Lege Artis Medicinae

[THE SIGNIFICANCE OF THE CARE OF CHILDREN WITH CLEFT LIP AND PALATE IN THE GENERAL PRACTICE]

HIRSCHBERG Jenő

OCTOBER 20, 2004

Lege Artis Medicinae - 2004;14(10)

[The cleft lip and palate (i.e. facial cleft) is a frequent and distorting abnormality. The basics of the successful management are the early introduction of therapy and a well-trained team with all relevant specialists included (surgeon, otolaryngologist, orthodontist, speech therapist) as well as good collaboration with the parents and general practitioners being also an important factor. The author with his co-workers has performed more than 6000 surgeries in about 3500 children with facial cleft in the last 45 years and has treated 60-70 patients annuallly with velopharyngeal insufficiency without cleft. According to his experience and international data he summarizes the etiology, pathomechanism of facial clefts and discusses its symptoms, functional consequences and the surgical and conservative solutions are suggested. The recent Hungarian prevalence is 1:500. Specific prevention does not exist, the 5-6% recurrent cleft risk may be decreased to half by administration of folic acid. The generally accepted timing of the lip plasty is the 3-month age. The palatoplasty may be performed in one or two stages, but closure of the velum should be made before the development of speech by all means. The logopedic treatment (speech therapy) should be started, if the speech disorder is already obvious and the child is able to cooperate with the speech therapist. If conservative therapy is unsuccessful, (velo)pharyngoplasty is proposed at the age of 5. The orthodontic treatment should begin in mixed dentition, major nose correction and oral surgery are allowed only after puberty. Just because of a cleft the infant does not aspirate, the brestfeeding is beneficial and could be performed in most cases. Regular hearing control is recommended because of frequent ear and hearing problems. It is suggested to provide the parents with written instruction about outcome, prognosis and timetable of management, which could be helpful also for the general practitioners.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[13th European Stroke Conference]

KÁPOSZTA Zoltán

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.]

Lege Artis Medicinae

[CURRENT PRACTICAL VACCINOLOGY]

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

[REVERSAL]

MATOS Lajos

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.]

All articles in the issue

Related contents

Hypertension and nephrology

[The importance of recognition and proper treatment of hypertension and the maintenance of adherence in hypertension care]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Hypertension is the leading cause of death and disability-adjusted life years. In the United States hypertension accounts for more cardiovascular (CV) deaths than any other modifiable CV disease risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In our country the situation is similar. In Hungary the number of subjects with hypertension is approximately 3.5 million and this high prevalence contributes markedly to the poor Hungarian CV morbidity and mortality figures. The recognition of hypertension, the initiation of drug therapy and the long-term follow- up of the patients is mainly the task of primary care. Besides that it inheres high responsibility, this is also a grateful commitment, as hypertension in most of the cases can be treated properly with lifestyle-changes and medications leading to a marked decrease of CV complications, especially stroke. In our review article we would like to focus on the high prevalence of hypertension worldwide as well as in our country, the exact implementation of screening, the risk reduction potential of the proper treatment and the importance of the long-term maintenance of treatment adherence.]

Lege Artis Medicinae

[REHABILITATION OF HEARING IMPAIRMENTS WITH HEARING AIDS IN CHILDREN AND ADULTS - INDICATIONS, POSSIBILITIES, CARE]

REJTŐ Kálmán

[The early diagnosis of the different types of hearing impairments and the adequate surgical or conservative therapy have changed in the last decades. Up-to-date objective audiological methods (otoacustic emission, auditory brain stem potentials, audiotory steady state potentials) and genetic laboratory examinations help us in the diagnosis of the congenital hearing impairments. Formerly, only patients with the different diseases of the middle ear consisted into the group for surgical rehabilitation but recently this has been completed with middle ear implantation of different types as well. In cases of sensoryneural hearing impairments of severe degree cochlear implantation is now possible and in the case of severe impairments nerve VIII brain stem implantation can be performed. The high level of the technical development brought revolution in the rehabilitation with hearing aids as well. The new digital technology, the sizes of the hearing aids, good cosmetic and excellent functional results help the medicaltechnical team in the optimal fulfilment of the demands and expectations. In the process of the complex rehabilitation with hearing aids, the exact diagnosis, the fitting of the proper hearing aids with individual ear moulds, the teaching and training and the care of the patient will bring the expected result.]

Lege Artis Medicinae

[Why is it important and ethical to treat anxiety patients?]

RADICS Judit

[The identification of anxious patiens is not always an easy task. The diagnose is clear in that case, when the symptoms (psychic or somatic) are evident or/and patients complain about anxiety. Anxiety itself is not a pathological symptom if it is adequate in strength and duration. Anxiety reactions have large individual variety -, they are pathological if inadequate and irrelevante and don’t match with the actual situation. According to epidemilogical data one third of patients of family doctors suffer from anxiety but somatic symptoms come to the front, so the patients participate in a great number of medical examinations. It is important to emphasise that medical examinations are necessary to preclude the possibility of any somatic disease. The di­ag­nostic criteria of DSM-5. are an excellent assistance for a good diagnosis. Anxiety is a risk factor for cardiological diseases and diabetes mellitus. The prevalence of anxiety disorders are 12.6-17.2%. Anxiety di­sorders are well-manageable, they need complex therapy: benzodiazepines, antidepressants, hypnotics and psychotherapy. They frequently co-exist with depression and insomnia so they have to be treated together. ]

Lege Artis Medicinae

[Screening for depression and suicidal risk in family and general medical practice]

RIHMER Zoltán, SZILI Ilona, KALABAY László, TORZSA Péter

[According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 percent in general practice. As un­treated depression is the most important risk factor for suicide, early detection and effective management of depression (especially depression which predisposes sui-cide) are critical in prevention. According to international and national studies the re-cognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we present two short questionnaires used for re-cognising depression and acute suicide risk and we describe their use in family/ general practice. We aim to raise awareness of the need of a systematic, nationwide sui-cide prevention programme which is supported on government level as well. ]

Journal of Nursing Theory and Practice

[The Prastige and Values of Nurses and Caregivers employed in the Social Service System]

SZŰCS Anett

[Aim of the study: During the study my target was to identify the career motivations, prestige of caretakers and nurses working in the Gödöllő social services and get acquainted with the most important values in their life. Sample and methods: Descriptive type research, number of elements are 81 (n=81). Summarization of the data was executed by Microsoft Office Excel 2007. Results: The employees took part in the research considered their profession as relatively low prestigious, although they would choose again this profession if they could decide again. Supporting professionals consider health, family, friendship and affection as the most important value in their life. Conclusions: The nursesand caretakers interviewed by me consider their choice of career successful in spite of its low prestige and they like their profession. Recognition the values of the employees is an important objective, because the identified values determine the quality of the work they perform.]