Lege Artis Medicinae

[Treatment of pneumothorax in cystic fibrosis]

CSISZÉR Eszter, CSEKEŐ Attila

MARCH 20, 2001

Lege Artis Medicinae - 2001;11(03)

[INTRODUCTION - More and more children affected by cystic fibrosis reach adulthood. The frequency of complications, such as pneumothorax, increases parallel with the long disease course. PATIENTS AND METHODS - The treatment of 17 manifestations of pneumothorax in 10 young adult cystic fibrosis patients in our institute was analysed retrospectively. RESULTS - Depending on the extension of pneumothorax and the clinical state of the patients the first choice of the treatment was observation alone in 6 cases, insertion of pleuracan in 3 cases and tube thoracostomy in 8 cases. Due to ineffective suction, thoracotomy was necessary in 6 patients, bilaterally in 3 cases. CONCLUSION - The outcome of conservative treatment even in "small, circumscribed pneumothorax" cases of symptom-free patients is uncertain and risky. Insertion of a pleuracan is recommended only in urgent, life-threatening cases, but definitive result should not be expected. If possible, chest drainage should be chosen as the first procedure. After 5-7 days of ineffective chest suction, thoracotomy is mandatory. Recurrence of the pneumothorax is direct indication for surgery. Antibiotic treatment is suggested for the duration of drainage, as well as for the surgical procedure.]

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Lege Artis Medicinae

[Antiatherosclerotic effect of ACE inhibitor drugs]

CZURIGA István

[Based on animal and human research data, it is likely that renin-angiotensin-aldosteron system has an important role in the pathogenesis and progression of atherosclerosis. It has been demonstrated in several large clinical trials that ACE inhibitors reduce the risk of ischemic events in patients with left ventricular dysfunction. Whereas some benefits of ACE inhibitors may be related to the lowering of blood pressure, other specific effects on vasculature have also been proposed. ACE inhibitors appear to possess unique cardioprotective and vasculoprotective properties even for patients without hypertension or left ventricular dysfunction. Recent data suggest that most patient with atherosclerotic cardiovascular disease should be considered for ACE inhibitor therapy, unless they are intolerant or have contraindication for the drug. The goal of this article is to review the data from clinical trials that support the anti-atherosclerotic and antiischemic effects of ACE inhibitors.]

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Lege Artis Medicinae

[The role of chief pathologist in training the new generation]

MAGYAR Éva

[INTRODUCTION - The present situation of pathology is disadvantageous, can even be considered critical in Hungary. There are not enough pathologists, the number of experienced, competent specialists is decreasing and young doctors do not prefer the specialty. We try to analyze the background of this situation based on our experience as tutors in medical education. METHODS - Participants of the annual fiveweek long exam preparation course took part in an anonymous survey. Based on this, we collected data on professional activity, working conditions and continuing education of young pathologists before their national specialist examination. Data were collected from the period 1991-2000. RESULTS AND CONCLUSION - Our experience suggest that chief pathologists of hospitals play key role for the future existence of this specialty in Hungary besides financial appreciation of the specialists. For successful replacement of elder colleagues with young specialists the task is threefold: 1. Getting young doctors acquainted with the specialty and help them prepare for the national exam. 2. In case of young specialists, professional support through continuous education as well as career-preserving support is necessary. 3. Choosing the best possible successor among colleagues for the position of chief pathologist and helping to prepare for this task.]

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[Background and purpose - Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. Methods - Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. Results - Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. Conclusions - According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.]

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[The cornerstone of the therapy of most tumors is still the resecability of the primary tumor: if the cancer can be removed, the chance for recovery will signifi cantly increase. The development of the complex oncologic therapy lead also to the headway of metastasis surgery that used to be a rarity few decades ago. Based on the fi ndings of recent molecular genetic research and multimodular oncologic treatment it was found in more and more tumors that the removal of their metastasis shows benefi t for patients with advanced disease. In order to operate metastatic disease successfully extensive surgical experience and the knowledge of the tumors biologic behavior are required. Thus, the continuous interdisciplinary cooperation and the role of the oncoteam are essential to correct therapeutic decisions. In this review we discuss the possible surgical interventions of abdominal hematogenous metastases of different tumors.]

Lege Artis Medicinae

[Treatment of chronic Pseudomonas aeruginosa lung infections in cystic fibrosis with inhaled tobramycin]

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[BACKGROUND - Intermittent or chronic pulmonary infections caused by Pseudo­monas aeruginosa (Pa) deteriorate clinical status and worsen lung function in patients with cystic fibrosis (CF). The prognosis of the disease and life expectancy of patients are substantially dependent on lung infections and inflammation; therefore the primary goal of the treatment is the early termination of the infection. PATIENTS AND METHODS - Efficacy of tobramycin (TOBI® 300 mg/5 mL solution for inhalation, henceforth TOBI®) inhalation in Pa pulmonary infections was studied in a non-interventional, observational, open-label, single-arm trial in subjects with CF. Fifty-three patients aged six to 31 years (averaged 15.8 years) were enrolled into the study. Three treatment cycles of TOBI® inhalation (28 days on drug, 28 days off drug) plus 6 months observational period were evaluated. Primary endpoint was changing in the predictive values of forced expiratory volume in 1 sec (FEV1) compared to the initial values after three cycles of the treatment. Secondary endpoints were changing in the FEV1 predictive values at the end of the complete study compared to the initial values; ratios of patients with decreased density of originally Pa-positive result of sputum culture; as well as safety and tolerability of the TOBI® treatment. RESULTS - FEV1 and FEV1% results were unchanged comparing to the initial values at the end of the treatment and after the observational period in the whole study population. However, sputum cultures became negative in 47.2% of all subjects as a result of the treatment, and the FEV1 values were gradually increased in these patients: after the third treatment cycle plus 160 mL, and at the end of the study plus 110 mL comparing to the initial values. Similar considerable increase was detected in the predictive FEV1% in this sub-group: after the first cycle plus 5.2%, at the end of third cycle plus 7%, after the observational period above 3.8% considering the starting results. CONCLUSIONS - TOBI® inhalation proved to be effective in improvement of lung function results and eradication of infection in our patients with Pa positive CF. The treatment was well tolerated and safe.]

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Attitude of spine surgeons towards the application of 3D technologies - a survey of AOSpine members

ÉLTES Endre Péter, KISS László, BARTOS Márton, EÖSZE Zsolt, SZÖVÉRFI Zsolt, VARGA Pál Péter, LAZÁRI Áron

Background - 3D technologies (3D virtual and physical model, 3D printing, computer aided engineering, finite element analysis based simulations) play an important role in personalized spine surgery. Objective - In collaboration with AOSpine a global, online survey-based study was performed in order to determine the acceptance rate and the factors which stand against the wider spread of 3D technologies. Methods - A survey containing 21 questions was developed and divided into five pages, every page corresponding to one chapter. Our analysis is based on the responses of 282 spine surgeons from 57 countries. To interpret our results in a global context, we used the Human Development Index of the respondent's countries in comparisons. Results - Significant difference between the AOSpine regions (p ≤ 0.05) was found, with the highest acceptance in Asia-Pacific region. There was no significant difference in acceptance score according to the field of spine surgery, or the surgical experience in years (p=0.77, and p=0.19). In the case of public practice, we found significantly higher acceptance compared to private and mixed (public and private) surgical practice (p ≤ 0.05). The acceptance of the technology varied based on the respondent’s resident country’s Human Development Index and was significantly different between „Medium” vs “Very high” (p = 0.0005) and „High” vs „Very high” (p=0.019) category. Significant positive correlation was found between the acceptance score and the HDI score (Spearman test, ρ = 0.37, p = 0.007). The main limitation factor was identified as the lack of information. Conclusion - There is high interest among spine surgeons towards the incorporation of 3D technologies into the clinical practice. Education, the healthcare system, and the economic environment plays a major role in acceptance. Our results provide the basis of a strategy to promote the application of 3D technologies.