Lege Artis Medicinae

[Patient rights in some foreign hospital laws]

KÖVESI Ervin

AUGUST 31, 1994

Lege Artis Medicinae - 1994;4(08)

[The welfare government is preparing a law on hospitals. This will certainly include patient rights that are already partly covered by the existing Health Act and other legislation (medical confidentiality, data protection, referral of psychiatric patients, compulsory treatment, etc.). However, many of these need to be updated and others need to be codified. The new Hospital Act should also bring the existing lower level legislation into law. ]

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Lege Artis Medicinae

[The role of baseline duplex sonographic examination in monitoring the transplanted kidney in the early postoperative period]

MORVAY Zita, MAROFKA Ferenc, CSAJBÓK Ernő, SZENOHRADSZKY Pál

[Routine baseline duplex sonography and sonographic monitoring have been performed afer kidney transplantation at our University since November, 1992. Data on 24 patients are analysed. Baseline sonograms were assessed as normal in 18 patients. Abnormalities involved collecting system dilatation, and swelling of the parenchyma. In every case in which the transplanted kidney had to be removed because of serious complications, we observed morphological changes in the follow-up examination. The resistance index (ARI) measured during duplex Doppler examinations was higher than 75% in 8 of the 24 cases. Four of these grafts had to be removed. From among the 16 cases having normal baseline RI, only 2 kidneys were lost during the postoperative period. Baseline and follow-up duplex sonographic examinations were found to have an important role in the management of kidney transplanted patients. Early complications can be detected, therapy can be initiated in time, and the changes occurring during follow-up can be evaluated more sensitively. ]

Lege Artis Medicinae

[Catheter ablation of supraventricular tachycardias]

KEMPLER Pál, LITTMANN László, TÓTH K. Zoltán

[Medical therapy for supraventricular arrhythmias is often ineffective. Arrhythmia surgery is limited by its considerable morbidity and cost. A better understanding of the exact anatomic-electrophysiologic correlations that govern supraventricular arrhythmogenesis and the advances in catheter ablative techniques have led to a new, effectual and costeffective therapy. Catheter ablation techniques result in a high rate of success rates and a low rate of complications. Radiofrequency ablation has become an accepted form of treatment for a variety of supraventricular arrhythmias. This review summarizes current data on catheter ablation of supraventricular arrhythmias.]

Lege Artis Medicinae

[The role of langerhans' cells in the development of cervical cancer]

PETE Imre, SÁPI Sándor, GONDA Gábor

[While the number of deaths from cervical cancer of women over the age of 45, has fallen in the recent years the mortality in women under the age of 35 has increased. The reason for this change is not clear. A large number of analytical studies tried to identify the risk factors for cervical cancer (age, marital status, time of first intercourse, number of sexual partners, coital frequencies, circumcision of partners, menstrual patterns, gravidity, type of contraception, smoking, viral infection, socioeconomic circumstances) but the real con nection between the disease and the varions risk factors remained unclear. The results of these studies suggest that, the 'one hit one tumor' hypothesis can't be proven, and it seems more appropriate to cousider a complex effect of these etiologic factors acting on the altered immunologic status of the cervix uteri. We tried to concentrate on one out of these factors from the literature which may play a cardinal role in the development of CIN or invasive cervix cancer. It is evident from the literature that the macrophages present in the cervix tissue in CIN, or infiltrating the tumor tissue in invasive cancer, could influence either the development of cervical cancer or the prognosis of the disease. It has long been known that in the cervical tissue there are a specific type of dentric cells taking part in the antigen presentation process. The examination of behavior, distribution and activity of these so – called Langerhans cells due to the exogen effect in the cervical tissue may be a which contributes to the understanding of the process leading to the development of CIN. ]

Lege Artis Medicinae

[Morbidity of ischemic heart disease in early breast cancer patients 15-20 years after adjuvant radiotherapy]

GYENES Gábor

[Our aim was to assess the frequency of cardiac side effects, primarily ischemic heart disease, in symptom-free patients with early breast cancer previously treated with radio therapy. Thirty-seven survivors of a previous randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left-sided disease (study group patients) were compared with 17 controls who were either treated for right-sided disease, or were non-irradiated patients. Radiotherapy was randomized in the original study; either tangential field Co-, or electron-therapy was delivered. A bicycle ergometry stress test with 99m Tc Sesta MIBI myocardial perfusion scintigraphy was carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), and none of the 17 controls exhibited some kind of significant defect on scintigraphy, indicating ischemic heart disease (p <0,05). Radiotherapy for left-sided breast cancer with the above-mentioned treatment technique may be an independent risk factor in the long-term development of ischemic heart disease. The need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer, is emphasized. ]

Lege Artis Medicinae

[Recovery from persistent vegetative state of four months or more]

KEITH Andrews

[A retrospective study was carried out on 43 patients admitted to a ward specifically designed for the rehabilitation of patients with persistent vegetative states after another. Of these, 11 regained consciousness four months or more after brain injury. It was reported that the patients' first reaction to being able to follow with their eyes was between the 4th month and the 3rd year of the condition, while the first reaction to being instructed was between the 4th and the 12th month. Only one patient was unable to communicate, six used non-verbal means to express at least yes and no, four could speak. Six patients required full care, while two became independent in their daily activities. Four patients were able to eat independently, three needed assistance, and four patients required maintenance of gastric tube feeding.]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

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.

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.]

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]