Lege Artis Medicinae

[Pro-Micro (Intracoronary Enalaprilat to Reduce Microvascular Damage During Percutaneous Coronary Intervention)]

MATOS Lajos

APRIL 20, 2013

Lege Artis Medicinae - 2013;23(03-04)

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Lege Artis Medicinae

[AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management)]

MATOS Lajos

Lege Artis Medicinae

[The “Long Tail” Responsibility of Healthcare ]

HANTI Péter

Lege Artis Medicinae

[Health-economic analysis of diseases related to disturbed neonatal adaptation: a cost of illness study]

BONCZ Imre, KOVÁCS L. Gábor, ERTL Tibor, ÁGOSTON István, MOLICS Bálint, BÓDIS József

[OBJECTIVES - The aim of our study is to perform a health-economic analysis of diseases related to disturbed neonatal adaptation by assessing the burden of health care costs in Hungary. DATA AND METHODS - Data were derived from the financial dataset of the National Health Insurance Fund Administration (OEP) covering year 2009. Four diseases were included in the analysis: polycystic ovary syndrome (E2820), retinopathy of prematurity (H3510), hyperstimulation of ovaries (N9810) and respiratory distress syndrome of the newborn (P2200). RESULTS - The annual health insurance costs of the assessed diseases were the following: polycystic ovary syndrome: 78.9 million Hungarian Forints (HUF) or 281 160 Euro (EUR), retinopathy of prematurity: 41.3 million HUF (147 090 EUR), hyperstimulation of ovaries: 8.7 million HUF (30 839 EUR) and respiratory distress syndrome of the newborn: 1.562 million HUF (5 567 336 EUR). We found by far the highest annual per capita health insurance expenditure for respiratory distress syndrome of the newborn (1,43 million HUF or 5098 EUR/patient/year). Hyperstimulation of ovaries (58 073 HUF or 207 EUR/patient/year), retinopathy of prematurity (19 513 HUF or 70 EUR/patient/year) and polycystic ovary syndrome (7679 HUF or 27 EUR/patient/year) was associated with significantly lower annual per capita health insurance expenditure. CONCLUSIONS - The diseases related to disturbed neonatal adaptation have substantial annual health insurance expenditures (1 689 million HUF or 6.02 million EUR) and of these diseases respiratory distress syndrome of the newborn has the highest burden of disease.]

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[At What Time did The Huckleberry Hound Show Start in TV? ]

NEMESI Zsuzsanna

Lege Artis Medicinae

[Report about endoscopic activity of gastroenterology in Hungary in the year of 2012]

NAGY György, OROSZ Péter

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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

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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.

Clinical Neuroscience

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