Lege Artis Medicinae

[MOTESZ General Assembly]

SIMON Tamás, GELEGONYA Katalin

FEBRUARY 09, 1991

Lege Artis Medicinae - 1991;1(03)

[The Federation of Hungarian Medical Societies and Associations (MOTESZ) held its renewal meeting of delegates on 15 December 1990, a new departure from the regular annual and even quinquennial meetings of delegates, and a renewal of this long-standing association.]

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Lege Artis Medicinae

[The role of computer tomography and magnetic resonance imaging in organic neurological diagnosis]

KENÉZ József

[In the last two decades, neuroimaging became the basic investigative method in the diagnostics of organic neurology due to the rapid development of medical electronics. In the nineties called the "Decade of the Brain", the importance of these methods could hardly bee overestimated. The two outstanding investigations of neuroimaging are computer tomography (CT) and magnetic resonance imaging (MR). Surely in the near future the application of these investigations will be incorporated in the Hungarian healthcare system as well. In this review all the points of view are collected on the basis of neurologic clinical symptomatology to help clinicians to decide, which method and when has to be chosen to gain the most valuable and detailed information on the quickest way, with less risk, and for the least amount of money ]

Lege Artis Medicinae

[Awareness of hypoglycaemia in diabetes mellitus: Prospective clinical-epidemiological investigations]

KERÉNYI Zsuzsa, TAMÁS Gyula, KEMPLER Péter, VARGHA Péter

[In order to survey the frequency of hypoglycaemia and its awareness we investigated 91 insulin- treated diabetic women (48 pregnant and 43 non-pregnant) consecutively using 9 to 15 blood glucose measurements. Subjective hypoglycaemic symptoms of patients were registered by using a structured questionnaire. Biochemically proved hypoglycaemia has been found in two third of patients (62/91). One third of the patients had a loss of awareness, 23 had partial awareness and 19 were aware of hypoglycaemia. No significant difference were found according to age, diabetes duration, daily insulin dose/kg body weight, glycated haemoglobin levels and frequency of diabetic complications. Five standard cardiovascular autonomic reflex-tests were performed in 31 patients. Age, diabetes duration, frequency of diabetic complications of patients with evidence of autonomic neuropathy significantly surpassed that of having normal cardiovascular reflex-tests. Our results confirm from clinical-epidemiological aspect that hypoglycaemia unawareness is not invariably associated with cardiovascular autonomic neuropathy. ]

Lege Artis Medicinae

[Five cases of operated atrial tumors]

NAGY Zsolt, HOLOMAY Miklós, VASZILY Miklós, SZÉCSI János, HORVÁTH Ambrus, PÉTERFFY Árpád

[Between November 1986. and June 1989. five patients underwent excision of an atrial tumour. Two of the patients had previous peripheral embolization, two had cardiac symptoms and one was symptomless. All the tumours were demonstrated by means of echocardiography and in four cases by angiocardiography as well. Four of them were left atrial tumors and one in the right atrium. The tumors were succesfully removed in all patients: in three cases by shaving them from the endocardium, in one case by excising a portion of atrial septum and in one case with a margin of normal atrial wall. Histological examination showed thrombus in one case. All patients survived operation and left hospital in good conditions. During the follow up there were no cardiac complication or local recurrence.]

Lege Artis Medicinae

[Hypothesis of natural birth]

BÁLINT Sándor

[It's supposed by the author that there exists a natural birth. According to his assumption in every woman's subconscionsness there is the code of the natural birth's behaviour (CODE), which can be spontaneously mobilized in the gravid woman. Putting into practice whichever way for the preparation of the birth, this mobilization can be advanced and in this way the child-bearing women's behaving repertory during their birth is increasing and it's drawing near to the equivalent of its own code. This may be the explication of the success and result of the alternative obstetrics end the preparing programs for the different births. The psychological explanation of the theory is given on the basis of C. G. Jung's activity.]

Lege Artis Medicinae

[Report on gastroenterological endoscopic activity in Hungary in 1989]

NAGY György, JUHÁSZ László

[The Endoscopic Section of the Hungarian Gastroenterological Society, under the leadership of Professor Wittmann, published an annual report on the status and development of endoscopy of the digestive organs in Hungary from 1975. In 1976, the report reported 27453 examinations performed at 75 endoscopic workplaces with 163 instruments. The 1987 survey already included 139496 examinations (36623 in Budapest, 102873 in the countryside) performed at 117 workplaces (37 in Budapest, 80 in the countryside) with 565 instruments (219 in Budapest, 346 in the countryside). In a statistical summary of 13 years, 968090 endoscopic examinations resulted in 389 (0.4 per thousand) complications, of which 71 (7 per 100,000) were fatal. The collection of study data was interrupted with the death of Professor Wittmann. ]

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Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

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[The importance of patient reported outcome measures in Pompe disease]

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[In recent decades it has become increasingly important to involve patients in their diagnostic and treatment process to improve treatment outcomes and optimize compliance. By their involvement, patients can become active participants in therapeutic developments and their observations can be utilized in determining the unmet needs and priorities in clinical research. This is especially true in rare diseases such as Pompe disease. Pompe disease is a genetically determined lysosomal storage disease featuring severe limb-girdle and axial muscle weakness accompanied with respiratory insufficiency, in which enzyme replacement therapy (ERT) now has been available for 15 years. In our present study, patient reported outcome measures (PROMs) for individuals affected with Pompe disease were developed which included questionnaires assessing general quality of life (EuroQoL, EQ-5D, SF36), daily activities and motor performance (Fatigue Severity Score, R-PAct-Scale, Rotterdam and Bartel disability scale). Data were collected for three subsequent years. The PROM questionnaires were a good complement to the physician-recorded condition assessment, and on certain aspects only PROMs provided information (e.g. fatigue in excess of patients’ objective muscle weakness; deteriorating social activities despite stagnant physical abilities; significant individual differences in certain domains). The psychological effects of disease burden were also reflected in PROMs. In addition to medical examination and certain endpoints monitored by physicians, patient perspectives need to be taken into account when assessing the effectiveness of new, innovative treatments. With involvement of patients, information can be obtained that might remain uncovered during regular medical visits, although it is essential in determining the directions and priorities of clinical research. For all orphan medicines we emphasize to include patients in a compulsory manner to obtain general and disease-specific multidimensional outcome measures and use them as a quality indicator to monitor treatment effectiveness.]

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The etiology and age-related properties of patients with delirium in coronary intensive care unit and its effects on inhospital and follow up prognosis

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Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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Validation of the Hungarian PHQ-15. A latent variable approach

STAUDER Adrienne, WITTHÖFT Michael, KÖTELES Ferenc

Somatic symptoms without a clear-cut organic or biomedical background, also called “medically unexplained” or “somatoform” symptoms, are frequent in primary and secondary health care. They are often accompanied by depression and/or anxiety, and cause functional impairment. The Patient Health Question­naire Somatic Symptom Scale (PHQ-15) was developed to measure somatic symptom distress based on the frequency and bothersomeness of non-specific somatic symptoms. The study aimed to (1) evaluate the Hungarian version of the PHQ-15 from a psychometric point of view; (2) replicate the bifactor structure and associations with negative affect described in the literature; and (3) provide the Hungarian clinical and scientific community with reference (normal) values split by sex and age groups. PHQ-15, depression (BDI-R), and subjective well-being (WHO-5) scores obtained from a large (n = 5020) and close to representative community sample (Hun­garostudy 2006) were subjected to correlation analysis and linear structural equation modeling. The PHQ-15 showed good internal consistency (Cronbach’s α = 0.810; McDonald’s ω = 0.819) and moderate to strong correlation with the BDI-R (rs = .49, p < 0.001) and WHO-5 (rs = -.48, p < 0.001). Fit of the bifactor structure was excellent; in independent analyses, the general factor was strongly associated with depression (β = 0.656±0.017, p < 0.001) and well-being (β = -0.575±0.015, p < 0.001), whereas the symptom specific factors were only weakly or not related to these constructs. The PHQ-15 score was higher in females and showed a weak positive association with age. The Hungarian PHQ-15 is a psychometrically sound scale which is positively associated with depression and ne­gatively related to subjective well-being. The bifactor structure indicates the existence and meaningfulness of a gene­ral factor representing the affective-motivational component of somatic symptom distress. The Hungarian version of the PHQ-15 is a brief and usable tool for the pre-screening of somatization disorder (DSM-IV) or somatic symptom disorder (DSM-5). The reported reference values can be used in the future for both clinical and research purposes.