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Clinical Oncology

DECEMBER 30, 2019

[Prevention and treatment of venous thromboembolism in cancer patients]

[Venous thromboembolism (VTE) is a common and severe complication of cancer. Deep vein thrombosis and pulmonary embolism are the second most common cause of death in cancer patients. Cancer, tumor-related factors as well as patient’s general condition and comorbidities are responsible for the increased risk of VTE. Chemotherapy is one of the most important risk factors for VTE, increasing incidence of VTE by 6.5-fold. In my paper, current guidelines for cancer VTE prevention and treatment are reviewed. Hospitalized patients with active tumor are at higher risk for VTE, and thrombosis prophylaxis is recommended in all cases. Extensive, routine prophylaxis for advanced cancer patients receiving chemotherapy is not recommended, but may be considered in high-risk ambulatory cancer patients (Khorana-score ≥ 3). Risk factors may change during the course of cancer disease, and the score should be continually reviewed and prophylactic treatment changed as necessary. LMWH is the recommended agent for both primary and secondary prophylaxis/treatment. Direct oral anticoagulants (DOACs) are knocking on our door, but results from further clinical trials are pending to determine their exact role.]

Clinical Oncology

AUGUST 30, 2019

[Electrochemotherapy]

KIS Erika Gabriella

[Tumors with standard electrochemotherapy (ECT) has raised over the past decade from skin cancers to locally advanced or metastatic tumors. The procedure became a reliable alternative of other local tumor ablation methods, because of its patient tolerability, effi cacy across histotypes, and repeatability. ECT is based on the physical phenomenon of reversible electroporation; short electric pulses are applied to tumor nodules to achieve transient cell membrane permeabilization to otherwire poorly permeant chemotherapy drugs, which consequently increases cytotoxicity. At present recognized indications include superfi cial metastases of malignant melanoma, breast cancer, head and neck skin tumors, Kaposi sarcoma, primary and recurrent nonmelanoma skin cancers, and in well-selected patients mucosal oropharyngeal cancers. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, certain benign skin lesions, and the combination of ECT with systemic immunotherapy. Thanks to the technical developments, the new ECT indications are deep-seated tumors, including bone metastases, liver malignancies, pancreatic and prostate cancers with the use of long needle variable geometry electrodes. Herein we review the present status of ECT from the basic principles to emerging applications, and report the effi cacy of standard ECT across histotypes.]

Clinical Neuroscience

JULY 30, 2020

[Objective measurement of manual dexterity of Parkinson patients operated with DBS]

SZÁNTÓ Ildikó, SÁNDOR Balázs, KATONA Krisztián, NAGY Máté, JUHÁSZ Annamária, BALÁS István

[The evaluation of hand dexterity is an important marker for the success of DBS (deep brain stimulation) operation in patients with Parkinson’s disease. In this study we applied a simple, semiquantitative optical dental plaque staining technique for the evaluation of the hand dexterity. Ten patient with Parkinson’s disease were involved in the study. After dental students aided tooth brushing, bacterial dental deposits (plaque) were stained then photographed, and quantified under standard conditions before and after DBS surgery. Our results showed a significant decrease in dental plaque deposits after DBS operation. This simple technique seems to be a routinely applicable marker for the evaluation of the hand dexterity. Our future plans is repeating the previous experiement on a higher number of cases.]

Clinical Neuroscience

NOVEMBER 20, 2015

[Sleep disordered breathing and epilepsy: relationships and therapeutic considerations]

FALUDI Béla, BÓNÉ Beáta, KOMOLY Sámuel, JANSZKY József

[The importance of the sleep related breathing disorders (obstructive sleep apnea syndrome, central sleep apnea, and Cheyne-Stokes breathing) in the pathophysiology crebro- and cardiovascular disorders is well known. The relationship of sleep related breathing abnormalities and epilepsy is also important but underestimated in the daily practice. The relation is bidirectional. The breathing abnormalities in sleep may play important role in generating epileptic seizure, but the adverse effect of seizure and antiepileptic therapy (generation of apneas and hypopneas) may worsen the seizure control. The effect of new therapies (vagal nerve and deep brain stimulation) on the sleep architecture and sleep disordered breathing must be examined and discussed. Here we present a brief case of epileptic patient with deep brain stimulation therapy on sleep as well. The examination of the sleep related breathing abnormalities in epilepsy patient may help improve the effectiveness of antiepileptic therapy.]

Clinical Neuroscience

NOVEMBER 20, 2015

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2019

[Conference Report: Pressure and venous ulcers’ wound care in a simulated learning environment ]

KORPONAI Zsófia, TÓTH Júlia, LŐRINCZ Attila

[Department of Nursing of Faculty of Heath Sciences Semmelweis University is a part of an international collaboration. The aim of the co-operation of 5 european universities is to labour an online theoretical and a simulation-based practical curriculum to improve the chronic wound care knowledge of nursing students and health care workers. 4th year nursing students presented the results of their research at the first international conference of the co-operation in december of 2018, in Istanbul. ]

Clinical Neuroscience

MARCH 30, 2020

[Intracranial EEG monitoring methods]

TÓTH Márton, JANSZKY József

[Resective surgery is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. Intracranial EEG (iEEG) is necessary if the seizure-onset zone is localized near to an eloquent cortical area, or if the results of presurgical examinations are discordant, or if an extratemporal epilepsy patient is MRI-negative. Nowadays, 3 kinds of electrodes are used: (1) foramen ovale (FO) electrodes; (2) subdural strip or grid electrodes (SDG); (3) deep electrodes (stereo-electroencephalographia, SEEG). The usage of FO electrode is limited to bitemporal cases. SDG and SEEG have a distinct philosophical approach, different advantages and disadvantages. SDG is appropriate for localizing seizure-onset zones on hemispherial or interhemispherial surfaces; it is preferable if the seizure-onset zone is near to an eloquent cortical area. SEEG is excellent in exploration of deeper cortical structures (depths of cortical sulci, amygdala, hippocampus), although a very precise planning is required because of the low spatial sampling. The chance for seizure-freedom is relatively high performing both methods (SDG: 55%, SEEG: 64%), beside a tolerable rate of complications.]

Lege Artis Medicinae

MARCH 10, 2020

[Summary data of Hungary's comprehensive health screening program (MAESZ) 2010-2019]

BARNA István, KÉKES Ede, HALMY Eszter, BALOGH Zoltán, KUBÁNYI Jolán, SZŐTS Gábor, NÉMETH János, PÉCSVÁRADY Zsolt, MAJOROS Attila, DAIKI Tenno, ERDEI Ottilia, DANKOVICS Gergely

[The comprehensive screening program of Hun­gary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free scree­ning tests for all residents in Hungary. The program developed by 76 pro­fessional organizations offers 38 scree­ning tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. More­over, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol con­sumption, physical inactivity, un­healthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of fami­lies. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hun­garian citizens to be informed about their health status and to reminds them of the importance of prevention. ]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[The effect of an alternative training method on the pelvic floor muscle]

ARANYNÉ Molnár Tímea, SZABÓ Kinga, RÁZSÓ Katalin, DOMJÁN Andrea, SZŰCS Mónika, SURÁNYI Andrea, BÓDIS József

[Aim: In our study we analysed an alternative training method alone or in combination with pelvic floor muscle (PFM) with deep abdominal muscle strengthen the PFM better. Material and Methods: The study was conducted on women (n=5, mean age ±SD: 51,8 years, ±9,23 years). The Callanetics® gymnastics consisted of training sessions of 2x1 hours (10 weeks only Callanetics® exercises, 10 weeks in combined with PFM contractions). The subjects completed a questionnaire (risk factors, symptoms) and to measure the body parts’ circumference at 0. and 20. weeks. The measurement of the conditional capacitance of the PFM was performed by EMG before the gymnastics, then at weeks 10 and 20. We used R Statistics Software. Results: Significant decreseing were observed in the circumference of extremities and on isometric contraction improves (p=0.036). The dynamic strength showed an increasing tendency. Conclusion: The alternative training method significantly increased the maximum contractions of the PFM.]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[The effect of whole body electrostimulation for the pelvic floor muscles ]

ARANYNÉ Molnár Tímea, NAGY Edit, DOMJÁN Andrea, FEKETE Zoltán, SURÁNYI Andrea, BÓDIS József

[The aim of the study: Few studies research the effects of trunk stabilizer muscle strengthening on pelvic floor dysfunctions. We assessed a new core strengthening method on the pelvic floor muscles. Material and method: Female patient (70 years) with stressincontinence and low back pain received the Whole Body Electric Muscle Stimulation for 10 weeks (2x25 minutes/week). The EMG (for the conditioning ability of pelvic floor muscle such as maximal isometric contraction, dynamic endurance and relaxation values), urodynamic assessment, introitus and the transabdominal ultrasound were used before and after training. Results: The patient’s the stressincontinence, low back pain and the conditioning ability of pelvic floor muscles improved. The urodynamic and ultrasounds values showed improvement in functions of the bladder neck and deep abdominal muscle. Conclusion: This method would increase the trunk stabilization and pelvic floor muscle strength of the eldery age group, which might decrease the prevalence of urinary incontinence.]