Lege Artis Medicinae



APRIL 21, 2004

Lege Artis Medicinae - 2004;14(04)

[On the basis of relevant international literature the author presents the indications, contraindications, risks and results of the lung volume reduction surgery applicable in cases of therapyresistant end-stage COPD. These interventions, which require strong interdisciplinary cooperation of a pneumonologist, a thoracic surgeon, an anaesthesiologist and a physiotherapeutist were introduced in 1995 as a result of Cooper's study. A multicentric prospective study analysed the efficiency of this new surgical procedure. The results were evaluated in 2003 and it is important to be emphasised that in short term (3-6 months) and medium term (2-4 years) an improvement of lung function and of the quality of life can be observed in those patients who have heterogeneous emphysema, mainly in the upper lobe. Also, in case of homogenous emphysema this surgical procedure can be effective but perioperative mortality is higher and a deterioration in the health-state can occur as soon as six month after the intervention. The follow-up analyses of COPD patients with alpha- 1 antitrypsin deficiency show similarly moderate results. In Szombathely, Hungary 67 such interventions were carried out on 55 patients between 1997 and 2002, with a 4.4 % mortality rate which corresponds the international standard. Our own experience also supports the fact that in short and medium term the FEV1, RV, paO2, paCO2 and the quality of life take a positive change, the continuous O2-demand of patients will cease to exist and they regain parts of the former activity. The LVRS bears remarkable cost due to the use of staplers and surgical materials as well as longer hospital stay with the need of intensive care unit. Today in Hungary the LVRS is a realistic alternative in case of severe COPD to lung transplantation. The cost of an LVRS is maximum 10% of a lung transplantation. Patients having undergone an LVRS as well as patients unacceptable for LVRS may be suitable for lung transplantation.]



Further articles in this publication

Lege Artis Medicinae



Lege Artis Medicinae


KIS Zoltán

[Dendritic cells represent important components of the innate and adaptive immune responses. Human dendritic cells can be divided into two major subsets: myeloid and plasmacytoid (lymphoid) dendritic cells. The unique function of the dendritic cells is to capture antigens, present and to activate the antigenic peptides to the T lymphocytes. Dendritic cells go through a maturation process both in vitro and in vivo. By the use of pathogenrecognition- receptors the immature dendritic cells sense diverse pathogens or their various components, or cellular factors produced by the infected neighboring non-dendritic cells, and maturation signals are transduced for the dendritic cells. The heterogeneity of the pathogen-recognition-receptors and the microbial stimuli initiate a broad range of interactions between dendritic cells and infectious agents. Dendritic cells infected with certain viruses produce only a few infectious particles, but express and present viral antigens to T lymphocytes and immune response is initiated (influenza virus). Dendritic cells infected with certain pathogens not only initiate immune response but also disseminate the pathogen (human immunodeficiency virus, Mycobacterium tuberculosis). Some pathogens are killed in the dendritic cells, but the antigens are presented to the T cells, and immune responses are induced (Chlamydia trachomatis and Chlamydia psittaci). Dendritic cells capture antigens produced by infected neighbouring cells and present them to T lymphocytes, thus immune response is initiated (human cyto-megalovirus, herpes simplex virus). Dendritic cells are responsible for virus-induced immunosupp-ression; dendritic cells infected with certain pathogens form syncytia with T cells, thereby contribute to the suppression of T cell functions directed against opportunistic infections (measles virus). Dendritic cells can present not only foreign antigens but also self-antigens and when immature dendritic cells become mature upon exposure to inflammatory processes or to pathogens capable of activating them they can induce autoimmunity.]

Lege Artis Medicinae

[Preliminary concept of the bill on protecting personal genetic data, on genetic research, on genetic test, screening, and on the biobanks]


Lege Artis Medicinae


SAS Géza

[The widespread application of the LMW heparins promoted the prevention and therapy of the thromboembolic diseases in Hungary. Their propagation is mainly due to their simple clinical application and the active promotion of the producing pharmaceutical companies. However, the recommended “unnecessary” (in the reality the lack of) laboratory control may cause severe complications (bleeding, thromboembolism etc.) sometimes especially at the therapeutic application. For this reason, unfractionated (UF) heparin is advised in case of acute deep vein thrombosis when a patient is in the particular danger of bleeding because of its better controllability and the opportunity to stop anticoagulation immediately. In recent years, the indication of the long-term anticoagulation therapy expanded significantly. The number of patients is ever growing who need continuous anticoagulation because of atrial fibrillation or venous thromboembolic episode taken place earlier. Large randomised multicenter trials proved the efficacy of prolonged coumarin therapy in the prevention of recurrence of thromboembolic episodes in these diseases. Due to its advantageous pharmacological characteristics warfarin is especially suitable for the attainment of continuous anticoagulation. The direct thrombin inhibitor melagatran (and its orally applicable form, ximelagatran) may open a new era in the prophylaxis and therapy of the thromboembolic diseases. Its advantageous pharmacological characteristics and its simple application may make them to the antithrombotics of the future in case of a reasonable price and/or subsidisation.]

Lege Artis Medicinae



[Stroke is a highly prevalent disorder worldwide; it is the third main cause of death and the leading cause of severe disability. Recent data showed that 72-86% of cerebrovascular disorders are of ischaemic type. Arterial hypertension is the most prevalent risk factor for both haemorrhagic and ischaemic stroke, it is present in approximately 70% of cases. All forms of hypertension, isolated systolic or diastolic and combined hypertension increase stroke risk about 3-4 times and the relationship with systolic blood pressure may even be stronger than with diastolic blood pressure. Hypertension is very common after acute stroke. In this phase the cerebral autoregulation is disturbed in the region of focal brain ischaemia or haemorrhage such that cerebral blood flow is directly dependent on systemic blood pressure. It is therefore essential to avoid systemic hypotension in acute stroke patients and the reduction of high blood pressure may lower cerebral blood flow in the ischemic penumbra. Evidence from clinical data shows that control of blood pressure leads to lower risk of first or reccurent stroke and patients have shown beneficial effects especially of ACE inhibitors and diuretics. In the PROGRESS study both hypertensive and non-hypertensive cerebrovascular patients benefited from antihypertensive therapy. Previous results suggests that there may be additional beneficial effects of the ACEinhibitor therapy not related to blood pressure lowering in the prevention of stroke.]

All articles in the issue

Related contents

Clinical Neuroscience

[Disease burden of Duchenne muscular dystrophy patients and their caregivers]


[Background and purpose - Data on the disease burden of Duchenne Muscular Dystrophy are scarce in Hungary. The aim of this study was to assess patients’ and their caregivers’ health related quality of life and healthcare utilisations. Methods - A cross sectional survey was performed as part of the European BURQOL-RD project. The EQ-5D-5L and Barthel Index questionnaires were applied, health care utilisations and patients’ informal carers were surveyed. Results - One symptomatic female carer, 50 children (boys 94%) and six adult patients (five males) participated in the study, the latter two subgroups were included in the analysis. The average age was 9.7 (SD=4.6) and 24.3 (SD=9.8) years, respectively. Median age at time of diagnosis was three years. The average EQ-5D score among children and adults was 0.198 (SD=0.417) and 0.244 (SD=0.322), respectively, the Barthel Index was 57.6 (SD=29.9) and 53.0 (SD=36.5). Score of satisfaction with healthcare (10-point Likert-scale) was mean 5.3 (SD=2.1) and 5.3 (SD=2.9). 15 children were hospitalised in the past 12 months for mean 12.9 (SD=24.5) days. Two patients received help from professional carer. 25 children (mean age 11.1, SD=4.4 years) were helped/supervisied by principal informal carer (parent) for mean 90.1 (SD=44.4) hours/week and further family members helped in 21 cases. Correlation between EQ-5D and Barthel Index was strong and significant (0.731; p<0.01) as well as with informal care time (-0.770; p<0.01), but correlation with satisfaction with health care was not significant (EQ-5D: 0.241; Barthel Index: 0.219; informal care: -0.142). Conclusion - Duchenne muscular dystrophy leads to a significant deterioration in the quality of life of patients. Parents play outstanding role in the care of affected children. This study is the first in the Central and Eastern European region that provides quality of life data in this rare disease for further health economic studies.]

Lege Artis Medicinae

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]


[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

Clinical Neuroscience

[The quality of life of the cluster headache patients during the active phase of the headache]


[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Lege Artis Medicinae

[Pulmonary aspects of COVID-19 infection]

BÖCSKEI Renáta Marietta

[COVID-19 caused already the most serious pandemic of the past 100 years with increasing morbidity and mortality rates worldwide. Due to the aerosol-born virus, pneumonia develops in a significant part (ca. 20%) of patients with serious forms of acute respiratory distress syndrome (ARDS) ca. in 5-8% of all cases. For patients with chronic obstructive pulmonary disease, it is very important to save their well-controlled condition and to continue the maintenance therapy in co-morbid COVID-19 infection. The role of pulmonary exercises and rehabilitation is crucial. Thus, pulmonology outpatient clinics gained additional follow-up activities such as the long-term post-COVID care with complex functional assessments and regular structural imaging of discharged patients.]

Journal of Nursing Theory and Practice

Use of Imogene King’s Nursing Model in the Care for a Patient with Heart Arrhythmias


Objectives: To discover the benefits of implementation of Imogene King’s nursing model into nursing care in a patient with arrhythmias. To find out how these patients are limited in saturation of their own needs and what are the most severe limitations for patients with arrhythmias. Material and methods: Qualitative research using semi-structured interviews. The interview with patients with arrhythmia was conducted in accordance with the structure of King’s nursing model. Results: The research group consisted of 20 respondents; 13 men and seven women. All respondents expressed satisfaction with their cooperation with staff. The respondents described a change in the subjectively perceived state, the psychic state, and emotions. Conclusions: Assessment of the subjectively perceived quality of life of patients with arrhythmias using the King’s interaction model allows nurses to see the patient from the holistic point of view and plan and provide individualized care.