Lege Artis Medicinae


OCTOBER 20, 2004

Lege Artis Medicinae - 2004;14(10)



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Lege Artis Medicinae



[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.]

Lege Artis Medicinae

[Minimally invasive hip replacement surgery]


Lege Artis Medicinae


JELENIK Zsuzsanna

[The author deals with the current situation and new trends of vaccinology by focusing on the interests of practitioners. The main topics are the changes of antigens (such as pertussis, measles, or poliomyelitis) to provide better efficacy and milder reactogenity or less adverse events. Purifying the vaccines, like thiomersal and human proteins free vaccines is another proven method to achieve better safety. New antigens e.g. Rota, Lyme, meningococcus B are in the pipeline of vaccinology. The aim of producing a combined vaccine is to achieve immunity against more diseases with less inconvenience for the patient, while achieving higher vaccine coverage (DPT-Hib-HBV-IPV). The epidemiological and clinical experiences will influence the current vaccine schedule such as revaccinations of MMR, and remove the need for revaccinations of BCG and hepaB. The special target groups of immunizations are the elderly and patients with chronic disease. Groups of specialists are working on the vaccine recommendation guidelines for certain risk groups. At the same time, with the successful eradication of polio in Europe the practitioners now have to face the antivaccination movement, as well. The main tools to convince people about the benefit of vaccinations are health education and information.]

Lege Artis Medicinae


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


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.]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

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[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Clinical Neuroscience

[A visual based proto-consciousness model of human thinking]

SZŐKE Henrik, HEGYI Gabriella, CSÁSZÁR Noémi, VAS József Pál, KAPÓCS Gábor, BÓKKON István

[Background and objectives – Here we present our results of many years of research on the visual (pictorial) representation model expanded with some new ideas in a simplified form. Our goal is to make available our new pictorial model for a broader scientific community and to point to its possible importance in the future. Method – Own scientific publications, selective literature analysis and preliminary experiments. Results – Our several scientific publications and preliminary experiments were presented outlining our new molecular visual representation model as brain might be able to generate internal images by regulated biophotons in early V1 retinotopic visual regions. We also proposed that some of symptoms and characteristics of autism and savantism may suggest that visual (pictorial) thinking might be a possible cognitive model in the case of healthy people as well. Our model can present a uniform molecular basis for many visual related phenomena. Conclusions – It is possible that a so-called visual proto-consciousness might be developed in evolution, which is directly related to the retinotopic visual areas, and which has a different cognitive ability from verbal abilities. If our model can be exactly proved it presents a common molecular basis for various visual phenomena such as visual perception and imagination, phosphenes ect. and might open new ways in several fields of science such as visual prosthesis for the blind, artificial intelligence, visual neuroscience, cognitive and autism research.]

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TAKÁTS Annamária