Lege Artis Medicinae

[Night Swim The Collages of Zsolt Sándor]

JULY 20, 2006

Lege Artis Medicinae - 2006;16(07)

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Lege Artis Medicinae

[Compounds – Plants...]

GRÉTSY Zsombor

Lege Artis Medicinae

[WEGENER’S GRANULOMATOSIS PRESENTING AS MASTOIDITIS: A DIAGNOSTIC CHALLENGE]

NAGY Pál, SZABÓ László, DOMJÁN Gyula, GADÓ Klára, BALOGH Károly

[INTRODUCTION - Wegener's granulomatosis has an uncertain pathomechanism, but is probably autoimmune in origin. In typical cases the mucosa of the nose, paranasal sinuses and of the lower respiratory tract, as well as the lungs and the kidneys are affected. Patients present with sinusitis, recurrent pneumonia or renal disease associated with microhaematuria, pyuria or azotaemia. Fever, polyarthralgia or polyarthritis may also occur. The underlying pathologic changes are necrotizing vasculitis, granulomas and parenchymal necrosis. The diagnosis is based on a combination of the clinical picture, microscopic findings and immunofluorescent demonstration of cANCA. CASE REPORT - A 27-year-old woman presented with symptoms of unilateral mastoiditis. In the following 7 months she underwent 7 operations in 4 hospitals for a locally progressive, destructive process of uncertain etiology showing a septic course. The clinical picture was not specific, the cANCA test was not definitive, and the histologic findings were initially interpreted as nonspecific inflammation. Repeated biopsies, multiple reviews of the microscopic specimens, consultations, differential diagnostic considerations, and, finally, the success of the treatment with corticosteroids and cyclophosphamide led to the diagnosis of Wegener’s granulomatosis. Currently the patient has been in remission for 32 months. CONCLUSION - The definitive diagnosis of Wegener’s granulomatosis, particularly of its localized or limited form, may be problematic despite well-defined diagnostic criteria. Setting up the correct diagnosis may take months or years. In case of unusual respiratory or otological symptoms, and in view of ineffective medical or surgical treatment, Wegener’s granulomatosis has to be considered. An atypical clinical picture, inconclusive histologic, radiologic and laboratory findings warrant the need for close collaboration of various specialists. This is particularly important since state-of-the-art therapy of Wegener’s granulomatosis promises a favourable prognosis.]

Lege Artis Medicinae

[Interdisciplinary forum of MOTESZ - Budapest, 23-25th March, 2006.]

KRAMER Imre

Lege Artis Medicinae

[Odour]

SZIGETI Zoltán

Lege Artis Medicinae

[CONTROVERSIAL ISSUES IN THE TREATMENT OF OPERABLE CERVICAL CANCER]

PETE Imre

[Wertheim hysterectomy as a baseline surgical treatment for patients with FIGO stage 1a2-2a cervical cancer was introduced in 1989 at the National Institute of Oncology, Budapest, Hungary. From then until 2002 when the results were first evaluated 308 such operations were performed. The average 5- and 10-year survival rates were 80% and 75%, respectively. Although these results are comparable to literature data, several issues concerning this group of patients remain to be solved. The participation rate in the Pap test screening programme covered by the national health insurance is only 30%. There is no national database on the current treatment of these patients that could help identify the necessary steps to be taken in order to improve the results. The number of radical hysterectomies performed a year in Hungary, or their outcome, is not known. The treatment scheme varies among the institutes and so does surgical experience. There is no consent regarding treatment policy, preoperative irradiation or chemotherapy, surgical technique, or postoperative management. The improvement of the participation rate in the screening programme, the use of prognostic factors to determine the most appropriate treatment, the role of minimally invasive and fertility-preserving surgery, the preservation of ovaries and the use of neoadjuvant chemotherapy are some of the further issues that need to be discussed. The first step should be data acquisition from all institutes in the country in order to develop and apply uniform treatment guidelines.]

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Clinical Neuroscience

Restless leg syndrome frequency in health workers

ÖCAL Ruhsen, ATGÜDEN Gizem, AYCAN Cagri, BALABAN Zeynep, SENAR Seran, YAVUZ Sena

Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.

Hypertension and nephrology

[State Ceremony on the 150th Anniversary of the Birth of Sándor Korányi ]

RADÓ János

Journal of Nursing Theory and Practice

[Complications of wearing contact lenses]

MÉSZÁROSNÉ PINTÉR Katalin

[Aim of the study: The author seeks to identify the reasons why contact lenses can cause wearers to develop inflammation of the cornea. She also examines whether the development of this severe condition can be avoided. Sample and method: The study was conducted among contact lens-wearing inpatients at the Ophthalmology Department of the Szent Pantaleon Hospital and Clinic. A questionnaire designed by the author, consisting of closed-ended questions, was distributed to 18 patients. Results: All 18 of the patients used soft, monthly-replacement contact lenses. Ten persons wore the lenses for two weeks longer, and five persons for one week longer than prescribed. Five persons neglected to wash their hands before inserting and removing the lenses. Five persons were not in the habit of cleaning contaminants from the lens, and seven persons did not use fresh storage solution every day. Four persons used tap water for the care of the lenses. Five persons did not remove the lenses at night, and four inserted the lenses into red, inflamed eyes. With the exception of one person they did not take a break from wearing the lenses, and three persons possessed spectacles. Fourteen persons were not satisfied with the information received from the optician. Conclusions: All of the changes were due to bacterial complications that were attributable to unsatisfactory cleaning of the contact lenses. ]

Lege Artis Medicinae

[That Place in the World... A Discussion with Zsolt Bugarszki, General Manager of Soteria Foundation and Professional Lead Ibolya Hegedűs]

GYIMESI Ágnes Andrea

Hypertension and nephrology

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]