Lege Artis Medicinae

[Longissima via]

NAGY Zsuzsa

SEPTEMBER 20, 2002

Lege Artis Medicinae - 2002;12(09)

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Lege Artis Medicinae

[The effect of angiotensin receptor antagonists in diabetic nephropathy]

BÍBOK György

[Influencing the renin-angiotensin system through receptor blockade has become a new therapeutic approach toward the treatment of several morbidities, i.e. hypertension, cardiac failure and diabetic nephropathy. The current paper reviews the importance of diabetic nephropathy, the physiology of the renin-angiotensin system and specific effects of receptor blockade on different organs based on 3 new studies (published last year) using angiotensin-II receptor blockers. The paper gives a summary of the IRMA, IDNT and RENAAL studies, including their clinical and therapeutic significance in general practice as well as in specialized diabetes care. The new therapeutic approach (with an excellent safety profile, and infrequent side effects) could delay the progression or might even prevent the manifestation of diabetic nephropathy not only with lowering blood pressure but with its direct effects on target tissues as well. The angiotensin-II receptor blocking agents might be useful for the treatment of cardiac failure in hypertensive patients.]

Lege Artis Medicinae

[How Drug Advertisements Perceive the World]

NÉMETH Éva

Lege Artis Medicinae

[Reference price system as a potential method for pharmaceutical cost containment]

KALÓ Zoltán, VINCZE Zoltán, LOVAS Kornélia, BODROGI József

[Reference pricing is one of the potential cost containment methods for pharmaceuticals. Authors describe its main types and the international examples of reference pricing together with technical details of its introduction. Consequences of the system are grouped into 5 categories: pharmaceutical expenditure, other health care expenditure, medical implications, consequences on patients and their health status, and political effects. They propose that reference pricing should be introduced only gradually based upon recommendations by multiprofessional teams. The system should be evidence based which includes clinical effectiveness, safety, compliance and cost-effectiveness. ”Real” active substance based reference pricing is justifiable for broad ranges of pharmaceuticals. General introduction of therapeutic reference pricing in Hungary, however, may result in serious negative consequences.]

Lege Artis Medicinae

[Cytological and genetic background of senescence]

LÁSZLÓ Valéria, FALUS ANDRÁS

Lege Artis Medicinae

[”I am responsible for my health but irresponsible for my illness”]

SZÁNTÓ Zsuzsa, SUSÁNSZKY Éva, RÓZSA Sándor

[INTRODUCTION - The aim of our study was to examine lay beliefs about illness causation of age groups with similar health status. METHODS - In 1997, research was conducted among the adult population of Budapest (N=720), in order to examine their health status and illness explanations. Based on self-rated health, ages of the 40s and the 60s were considered as the age-thresholds of significant decline in health status. Thus, the study concentrated on the three age groups of people: under 40, between 40 and 60, over 60 years of age. The Health and Illness Scale of Stainton Rogers and Furnham was employed. For identifying the patterns of illness explanations, factor analysis (varimax method) was used. RESULTS AND CONCLUSION - 5 factors were found as the basic types of illness explanations: psychical condition, external environmental determinants, work and life style, health care, internal predetermination. Parallel to deterioration of health, dominant illness explanations are also changing: emphasis moves from work and life style to biological predetermination.]

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Clinical Neuroscience

Mid-term oral isotretinoin therapy causes a predominantly sensory demyelinating neuropathy

ALTUN Yasar, INAN Esra

Aim - The purpose of this prospective study was to investigate whether mid-term treatment with oral isotretinoin may impact peripheral nerve function. Methods - In this study, we included 28 patients with no apparent neurological or neurophysiological findings. The patients received treatment with oral isotretinoin for papulopustular or nodulocystic acne. The patients with normal findings in the first examination were given 1 mg/kg/day oral isotretinoin. Neurological examinations and electroneurographic studies were performed before and 6 months after the onset of isotretinoin treatment. Results - Clinical examinations and electroneurographic evaluations prior to treatment revealed no abnormalities in any of the patients. However, 20 patients (72%) displayed one or more abnormal values in the tested parameters after treatment. Although the mean amplitudes of compound muscle action potential of the ulnar and median nerves did not vary, significant decreases were observed in the mean sensory conduction velocities of median, ulnar, sural, medial plantar, medial dorsal cutaneous, and dorsal sural nerves 6 months after the onset of treatment. Conclusion - Systemic use of isotretinoin may cause electroneurographic changes. Probable electroneurographic alterations may be detected at a much earlier period via dorsal sural nerve tracing when electrophysiological methods used in routine clinical practice cannot detect these changes.

Hypertension and nephrology

[Experience with mycophenolate mofetil containing immunosuppressive regimen in de novo kidney transplant recipients (ORANGE study).]

WAGNER László, KALMÁR-NAGY Károly, TORONYI Éva, TÖRÖK Szilárd, PATONAI Attila, SZAKÁLY Péter

[Mycophenolate mofetil (MMF) has been used as an immunosuppressive agent in renal transplant recipients for more than two decades. The aim of the ORANGE study was to collect data with respect to the efficacy and safety of MMF containing immunosuppressive regimens during standard nephrology care in Hungarian clinical centres. Efficacy of the therapy was primarily evaluated via moni - toring of renal function based on glomerular filtration rate (GFR) values calculated on the basis of the MDRD-175 formula. A total number of 128 patients were en rolled in two clinical centres within the frames of an open-label, non-interventional study. During the course of the study, mean GFR values showed stable renal function between the 1st month (53.5±33.4 ml/min/1,73 m2) and the 12th month (58±16.3 ml/min/1,73 m2). Acute graft rejection occurred in 21 patients during the first month, further, 1-1 rejection was documented in the remaining period between 2-6 and 6-12 months after renal transplantation, respectively. The graft survival was 100% 1 month after renal transplantation, while this ratio was calculated to be 98.4% after 12 months.]

Hungarian Radiology

[Can magnetic resonance imaging play a role in planning the method of delivery after Caesarean section?]

GERGELY István, CSÉCSEI Károly, DORFFNER Roland, BARANYAI Tibor

[INTRODUCTION - The number of Caesarean sections has been dramatically increasing worldwide, and also in Hungary in the last decade. In case of pregnancy following a preliminary Caesarean section it is always questioned if repeated Caesarean section or vaginal birth is required. The authors try to draw a conclusion from the thickness and the structure of the uterinal scar. The aim of the current study is to assess the additional role of uterinal MR examination undertaken between two births. PATIENTS AND METHODS - During our retrospective preliminary study T2 weighted sagittal images of uterinal MR examinations of 13 female patients were analysed. The presence of scar line was evaluated for thickness (millimetres, mm). This measurement was compared with the surgical report following consequent Caesarean section. Thus, a correlation was made between the surgical scar found at the repeated Caesarean section and the structure of the uterine scar seen by MR examination (between two births) which could play a role in the indication of the next birth. RESULTS - Three of our 13 patients gave birth via vagina (VBAC), and 10 via repeated Caesarean sections. According to the descriptions of the surgical scar the scars thinned out in six cases, whereas they made thickness in four. According to the appearance of the place of incision the scar was homogeneous and hypointens in nine cases, and inhomogeneous but basically hypointense in one case. According to the description of surgery in the MR examination the thinned out scar was thinner than 6 mm in 4 cases, and thicker than 6 mm in two cases. According to the description of surgery in the MR examination the nonthinned out scar was thinner than 6 mm in three cases, and thicker than 6 mm in one case. In two patients of three who gave birth via vagina the scar was thicker than 6 mm in the MR examination, and thinner than 6 mm in one case, the MR appearance of the scar was homogeneous and hypointens in two cases and complied with the original zonal anatomy in one case. CONCLUSION - In case repeated Caesarean section is not necessary from the aspect of the foetus or the mother, uterinal MR examination is of an additional significance in the complex indication of birth following a previous Caesarean section. The thickness, structure and signal intensity of the uterinal scar may provide a useful additional information.]

Journal of Nursing Theory and Practice

[Care of the fistula, advantages of the monitoring and the surveillance with thermodilution technique]

GREGUSCHIK Judit, RIKKER Csaba, LUKÁCSI Attila, MOGYORÓSI Róza

[Introduction: The best choice of vascular access for haemodialysis patients is the native arteriovenous fistula (AVF). Therefore, monitoring and surveillance of vascular accesses has a high priority. Aim of the research: The aim of our study was to evaluate the AVF surveillance protocol of our dialysis clinic. Research and sampling methods: We began AVF monitoring and surveillance in our dialysis clinic in February 2003. Until May 2015 we evaluated the data of 307 patients. Results: Besides the regular physical investigation of fistulas we performed measurements of vascular access flow (Qa) with thermodilution technique. In cases of suspected stenosis we performed Colour Doppler Ultrasonography and/or fistulography. Stenosis was verified in 154 cases at 344 patients. Percutan transluminal angioplasty was performed in 241 cases at 127 patients. Creation of a new fistula was necessary only in 24 cases at 21 patients. Within the last three years the percentage of patients treated via AVF has risen from 75% to 84%. Conclusions: Regular monitoring and surveillance of vascular accesses and the timely correction of its complications are able to reduce thrombosis of fistulas and the necessity of using central venous catheters. ]

Hungarian Radiology

[7th Paraclinical radiological forum Measurements via the radiological equipments: in the interest of safety and quality - Budapest, October 12th, 2010]

GÁSPÁRDY Géza