Lege Artis Medicinae

[Permanent remission with fulvestrant therapy in hepatic metastases]

SIPŐCZ István

JULY 20, 2015

Lege Artis Medicinae - 2015;25(06-07)

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Lege Artis Medicinae

[Ethical Considerations of Organ and Tissue Transplant Part 2 – Crossing the Borders of Species. Transgenesis and its Significance ]

SZEBIK Imre

Lege Artis Medicinae

[New opportunities for the estimation of health loss in Hungary]

VITRAI József, VARSÁNYI Péter, BAKACS Márta

[BACKGROUND - The Global Burden of Disease Study has been publishing its reports since the early 1990’s. The last one from 2010 covers 291 diseases, and 67 risk factors for 187 countries. AIMS - Presenting examples of the Hungarian health burden status the authors advocate the use this unique data source. METHODS - The authors downloaded the 1990 and 2010 data for Hungary from the Global Burden of Disease Study website. To quantify the economic burden they calculated the change in GDP related to the absence from work as a consequence of risks and diseases. RESULTS - In the publication the authors presented some of the versatile utilization methods of the GBD data and the data visualization tools available on GDB’s website. In 2010 the DALY for Hungary was 3,714,900 years which is the 84% of the country’s DALY in 1990. The most Years Lived by Disability was caused by musculoskeletal disorders (YLD: 28.4%), while cardiovascular and circulatory diseases caused the most Years of Life Lost (YLL: 40.3%). In 2010 the dietary risk was the leading risk factors in Hungary accountable for 840 thousand of life years lost which economic cost was over 950 milliard Hungarian forints. CONCLUSIONS - The use of the result provided by the Global Burden of Disease Study can significantly contribute for planning and evaluating interventions to promote healthy lifestyle, to advance supporting living conditions, and to distribute health care capacity efficiently.]

Lege Artis Medicinae

[It Was Done... and Worth It! ]

CSEUZ Regina

Lege Artis Medicinae

[Incisional hernia and diabetes. Could we improve the results?]

MARTIS Gábor, DAMJANOVICH László

[GOALS - Diabetes mellitus is considered as a risk factor concerning surgical interventions as well. Connection between incisional abdominal hernias and diabetes mellitus were investigated in this prospective four years study. The primary aim was to evaluate the proportion of recurrencies, the secondary aim was determining the ratio of surgical complications in the investigated two groups (Group I: non diabetic, group II: diabetic patients). PATIENTS AND METHOD - The results of the incisional and abdominal hernia operations performed between 01. 01. 2011. and 31. 12. 2014. were investigated. Data for study was gained from the consecutively and obligatorily registered database of the authors’ institution. The type of reconstruction, elective or acute character of surgery, primary or recidive operation, the patients’ body mass index (BMI), as well as among complications the seroma and fistula formations, the reoperations and postoperative infections were registered. Patients with type I and type II diabetes mellitus were not differentiated. The HgbA1c was investigated separately in elective and acute operations. RESULTS - There were 56 (8.94%) diabetic patients (39 male, 17 women, avr. age 54.3 years) out of all 626 patients operated on incisional and/or abdominals wall hernias. Total recurrency rate was 19.6% during the average 32 months (6-66 months) follow-up period. The recurrency rate in diabetic patients was 50.0% (48.7% in women, 52.9% in men). Non-diabetic patients’ recurrency ratio were only 8.3% (11.2% and 5.4% in men and women, respectively). Median BMI is significantly higher in patients with diabetes than in those of non diabetics (35.4kg/m2 vs 27.75kg/2). Ratio of the elective and acute operations were 69.6% and 28.6%, respectively. The most frequently used operations technique was the direct transversal abdominal wall suture (14.3%) and the direct suture plus synthetic mesh implantation (64.3%). Eleven (19.7%) diabetic patients with incisional hernia were reconstructed with a so-called autologous tension free dermal flap. In 2 (18.2%) out of 11 patients were registered recurrency. Seroma and haematoma formation was occured in four patient (36.4%) and in one (9.1%), respectively after dermal flap reconstructions. Mean recurrency time after surgery in non-diabetic and in diabetic patients was 12.3 months and 9.2 months, respectively. The average HgbA1c level was significantly higher (8.1% in electively operated patients than in those acutly operated ones (9.8%). There were two lethal (0.36%) postoperative complications in this study. CONCLUSION - Considering the recurrency ratio of the incisional hernias and the postoperative complications, diabetes mellitus is a significant risk factor compared the data to non-diabetic patients. Seroma and haematoma formations, postoperative complications ratio are significantly higher in patients with diabetes than in those of non-diabetic. Appearance of recurrencies require significantly shorter time in patients with diabetes mellitus The rate of recidive and postoperative complication after the autolog, dermal, traction free abdominal wall reconstructions made by authors was lower, than in abdominal hernias reconstructed in other ways (direct suture, direct suture plus xenograft).]

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