each groups about refusing/authorizing blood transfusion, but these have no great importance. CONCLUSION - Regarding to our results we recommend to open the eyes to the need for common, aligned collaboration, and to the modifying the current competencies, to the betterment of the opportunities for further trainings in order to further increase of blood donation habits and attitudes. ]

Journal of Nursing Theory and Practice

[Preventive strategies applied in decubitus prevention in Hungary and Slovakia]

DARNAYOVÁ Monika

[The incidence of decubitus ulcers affects nurses working not only in Slovakian hospitals, but those in Hungary too. The proportion of patients with bedsores in a given institution partly depends on the nurses, since improper nursing has a major role in the development of this syndrome. By the same token, a low incidence of pressure ulcers is the best proof of high-quality nursing. The main motivation for the research was to gain an insight into the methods of decubitus prevention applied in the two countries. The purpose of the study was to show the current state of the prevention carried out in the two institutions, how a preventive attitude is instilled, what kind of assessment scale is used, what the protocols contain, what kind of aids are available for us, and how documentation is maintained.]

Clinical Neuroscience

Unilateral thalamic infarction causing downward gaze palsy in a patient with uncorrected tetralogy of fallot: a case report

ANNUS Ádám, BENCSIK Krisztina, JÁRDÁNHÁZY Tamás, VÉCSEI László, KLIVÉNYI Péter

Introduction - Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Adults with surgically uncorrected forms of this condition are extremely rare, since operation is recommended in childhood to prevent cyanosis. Cyanotic CHD increases the risk of thromboembolic events. An endothelial dysfunction caused by chronic hypoxia and shear stress due to rheological alterations with a platelet dysfunction appear to be the explanation behind this finding. Paramedian thalamic infarction causing vertical gaze palsy without midbrain involvement is an infrequent finding. We report here a rare case of a patient with untreated TOF, who suffered a left-sided unilateral thalamic infarction presenting as downward gaze palsy and diplopia. Case presentation - A 44-year-old women complained of sudden onset diplopia and vertigo. Neurological examination revealed a downward gaze palsy with other symptoms related to a vertebrobasilar territory circulatory disturbance. The MRI scan revealed an acute infarction, 8 mm in diameter in the left medial thalamic region without midbrain involvement. Discussion - Adults with uncorrected forms of TOF are extremely uncommon, and descriptions of stroke in these patients are therefore rarities. We set out to give a concise survey of the literature regarding TOF patients with stroke. Conclusion - We present a rare case of unilateral thalamic infarction causing downward gaze palsy in an adult patient with uncorrected TOF. Cyanotic CHD is regarded as one of the risk factors of stroke. Besides other pathologic conditions, ischaemic stroke at an early age should raise the suspicion of a cardioembolic origin and, in rare cases, might result from cyanotic CHD.

Clinical Neuroscience

[Extension of polynomial analysis of interstitial I-125 brachytherapy for 48 months]

KOLUMBÁN Zsuzsa, MAJOR Tibor, JULOW Jenő

[Objective - Previously we described from 20 patients’ data with our new “polynomial prediction approach” the volumetrical changes following gliomas I-125 brachytherapy. The aim of this study is to extend the polynomials for 48 months, and to carry out multivarial analysis of several different aspects. Methods - 20 inoperable low-grade gliomas were followed for a 48-month period after I-125 interstitial irradiation. The delivered dose on the tumor surface was 50-60 Gy. Dose planning and image fusion were done with the BrainLab Target 1.19 software, mathematical and statistical computations were carried out with the Matlab numeric computation and visualization software. Volumes of tumor necrosis, reactive zone and edema referred to as “triple ring” were measured on image fused control MRI and planning CT images. The measured volumes were normalized with respect to the reference volumes. Mean values of volumes were determined, then polynomials were fitted to the mean using the polynomial curve fitting method. The accuracy of our results was verified by correlating the predicted data with the measured ones. Results - We have found that the edema reaches its maximum two times after irradiation during the 48 months follow up period. We have shown that small tumors react more rapidly and creating greater volumes of the “triple ring” than bigger ones. Conclusions - The polynomial prediction approach proposed here reveals the dynamics of triple ring for 48 months. The derived polynomials and the multivarial analysis carried out afterwords help to (i) design the best treatment, (ii) follow up the patient's condition and (iii) plan reirradiation if necessary.]