Search results

Journal of Nursing Theory and Practice

AUGUST 30, 2015

[Investigation of the factors infl uencing among members of the care team in terms of the identity of the leadership]


[Aim of the research: The objective of the research is to map the different subcultures, examine in detail the role of subgroups and the influencing factors that are determining the relationships between the members of the Institution’s healthcare provider teams. Research and sampling methods: Data and information collection was advisedly planned, guided and implemented with help of personal communication techniques. With regard to the final form of data collection method based on standardized preliminary research plan, I’ve selected partly structured and unstructured interview forms, with closed and open questions. The analysis was performed by interviewing 10 chief physicians and 10 head assistants. Results: 100% of the interviewed leaders related that competencies are determined primarily by skills, human attitudes and personality. The analyzed subjects confirmed that well defined expectations expressed by leaders and open communication is enhancing the close co-operation between team members and is reducing hereby the work stress. The investigation underpinned that good co-operation of team leader couples, or lack of co-operation has strong impact on the team’s performance and on the relationships between team members. Conclusions: Identifying, understanding and handling our own or other people feelings, the behavior with our fellow creatures is matter of emotional intelligence, and not of cognitive capability. With help of deep interviews, valid facts, leadership manners, management of conflict situations were identified and pointed at the influencing factors of department’s micro culture and the work atmosphere of the organization. Diversity of the work, rate of workplace monitoring, rate of qualifications and skills required for the job, quality of interpersonal relationships are contributing to workplace satisfaction and the evolution of team spirit among colleague ]

Lege Artis Medicinae

DECEMBER 15, 2015

[Actual questions of the longterm anticoagulant therapy]

SAS Géza

[In the last few years we have witnessed some changes in the area of the chronic oral anticoagulant therapy. The nomenclature of the anticoagulant drugs has been modified and concern has arisen about the possible vascular calcification in patients on long-term warfarin therapy. Because of the novelty of the “new” anticoagulants (dabigatran etc.) has been lost, instead of their previous acronym (NOAC) the DOAC (direct oral anticoagulants) term has been accepted for their marking. Experimental and clinical data suggested that vitamin K-antagonists (VKA) in addition to the coagulation factors disturb the production of other proteins, too. By inhibiting the matrix Gla protein (MGP), the chronic warfarin therapy promotes the calcification in media of the arteries as it was shown in women participating in routine mammography. However, the clinical importance of this observation is dubious, because the incidence of acute coronary events is not increased in cases of warfarin therapy in patients with atrial fibrillation. Notwith­standing, in addition to the bleeding complications we have to take into account of the possible harmful vascular calcification, too, at the indication of chronic coumarin therapy. Therefore, this therapy should be applied only in proper cases, such as non-valvular atrial fibrillation with a high risk of ischaemic stroke or unprovoked venous thromboembolic disease with a high risk of recurrence. The results of the Swedish anticoagulant register show that the efficacy and safety of the well-managed coumarin therapy may be superior to the treatments with DOACs. However, DOACs are indispensable in certain cases in which a previous “probe” coumarin treatment is unfounded.]

Lege Artis Medicinae

SEPTEMBER 20, 2015

[Pleiotrop effect of rosuvastatin: clinical revelance of decreasing the mean platelet volume]

PUKOLI Dániel, SEMJÉN Judit, SZÉKELY Anita, RAJDA Cecília

[INTRODUCTION -Activated platelets play a key role in the patomechanism of cardiovascular diseases. One biomarker of platelet activation is mean platelet volume (MPV). Increased MPV level is connected to higher cardiovascular risk. Statins are frequently used in vascular diseases. We examined the effect of rosuvastatin on platelets in serum. METHODS - The patient were divided in medium risk and high risk (suffering ischaemic stroke) groups. Altogether parameters (total-, HDL, LDL-cholesterol, MPV) of 66 patients were examined before and after rosuvastatin treatment. RESULTS - Rosuvastatin decreased the cholesterol and MPV levels in both groups. This effect was greater in the high risk group. DISCUSSION - According the our findings rosuvastatin decreases the MPV both in hypercholesterolaemic and ischaemic stroke patients. The high LDL level causes increased platelet activation leading to increased thrombosis. This cascade worsens the underlying pathways in cardiovascular diseases. We found that aspirin taken together with rosuvastatin has a greater effect on decreasing the MPV. This probably doubles the antithrombotic effect. ]

Clinical Neuroscience

JULY 30, 2015

[Radiosurgery of intracerebral cavernomas - Current international trends]

NAGY Gábor, KEMENY A. Andras, MAJOR Ottó, ERÕSS Loránd, VÁRADY Péter, MEZEY Géza, FEDORCSÁK Imre, BOGNÁR László

[Although still a controversial management option, radiosurgery of intracranial cavernomas has become increasingly popular world-wide during the last decade. Microsurgery is a safe and effective treatment for symptomatic hemispheric cavernomas. However, the indication for microsurgical resection of deep eloquent cavernomas is relatively limited even in experienced hands. The importance of radiosurgery has recently been appreciated in parallel with increasing positive experiences both in terms of effectiveness and safety, especially for cases high risk for surgical resection, in the brainstem, thalamus and basal ganglia. While radiosurgery was earlier indicated mainly for surgically inaccessible lesions that had bled multiple times, a more proactive policy has recently become more accepted. In our opinion preventive treatment with the low morbidity radiosurgery serves the patients’ interest especially for deep eloquent lesions that had bled not more than once, due to the cumulative morbidity of repeated hemorrhages. Despite our increasing knowledge on natural history, there is currently no available treatment algorithm for cavernomas. Arguments for all three treatment modalities (observation, microsurgery and radiosurgery) are established, but their indication criteria are yet to be defined. It is time to organize a prospective population based data collection in Hungary, which appears to be the most realistic way to clarify indication criteria.]

Clinical Neuroscience

JULY 30, 2015

[Radiosurgery of intracerebral cavernomas - Current Hungarian practice]

FEDORCSÁK Imre, NAGY Gábor, DOBAI József Gábor, MEZEY Géza, BOGNÁR László

[Background and purpose - Radiosurgery is an increasingly popular treatment option especially for deep eloquent intracerebral cavernomas that are often too risky for surgical removal, but their re-bleed carries significant risk for persisting neurological deficit. Gamma-radiation based radiosurgery has been being available since 2007 in Hungary in Debrecen. Our aim is to summarize our experience accumulated during the first five years of treatment and to compare it to the international experience. Patient selection and methods - We retrospectively analyzed 51 cavernomas in 45 patients treated between 2008 and 2012 in terms of localization, natural history, and the effect of radiosurgery on re-bleed risk and epilepsy, and its side effects. Results - We treated 26.5% deep eloquent (brainstem, thalamic/basal ganglia) and 72.5% superficial hemispheric cavernomas. The median presentation age was 25 years (13-60) for deep, and 45 years (6-67) for superficial cavernomas. They were treated median of 1 year after presentation. 64.5% of deep cavernomas bled before treatment, the annual risk of first hemorrhage was 2%/lesion, re-bleed risk 21.7%, with 44% persisting morbidity. 13.5% of superficial cavernomas bled prior to treatment, the risk of first bleed was 0.3%, there was no re-bleed, and 35% caused epilepsy. We used GammaART-6000TM rotating gamma system for treatment, marginal dose was 14 Gy (10-16), and treatment volume 1.38-1.53 cm3. Re-bleed risk of deep eloquent lesions fell to 4% during the first two years after treatment and to 0% thereafter, and no hemorrhage occurred from superficial lesions after treatment. Persisting morbidity in deep lesions came from adverse radiation effect in 7% and from re-bleed in 7%, and there was no persisting side effect in superficial cavernomas. 87.5% of cases of epilepsy resistant to medical therapy improved. Radiological regression was found in 37.5% and progression in 2% after treatment. Conclusions - Radiosurgery of cavernomas is safe and effective. Early preventive treatment for deep cavernomas carrying high surgical risk is justified. Moreover, for superficial lesions that are surgically easily accessible radiosurgery also appears to be an attractive alternative.]

Clinical Neuroscience

MAY 30, 2015

Chronic cerebrospinal venous insufficiency - disease or misdiagnosis?

PÁNCZÉL Gyula, SZIKORA István, BERENTEI Zsolt, GUBUCZ István, MAROSFŐI Miklós, KOVÁCS Krisztina, RÓZSA Anikó, RÓZSA Csilla

Background and purpose - Former studies reported internal jugular vein stenosis in patients with multiple sclerosis. We aimed to evaluate if these venous stenoses were real and cerebral venous outflow of patients with multiple sclerosis differed from that of normal controls. Methods - 20 controls were prospectively investigated by angiography and duplex ultrasound. Seven patients with multiple sclerosis underwent angiography in other centers; we reviewed these registrations and performed venous ultrasound examinations. Results - Angiography displayed >50% stenosis of internal jugular vein in 19 controls (69±17% on the right and 73±13% on the left side) and <50% stenosis in 1 control (43.5% and 44.6%). All 7 patients had at least one-sided stenosis. The mean degree of stenosis was 63±16% on the right and 67±13% on the left side. There was no significant difference in the degree of stenosis between patients and controls. However, these “stenoses” disappeared if the contrast agent was injected at a catheter position below the orifice of the subclavian vein during venography. The venous flow volume was also similar between groups: 479.7±214.1 and 509.8±212.0 ml/min (right and left side) in the patients and 461.3±224.3 and 513.6±352.2 ml/min in the control group; p=0.85 and 0.98 (right and left). Color and power duplex imaging also revealed normal blood flow of the internal jugular vein in all patients and controls. Conclusion - The cerebral venous status of patients with multiple sclerosis and controls were similar. The angiographic “stenoses” were virtual, caused by the contrast dilution effect of the non-contrast blood stream of the subclavian vein.

Hypertension and nephrology

DECEMBER 20, 2014

[Genetic diagnostics of the trombosis risk]

SZOKOLAI Viola, HARSÁNYI Gergely, VÉGH Csaba, ELBERT Gábor, TÚRI Sándor, NAGY Zsolt B.

[The cardiovascular system and the coalugation process play essential role in regulating the homestasis of the human body. Thrombuses may appear in veins (venous thrombosis) as well as arteries (arterial thrombosis) that may cause a wide range of ischemic vascular diseases. By mapping genetic risk factors that may accelarate the development of thrombosis, the quality of medical preventions and therapies can be improved. The most frequent gene mutations (FII, FV, PAI-1, MTHFR and EPCR gene polimorphisms) can be tested by methods based on PCR, real-time PCR and macroarray techniques. Professionals may use genetic results for selecting appropriate and optimal therapies based on the context of a patient’s medical history.]

Clinical Neuroscience

NOVEMBER 28, 2014

[The interactive neuroanatomical simulation and practical application of frontotemporal transsylvian exposure in neurosurgery]


[Background and purpose - There is an increased need for new digital education tools in neurosurgical training. Illustrated textbooks offer anatomic and technical reference but do not substitute hands-on experience provided by surgery or cadaver dissection. Due to limited availability of cadaver dissections the need for development of simulation tools has been augmented. We explored simulation technology for producing virtual reality-like reconstructions of simulated surgical approaches on cadaver. Practical application of the simulation tool has been presented through frontotemporal transsylvian exposure. Methods - The dissections were performed on two cadaveric heads. Arteries and veins were prepared and injected with colorful silicon rubber. The heads were rigidly fixed in Mayfield headholder. A robotic microscope with two digital cameras in inverted cone method of image acquisition was used to capture images around a pivot point in several phases of dissections. Multilayered, high-resolution images have been built into interactive 4D environment by custom developed software. Results - We have developed the simulation module of the frontotemporal transsylvian approach. The virtual specimens can be rotated or tilted to any selected angles and examined from different surgical perspectives at any stage of dissections. Important surgical issues such as appropriate head positioning or surgical maneuvers to expose deep situated neuroanatomic structures can be simulated and studied by using the module. Conclusion - The simulation module of the frontotemporal transsylvian exposure helps to examine effect of head positioning on the visibility of deep situated neuroanatomic structures and study surgical maneuvers required to achieve optimal exposure of deep situated anatomic structures. The simulation program is a powerful tool to study issues of preoperative planning and well suited for neurosurgical training.]

Clinical Neuroscience

NOVEMBER 28, 2014

[Hungarian experiences with levodopa/carbidopa intestinal gel in the treatment of advanced Parkinson’s disease]

NAGY Helga, TAKÁTS Annamária, TÓTH Adrián, BERECZKI Dániel, KLIVÉNYI Péter, DÉZSI Lívia, DIBÓ György, VÉCSEI László, KOVÁCS Norbert, ASCHERMANN Zsuzsa, KOMOLY Sámuel, VARANNAI Lajos, ZEMLÉNYI Gyöngyi

[In the advanced Parkison’s disease (PD) the late complications of levodopa therapy have to be considered: motor and/or non-motor fluctuations with or without disturbing dyskinesias. The non-motor fluctuations often influence the quality of life (QoL) in a much more negative way compared with the motor symptoms. In the treatment of advanced PD there are several device-aided methods - deep brain stimulation, apomorphine pump, levodopa/carbidopa intestinal gel (LCIG ) - to improve the symptoms, the QoL, sometimes even in an individual, tailored custom form. The LCIG therapy was introduced in Hungary in 2011. Here we summarize the data of our patients: we have tested almost 60 patients and in 43 cases we have started this treatment. We analyze the duration of illness, levodopa therapy, motor and non-motor fluctuation of patients and present our experiences with the test phase and the chronic LCIG therapy via PEG/PEJ implantation. We paid attention to the surgery and device - depending side effects. Our experiences are similar to the international data. In patients selection „the right treatment, to the right patient, in the right time” is of importance.]