Lege Artis Medicinae

[Looking back - 1991]


DECEMBER 23, 1992

Lege Artis Medicinae - 1992;2(12)

[It is coincidental, but not without lessons to be learned, that the Parliament debated in parallel the bill on the implementation of the 1991 state budget of the Republic of Hungary and the parliamentary resolution on the 1993 central budget guidelines and the main issues of budgetary policy. (The paragraphs on health and social security in the latter were published in the September supplement to the LAM, while the fate of the parliamentary resolution was reported in the October issue of the LAM.) The economic and political lessons are there, but it is not our place to go into them. We will therefore take a look at the people's welfare chapter of the 'final accounts' on the implementation of the budget, and then turn to the politician who has criticised the opposition.]



Further articles in this publication

Lege Artis Medicinae

[Cephalosporins in the nineties]


[The cephalosporin group is the largest and most widely used family of antibiotics in the nineties. According to their antimicrobial activity, the cephalosporin derivatives are classified as three generations; in Hungary seven parenteral and three oral compounds are available, while some newer ones are under registration. The chemistry and antimicrobial spectra of the cephalosporins are presented, as well as the main problems of bacterial resistance. Pharmacokinetics, adverse effects, and clinical indications of the individual compounds are discussed. The importance of critical use is emphasized.]

Lege Artis Medicinae

[Regionally Organized Cardiac Key European Trial]


[Nisoldipine reduced ST-segment depression and the frequency of silent ischaemic periods compared with placebo, but this did not reach the level of statistical significance. The active agent did not affect the diurnal distribution of ischaemic signs and did not improve exercise capacity.]

Lege Artis Medicinae

[New trends in the nonpharmacological therapy of atrial fibrillation]


[Atrial fibrillation is the most common of all sustained cardiac arrhythmias, and it is often resistant to medical therapy. This paper summarizes ourcurrent understanding of the pathophysiology of atrial fibrillation, surveys the factors which have led to the development of nonpharmacologic therapy, and describes the advantages and disadvantages of these procedures. Potential new research directions are presented. ]

Lege Artis Medicinae

[International Nifedipine Trial on Antiatherosclerotic Therapy]


[ The coronarograms showed that neither the number nor the extent of atherosclerotic lesions observed in the first study changed appreciably over three years in either the nifedipine or placebo group. However, the incidence of new lesions was significantly lower in the active drug group than in the placebo group (0.59 vs 0.82/patient; -28%). Side effects were significantly more frequent in patients taking nifedipine (55/173) than in the placebo group (16/175; p<0.03).]

Lege Artis Medicinae

[Acute porphyrias]

TASNÁDI Gyöngyi, NAGY László

[Acute porphyrias - acute intermittent porphyria, variegate porphyria, hereditary coproporphyria and plumboporphyria – are due to lowered activity of the enzymes of the heme biosynthesis. All of them are inherited as autosomal dominants. From the pathobiochemical and clinical points of view there are 4 phases of the disease: genetic phase, compensated latent and decompensated latent phases and the generally life-threatening acute at tack. The clinical symptoms are caused by peripheral and autonomic neuropathy, which are primarily induced by various precipitating factors: in part by endogenous hormones but mainly by drugs, alcohol and severe infections. The diagnosis is based on measurement of the activities of the enzymes and porphyrins and their precursors in urine and feces. The therapy includes the use of glucose infusions administered in large doses and haematin. However the most effective mode of treatment is to prevent the acute syndrome. It is crucial to recognize the disease in the earliest (genetic) phase because in this way it is possible to avoid inducing factors. 91 patients are under permanent control and care by the authors, but there are many more patients in Hungary according to European estimates. Discovery of these patients would serve prevention.]

All articles in the issue

Related contents

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

Review of electrode placement with the Slim Modiolar Electrode: identification and management

DIMAK Balazs, NAGY Roland, PERENYI Adam, JARABIN Andras Janos, SCHULCZ Rebeka, CSANÁDY Miklós, JÓRI József, ROVÓ László, KISS Geza Jozsef

Background - Several cochlear implant recipients experience functionality loss due to electrode array mal-positioning. The application of delicate perimodiolar electrodes has many electrophysiological advantages, however, these profiles may be more susceptible to tip fold-over. Purpose - The prompt realization of such complication following electrode insertion would be auspicious, thus the electrode could be possibly repositioned during the same surgical procedure. Methods - The authors present three tip fold-over cases, experienced throughout their work with Slim Modiolar Electrode implants. Implantations were performed through the round window approach, by a skilled surgeon. Standard intraoperative measurements (electric integrity, neural response telemetry, and electrical stapedial reflex threshold tests) were successfully completed. The electrode position was controlled by conventional radiography on the first postoperative day. Results - Tip fold-over was not tactilely sensated by the surgeon. Our subjects revealed normal intraoperative telemetry measurements, only the postoperative imaging showed the tip fold-over. Due to the emerging adverse perception of constant beeping noise, the device was replaced by a CI512 implant after 6 months in one case. In the two remaining cases, the electrode array was reloaded into a back-up sheath, and reinserted into the scala tympani successfully through an extended round window approach. Discussion - Future additional studies using the spread of excitation or electric field imaging may improve test reliability. As all of these measurements are still carried out following electrode insertion, real-time identification, unfortunately, remains questionable. Conclusion - Tip fold-over could be reliably identified by conventional X-ray imaging. By contrast, intraoperative electrophysiology was not sufficiently sensitive to reveal it.

Clinical Neuroscience

[The examination of burnout among healthcare workers]

FEJES Éva, MÁK Kornél, POHL Marietta, BANK Gyula, FEHÉR Gergely, TIBOLD Antal

[Health reforms in recent decades have been largely based on economic considerations and have led to a significant problem in the sector today, with the issue of human resources being pushed back, which is exacerbated by burnout syndrome. The aim of this questionnaire-based study was to examine the complex background of burnout among health care workers in the cities of Komló, Pécs and Kecskemét. Baseline demographic data were recorded. Burnout was assessed by the Maslach Burnout Inventory (MBI), and the intensity of dysfunctional attitudes were also studied. Depression was detected by the Beck Scale and social supports, and effort-reward dysbalance were also examined. Overall 411 employees participated in our study. Age group distribution was middle aged access, vast majority of the workers was between 36 and 55 years. Mean burnout scale was 58.6 (SD = 16.3), 63 workers had mild (14.2%), 356 had moderate (80.7%) and 22 had severe (5.1%) burnout. In a multivariate analysis the type of work (OR = 1.018), age (OR = 2.514), marital status (OR = 1.148), job type (OR = 1.246) the lack of social support (OR = 1.189) and allowance (OR = 9.719) were independently associated with burnout (p < 0.05 in all cases). There was a significant association among burnout, depression and dysfunctional attitudes. The vast majority of our social workers suffered from moderate and a small, but significant proportion suffered from severe burnout. Our work draws attention to the modifiable and unmodifiable risk factors of burnout in this population, which may help in the development of preventive strategies.]

Clinical Neuroscience

[Thrombolysis in case of ischemic stroke caused by aortic dissection]

LANTOS Judit, NAGY Albert, HEGEDŰS Zoltán, BIHARI Katalin

[Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis. ]

Clinical Neuroscience

Different work schedules of nurses in Hungary and their effects on health

FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.