Lege Artis Medicinae

[Prediction of rebleeding and its importance in the treatment of upper gastrointestinal bleedings originating from peptic ulcers]

ONDREJKA Pál

JULY 20, 2002

Lege Artis Medicinae - 2002;12(06-07)

[Nearly 50% of upper gastrointestinal bleedings originate from peptic ulcers. While the number of scheduled operations carried out due to peptic ulcers is decreased to nearly zero in the past decade, the number operations due to the complications of peptic ulcers remained unchanged. Bleeding from peptic ulcers usually stops spontaneously in a remarkable part of the cases, but in many times rebleeding is anticipated. These patients present several problems which are difficult to treat, and patients in need of emergency surgery are usually from this group. This is the main reason why the identification of those patients with high risk for rebleeding is important. With the help of the modified "Baylor Bleeding Score" rebleeding can be predicted. In the case of high risk for rebleeding, an early elective operation can avoid a latter urgent operation, which has markedly higher mortality and morbidity. In peptic ulcer bleeding, endoscopic treatment modalities have the priority. Most preferred method is the injection of different haemostatic drugs, with thermal methods and haemoclips being also accepted. Among surgical treatments, ”aggressive” resection operations are preferable. Additional "conservative" medical treatment with proton pump inhibitors is also recommended.]

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[The future of chest X-ray screening in Hungary]

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[In 2001 4.095.134 chest screening examinations were carried out at 154 fixed and 50 mobile Xray screening stations in Hungary. Currently, screening for tuberculosis is mandatory by law, but a recently issued decree by the Health Minister states that the method is suitable for the screening of lung cancer as well. Unfortunately, the majority of the machines are old and since replacements are long overdue, the assessment with a high technical standard and quality is not always possible. These are the reasons why a plan must be outlined for the necessary improvement and for the renewal of the equipment pool, based on expert opinion. In the literature, there are ongoing spirited discussions on the efficacy of X-ray screening as well as on the possibilities of CT-scans for the identification of lung cancer. The size of the investment needed makes it necessary that costbenefit factors and the possibility of joining the National Health Prevention program should be considered.]

Lege Artis Medicinae

[Annual Meeting of the Hungarian Association of Gastroenterologists]

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Lege Artis Medicinae

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Lege Artis Medicinae

[Changes in the treatment of childhood asthma with inhalational steroids]

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[Since about 30 years, inhalational steroids are the most important drugs in the treatment of persistent (chronic) asthma. According to the severity of the disease, small, medium and high doses of steroids should be given, often together with long lasting beta-agonists. In the last years the therapeutical advice was simplified as the cromolyns and the theophyllins were almost excluded. Leukotrien antagonists appeared either in combination or as monotherapy. Using conventional doses in inhalational steroid therapy there are hardly any side effects, but it is important to give the smallest possible effective dose while achieving maximum bioavailability. Patients all over the world - including Hungary - do not receive optimal antiasthmatic therapy or use drugs ideally, which is especially true to inhalational steroids, resulting in a treatment much less efficient than possible.]

Lege Artis Medicinae

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[DIVERTICULOSIS, DIVERTICULITIS - SYMPTOMS, DIAGNOSTICS AND TREATMENT]

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[Diverticulosis of the colon is frequent in developed countries. Decreased intake of dietary fibre have been implicated as an important pathogenetic factor. Most of the affected patients are asymptomatic but 10-20% of them have abdominal problems. Clinical manifestations range from simple, non-complicated form (abdominal pain, distension, constipation, urgency etc.) to severe complications (diverticulitis, abscess, peritonitis, perforation, haemorrhage etc.) The diagnosis and therapy of different forms of diverticular disease can be very simple but in several cases differential diagnostical problems and therapeutical difficulties may arise. The gold standard for establishment of uncomplicated diverticulosis is the barium enema or colonoscopy. In case of complicated forms non-invasive methods (US, CT scan, CT-colonography, MRI) have to be preferred. These examinations have no risk for perforation and extraintestinal pathology (air, fluid, abscess) can be detected. Colonoscopy or angiography are the methods of choice in case of haematochesia. The choice of therapy is based on clinical presentation, symptoms and pathology. Fibre supplementation is recommended for patients with diverticulosis without symptoms. In case of noncomplicated symptomatic diverticular disease fiber supplementation or cyclic administration of broad spectrum, poorly absorbable antibiotic can be effective in the prevention of inflammatory episodes and complications. If some of the severe or recurrent complications can not be treated conservatively, surgery is necessary. Prevention of diverticulosis and diverticular disease has to be emphasized. While fibre supplementation in the diet is recommended, other efficacious preventive strategies remain to be identified.]