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Lege Artis Medicinae

OCTOBER 20, 2018

[Does venous congestion decrease renal function - fiction or real?]


[Venous congestion can result in dysfunction of several organs. Although experimental data on renal dysfunction caused by venous congestion were already published about 90 years ago, those were difficult to extrapolate to humans, due to significant interracial differences. Acute pre-renal, or volume-sensitive kidney injury might respond to volume replacement; however, overt fluid resuscitation with or without right ventricular dysfunction can result in elevated central venous pressure. The glomerular capillary blood pressure, i. e. net filtration pressure in a single glomerulus is about 10 mmHg. Kidney dysfunction can both increase intra-abdominal pressure or elevate central venous pressure with or without decreased mean arterial pressure, can lead to renal dysfunction. In studies among patients with heart failure, or after cardiac or abdominal surgery, the increase of central venous pressure or intra-abdominal pressure above 8 mmHg resulted in impaired kidney function. This review summarizes both pre-clinical and clinical data on the role of intra-abdominal hypertension and venous congestion in the development of acute kidney injury.]

Clinical Neuroscience

MARCH 30, 2018

A case with angiographic demonstration of isolated anterior spinal artery occlusion

DOGAN Burcu Vasfiye, KARA Batuhan, SELCUK Hatem Hakan, DIRICAN Ceyhan Ayten, KOKSAL Ayhan

Anterior spinal artery syndrome (ASAS) is a rare syndrome which occurs due to thrombosis of anterior spinal artery (ASA) which supplies anterior two thirds of the spinal cord. A 27-year-old female patient was admitted to emergency clinic with sudden onset neck pain, sensory loss and weakness in proximal upper extremities which occurred at rest. Thrombophilia assessment tests were negative. Echocardiography was normal. Serum viral markers were negative. In cerebrospinal fluid (CSF) examination, cell count and biochemistry was normal, oligoclonal band was negative, viral markers for herpes simplex virus (HSV) type-1 and type-2, Brucella, Borrellia, Treponema pallidum, Tuberculosis were negative. Diffusion restriction which reveals acute ischemia was detected in Diffusion weighted MRI. Digital subtraction angiography (DSA) was performed. Medical treatment was 300mg/day acetilsalycilic acid. Patient was discharged from neurology clinics to receive rehabilitation against spasticity.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2017

[Advantages of the bevel down puncture technique]

SOMOSI László, KISS Szilvia, LADÁNYI Erzsébet

[The arterio-venous fistula is also called the dialysis patient’s lifeline. The name lifeline stands for the essential connection between the body and the dialysis machine. Keeping it in good condition is very important, because fistulas play a keyrole in the successful dialysis treatment. Fistula care is indispensable both from the nurse and patient side. The dialysis team is responsible for the fistula puncture and care. We introduced the bevel down puncture technique in November of 2011 for better arterio-venous shunt care. Our dialysis nurses were trained on the correct position of the fistula needle. We emphasised the benefits and long-term effects. We use this technique for all patients, except for the first fistula puncture. The bevel down puncture technique reduces the patient’s fear of fistula puncture as it causes less pain. After removal of the needle, the bleeding time decreased from the approximate 6-7 minutes to less than 5 minutes and bleeding volume is also decreased. It also reduces the size of the scab and the aneurysm formation. In our dialysis unit we have had good experiences with the bevel down puncturing technique, as it kept our patients’ fistulas in good condition, this may prolong vascular accesses lifetime.]

Clinical Neuroscience

MAY 30, 2017

Independent validation of the Quality of Life in Essential Tremor Questionnaire (QUEST)

KOVÁCS Márton, MAKKOS Attila, JANSZKY József, KOVÁCS Norbert

Quality of Life in Essential Tremor Questionnaire (QUEST) was specially developed for essential tremor population to measure the health-related quality of life. Besides the development of the Hungarian version, we performed an independent testing of the scale adding further information on its clinimetric properties. In this study 133 ET patients treated at University of Pécs, Hungary, were enrolled. Besides QUEST, we assessed Patient’s Global Impression-Severity (PGI-S) and Fahn-Tolosa-Marin Tremor Rating Scales. After the independent validation in accordance to the Classic Theory of Tests, we evaluated cut-off values for detecting clinically meaningful ET-related disabilities based on receiver operating characteristics analysis. Cronbach’s a was 0.897. QUEST demonstrated high convergent validity with PGI and divergent validity with disease-duration, positive family history, need for deep brain stimulation surgery, and the presence of depression and anxiety. Presence of moderate ET-related disabilities was identified by scores > 11.25 points on QUEST-SI (sensitivity: 77.4%, specificity: 83.3%); whereas scores > 20.35 points indicated severe ET-related disabilities (sensitivity: 83.3%, specificity: 59.1%). We demonstrated that the fundamental clinimetric properties of the QUEST are satisfactory.

Clinical Neuroscience

MAY 30, 2017

The role of the insula in the parieto-frontomedial epileptic network. Clues from successful surgical treatment

BALOGH Attila, AIMEN Anwar, KELEMEN Anna, ERÕSS Loránd, FABÓ Dániel

We present a case of MRI negative SMA seizure with the seizure onset zone in the secondary leg area on the superior bank of the Sylvian fissure, localized with multiscale electro-clinical and neuroradiological examinations. The 34-year-old female patient’s intractable epilepsy started at age 14. She had diffuse pain aura in her left leg followed by tonic posturing with fully preserved consciousness suggesting parieto-fronto-medial seizure propagation. Her daily nocturnal SMA seizures became drug-resistant. Multiple 3T MRI images and neuropsychological evaluations were normal. Interictal PET detected a right parietal and insular FDG hypometabolism. The seizure onset zone and the symptomatogenic zone were localized by invasive electrophysiology. The insular deep electrode showed the propagation of ictal activity with an onset in the secondary sensory leg area through the insula to the fronto-medial surface. Eighteen spontaneous seizures, electrical cortical stimulation and cortical mapping confirmed the designated area of the resection, which was later proved macroscopically abnormal during surgery. The histological and immunohistological workup confirmed focal cortical dysplasia (IIb type). Postoperative postprocessing morphometry of the preoperative MRI study confirmed the lesion in the right inferior parietal lobe. The patient remained seizure free after surgery for more than 4 years, and medication free for the last two years. Our results concluded that the insula has a „relay” or „node” function in the parieto-opercular-fronto-medial epileptic network. The insular functional connectivity predisposed frontal propagation of the epileptic activity in the connectome of her epilepsy. The three-way insular structural connectivity has determining function on the seizure propagation.

Clinical Oncology

SEPTEMBER 15, 2016

[Intersphincteric resection for low rectal tumors]


[The technical development of rectal surgery, together with chemo- and radiotherapy, improved the effi ciency of surgical intervention as well as the patients‘ survival and quality of life. The treatment of ultra deep malignancies - 2-3 cm from linea dentata - is a real challenge for rectal surgery. Before the introduction of laparoscopy the removal of the deep tumors with conventional surgical techniques was impossible to save the tumorous rectum. The new techniques made possible the ultra deep resection, i.e. the removal even those tumors which progressed until the linea dentata. The explosive use of laparoscopy and the new waves of chemo- and radiotherapy resulted signifi cance advance contributed to an interdisciplinary therapeutic approach, which is a well adapted method in deep rectal surgery. In case of ultra deep localization of tumors - 0.5-1.0 cm to linea dentata - the neoadjuvant therapy supported the saving the anal sphicter. This new techniques contributed to the preservation of feces continentia of the patient.]

Clinical Oncology

DECEMBER 10, 2016

[Long-term central venous access devices in oncology]


[Long-term central venous access devices are essential in the management of oncology patients, as they minimize the discomfort caused by frequent venipuncture and cannulation. Indications of application of central venous accesses, possibilities of implantations, immediate and long term complications, they prevention and obviation has been reported based on guidelines and relevant publications. Long term implantable central venous accesses handled by well-trained and exercised team, working with principles of maintenance, these manipulations are effective and safe, therefore suitable in oncological practice.]

Lege Artis Medicinae

AUGUST 20, 2016

[Catheter related infection caused by Rhizobium radiobacter in hemodialysis patient]

SÁGI Veronika, OROSZ Attila

[INTRODUCTION - Rhizobium radiobacter is a rare opportunistic pathogen. The bacteria present in soils causes systemic infection mostly in immuncompromised patients and frequently forms biofilm on intravascular and other indwelling plastic catheters. Majority of the pathogen stems shows sensitivity to cephalosporins, carbapenems and ciprofloxacin. CASE REPORT - In case of our hemodialysis patient a vegetation developed on the tip of the tunneled central venous catheter. The patient was exposed to dust emerging from soil during agricultural work before the infection. After removal of the intravascular device and ceftazidim treatment for seventeen days the patient recovered. CONCLUSION - Overcoming the infection is in greater part of the cases only possible if the plastic device is removed because it forms an infective focus.]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2016

[Care of the fistula, advantages of the monitoring and the surveillance with thermodilution technique]


[Introduction: The best choice of vascular access for haemodialysis patients is the native arteriovenous fistula (AVF). Therefore, monitoring and surveillance of vascular accesses has a high priority. Aim of the research: The aim of our study was to evaluate the AVF surveillance protocol of our dialysis clinic. Research and sampling methods: We began AVF monitoring and surveillance in our dialysis clinic in February 2003. Until May 2015 we evaluated the data of 307 patients. Results: Besides the regular physical investigation of fistulas we performed measurements of vascular access flow (Qa) with thermodilution technique. In cases of suspected stenosis we performed Colour Doppler Ultrasonography and/or fistulography. Stenosis was verified in 154 cases at 344 patients. Percutan transluminal angioplasty was performed in 241 cases at 127 patients. Creation of a new fistula was necessary only in 24 cases at 21 patients. Within the last three years the percentage of patients treated via AVF has risen from 75% to 84%. Conclusions: Regular monitoring and surveillance of vascular accesses and the timely correction of its complications are able to reduce thrombosis of fistulas and the necessity of using central venous catheters. ]

Clinical Oncology

MAY 20, 2014

[Thromboprophylaxis in cancer patients]


[Cancer- and chemotherapy-associated venous thromboembolism (VTE) is a serious complication in patients with malignancies. Most important questions and challenges are summarized in the review and an attempt is made to answer some of them. Epidemiology, causes of thrombophilia and risk factor analysis including thrombogenicity of both tumorous disease and chemotherapy are discussed. The following special risk groups are detailed: (a) postoperative, (b) hospitalized non-surgical patients, (c) ambulatory patients with chemotherapy, (d) tumorous patients without chemotherapy. As conclusion, most important messages of the recent guidelines for preventing and treating cancer-associated thrombosis are discussed.]