Lege Artis Medicinae

[The key to real change: management with IT]

BALOGH Nándor

AUGUST 28, 1991

Lege Artis Medicinae - 1991;1(14)

[I regretted the new electoral system. Forgive me for not running for office - I don't think we've got the point this time either. What I miss in the somewhat over-politicised (albeit democratic in appearance) system is a set of criteria and examination system that meets international standards. What are the main tasks of a director, what knowledge, qualifications and qualities does he or she need to have to perform them; how and by whom is the performance of his or her work measured? Of course, these last questions will be answered more precisely by the expected reform of the health sector, when it will become clear what external standards a hospital must meet.]

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Lege Artis Medicinae

[Laparoscopic surgery]

ANTAL András, BÁTFAI László, EZER Péter

[In the recent years abdominal surgery has developed quickly. Laparoscopic operating procedures have spread worldwide. These techniques have reached Hungary as well, though there are only few articles in this topic. Since last December - date of the first laparoscopic cholecystectomy – more than 200 operations have been done, among them the first appendectomy. These procedures are less troublesome for the patients with better cosmetic results, and the shorter period of hospitalisation and unability for work make economical advantages. First, the technical instruments and their usage, then personal coditions and the preparation programme are described. In the second part the usage of the new technique is summarized in cholecystectomy as well as in appendectomy. ]

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[Report of the American Society of Gastrointestinal Endoscopic Surgeons Postgraduate Course and Scientific Meeting]

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[This year's congress of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was held in Monterey, California. As a fellow of the Department of Gastroenterology at the University of Southern California, I was able to attend the congress with the support of Dr. Berci, Professor of Surgery at Cedars-Sinai Hospital.]

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[Quo vadis chirurgia biliaris?]

SÁNDOR József, IHÁSZ Mihály

[Mankind has suffered from the agony of gallstones for thousands of years. Until the second half of the last century, there was practically no cure, the only relief being spontaneous internal and external fistulas in the midst of great pain.]

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[Renal cell carcinoma in a horseshoe kidney treated with radical nephrectomy]

SZENTGYÖRGYI Ervin, KONDÁS József, KONDÉR Gyula

[A horseshoe kidney is diagnosed usually after the onset of its complication or the symptoms caused by an arising tumor from it. A tumour was diagnosed in the right half of the horseshoe kidney in a 68 year old female patient by excretory urography, ultrasound examination and renovasography. The tumour was removed by radical nephrectomy. The kidney was exposed through a horizontal abdominal approach. Special attention was given to the separate renal arteries supplying the right half of the horseshoe kidney and to the resection of the isthmus and also regional lymphadenectomy. In the diagnosis of a horseshoe kidney excretion urography had exclusively been used earlier but nowadays ultrasound is playing an increasingly important role. Reno vasography is usually needed only before resection or nephrectomy. The appropriate treatment of a horseshoe kidney tumour - in case of a well functioning contralateral kidney - is radical ablastic tumour nephrectomy including regional lymphadenectomy. ]

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[I. General principles before surgical treatment of epilepsy; II. The surgical investigation process; III. Indications for surgery]

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[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

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[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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Journal of Nursing Theory and Practice

[Identifying osteoporosis in a primary care setting with quantitative ultrasound]

HIRDI Henriett Éva, SZOBOTA Lívia

[Osteoporosis is one of the most under-diagnosed and under-treated health conditions. In recent decades, several risk indices have been developed to identify women at risk for low bone mineral density (BMD) who require a BMD test. This study aimed to demonstrate that quantitative ultrasound bone density measurement can indeed be performed simply by nurses working in primary care, which can significantly facilitate early detection of osteopenic and osteoporotic conditions. Method: The medical records of all patients who had an ultrasound of the left heel using the quantitative heel ultrasound machine between March 2021 through December 2021 were reviewed retrospectively. The subjects were 20-64-year-old adults (N=1032). Calcaneal quantitative ultra­sound parameters were registered with Sonost-2000 bone densitometer. The body composition was measured using a multi-frequency segmental body composition analyzer. The measurement results were evaluated with SPSS 22.0 statistical program and descriptive statistics. The mean age of the population studied was 43.12±9.6 years; 29.7% were men and 70.3% were women. Of the women in our study, 2.4% were osteoporotic (T ≤ −2.5), and 49.86% were classified as osteopenic according to the WHO operational definition. Osteopenic values were measured in 32.35% of men. A total of 273 subjects (26.45%) in the study sample were in the 50-64 age group (223 women and 50 men). 4% of women over the age of 50 had osteoporosis and 63.7% had osteopenia. Rating of the OST score no one was placed in the high-risk group. Of the 9 women with osteoporosis, 8 were classified as low-risk and 1 as medium based on OST. Nurses in primary care are able to identify key risk factors for osteoporosis, examine the measurement with quantitative ultrasound, and identify individuals with the disease. ]

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