Lege Artis Medicinae

[REVERSAL]

MATOS Lajos

OCTOBER 20, 2004

Lege Artis Medicinae - 2004;14(10)

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Lege Artis Medicinae

[TRANSBRONCHIAL NEEDLE ASPIRATION IN THE DIAGNOSIS OF SARCOIDOSIS]

ZSIRAY Miklós, BADÁR Éva, UDUD Katalin, FÜLÖP Andrea, SZABÓ Zsuzsanna, MATESZ István, MARKÓCZY Zsolt

[INTRODUCTION - The histological pattern of sarcoidosis and cytological characteristics are similarly unspecific. Nevertheless, both forms of the diagnosis based on morphology can be taken into consideration if the clinical picture and chest X-ray respectively, are fitted and other diseases are excluded. PATIENTS, METHOD AND RESULTS - Enlargement of hilar lymph nodes is present in 80% of cases of sarcoidosis. In this study, transcarinal needle aspiration combined with rapid on-site cytological staining was performed in the case of 33 patients with I. or II. stage of sarcoidosis. The sensitivity was found to be 76%. CONCLUSION - Since the cytologist can inform the bronchologist fairly soon: during the bronchoscopy, bronchial mucosal biopsies or transbronchial lung biopsies are only necessary to obtain in about quarter of patients.]

Lege Artis Medicinae

[COST-EFFECTIVENESS OF PIMECROLIMUS CREAM - A NEW TREATMENT FOR ATOPIC DERMATITIS IN HUNGARY]

KÓSA József, HUNYADI János, SZALAI Zsuzsanna, KÖRMENDY Miklós, KALÓ Zoltán

[OBJECTIVE - To assess the costs, consequences and cost-effectiveness of pimecrolimus cream 1% in the treatment of children with atopic dermatitis in Hungary. METHODS - A Markov-model for atopic dermatitis developed by the Erasmus University (Rotterdam, the Netherlands) was adopted to the Hungarian health care setting. The model is based on a double-blind, multicenter, randomized, parallelgroup study. Patients were randomised (2:1) to receive pimecrolimus treatment (i.e. emollients, pimecrolimus, medium potency topical corticosteroids) or standard of care (emollients, vehicle, medium potency topical corticosteroids). The study was conducted in children and adolescents (2 to 18 years of age). Hungarian cost vectors were calculated by linking severity of disease as defined by Investigator’s Global Assessment (IGA) to average resource use. Resource use was multiplied by drug costs and unit costs as published in official databases. RESULTS - Pimecrolimus treatment has an incremental cost of HUF 143 897 over standard care. This additional cost of care resulted in an incremental 0.05 QALY gain over the 6 months period. The incremental cost effectiveness ratio was 2 863 913 HUF/QALY for the pimecrolimus therapy. CONCLUSION - Pimecrolimus is more costeffective than many other health care interventions currently reimbursed by the Hungarian National Health Fund.]

Lege Artis Medicinae

[THE ANALYSIS OF LIFE EVENTS IN HUNGARY]

NAGY Judit

[INTRODUCTION - In the social vulnerability model the concept of Life Events is the measure of forces and life events presenting in the social field that makes someone susceptible to mental illnesses. The stress value of these events add up. The Life Events Scale by Paykel is a questionnaire used in international practice. The objective of this study is the Hungarian adaptation and introduction of the Life Events Scale in the national practice, the international comparison of our results, the comparison of healthy people with the patient population and the analysis by social data. PATIENTS AND METHOD - The questionnaires were filled in by both healthy people and different patient populations. The participants rated the life events between 0-7 points according to their degree of causing stress, then they indicated whether it had happened with them. This was followed by a questionnaire about social data. We separated question groups by factor analysis: losses, changes, failures, difficulties, joyful events. RESULTS - When making the international comparison we only found differences in two areas: becoming unemployed and infidelity/divorce. Young people scored losses higher, while older ones scored changes higher. Those who declared themselves as religious scored suicide attempts higher. The mean scores of patient populations were higher compared to healthy subjects. The number of life events occurred was the highest in the depression-suicide attempt group. CONCLUSION - Our results can be used in everyday clinical practice and may be extremely important in suicide prevention.]

Lege Artis Medicinae

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Lege Artis Medicinae

[LONG-TERM RESULTS OF ENDOSCOPIC SPHINCTEROTOMY - EFFECTS OF THE TRANSECTION OF BILE PAPILLA]

DÖBRÖNTE Zoltán

[The abolishment of the choledochoduodenal pressure gradient due to endoscopic sphincterotomy results in the enhancement of the enterohepatic circulation of the bile salts, in the reduction of the cholesterol saturation index and in the modification of the gallbladder function: the reduced gallbladder storage time and the increased ejection fraction facilitates gallbladder emptying. On the contrary, bacterial colonisation of the bile ducts due to duodenobiliary reflux plays a causative role in the increased risk of pigment stone formation. However, when the biliary tree is well-drained, no clinically relevant chronic inflammation develops, furthermore there is no evidence for an increased cancer risk caused by the duodenobiliary reflux. Long-term complications may occur in about 12%, as the recurrence of common bile duct stones, post-EST papillary stenosis, and biliary symptoms caused by retained gallbladder stones. Risk factors for recurrence of bile duct stones are juxtapapillary duodenum diverticulae and persistently dilated bile ducts being the main reason for papillary restenosis and sphincterotomies are mainly performed because of papillary stenosis. In cases of retained gallbladder with stones patency of the cystic duct and contractility of the gallbladder are important predictive factors of late gallbladder complications as it was confirmed by our investigations. Accordingly, small gallbladder stones may pass spontaneously after EST. The indication of a cholecystectomy following EST should be considered individually, particularly in elderly patients. As 30-year-experience confirms, EST is a safe and effective treatment of choledocholithiasis and papillary stenosis even in the long term, and also in young patients. Regular follow-up of patients with high risk for recurrent biliary symptoms is recommended to detect late complications and treat them endoscopically in time.]

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Clinical Neuroscience

[Administration of idarucizumab in spontaneous intracerebral hemorrhage under dabigatran-therapy]

BERECZKI Dániel Jr., SZILÁGYI Géza, KAKUK Ilona, SZAKÁCS ZOLTÁN, MAY Zsolt

[Introduction - Among antidotes in development for reversal of novel oral anticoagulants, dabigatran-specific idarucizumab was the first one to reach the market. Case presentation - We present the first Hungarian case of intracerebral hemorrhage under treatment with dabigatran, where idarucizumab was administered to suspend anticoagulation. Discussion - Our report is concordant with prior publications, confirming the efficacy of the antidote in reversing the effect of dabigatran, and thus, preventing intracerebral hematoma progression in the acute phase. Conclusion - Since there is no proven alternative to idarucizumab, conducting randomized clinical trials would be unethical. Therefore, besides case reports, positive results of prospective studies could help us revise therapeutic guidelines, and thus, improve the prognosis of dabigatran-associated intracerebral hemorrhages.]

Lege Artis Medicinae

[The treatment of bleeding complications associated with anticoagulant therapy]

SCHLAMMADINGER Ágota

[The last few years have seen an increasingly widespread use of anticoagulant treatment. Not only is it applied in a wider range of diseases, but the duration of the treatment has also become longer on the basis of recent recommendations. Beside the traditional anticoagulant agents, coumarin and heparin, a new generation of anticoagulants has emerged in the past few years. These can be administered orally in a fixed dose, which will make anticoagulant treatment available for an even wider patient population. However, the more widespread use of anticoagulants will result in the growing occurrence of their most threatening adverse effect, bleeding. We summarize the treatment options for the bleeding complications in connection with the administration of the currently used anticoagulants and the available methods of their reversal.]