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Clinical Neuroscience

SEPTEMBER 30, 2018

[Minimally invasive, extrapleural-anterolateral approach to the spine]

SZABÓ Viktor, BÜKI András, DÓCZI Tamás, SCHWARCZ Attila

[In spine surgery, minimally invasive approaches (MIS) are getting accepted and more popular worldwide during the last decades. It is due to the reduced intraoperative blood loss, decreased infection rate, less postoperative pain and earlier discharge from hospital compared to traditional approaches. The present paper puts forward a minimally invasive extrapleural approach to the thoracic spine that is not applied in Hungary. This new approach, in contrast to the standard costotransversectomy, provides direct visual control over the ventral surface of the dural sac. Furthermore, contrary to the transthoracic way, following minimally invasive extrapleural surgery thoracic drainage and intensive care are not necessary. The approach can be applied safely in treatment of ventral or ventrolateral pathologies of the thoracic spine. ]

Journal of Nursing Theory and Practice

AUGUST 30, 2016

[Nursing care workers to assess job skills calicivirus caused by the accumulation of tasks required hospital infections]

KASZONYINÉ ENGI Erika

[Introduction: Author presents the results of surveys of knowledge-prepared nurses’ll need to Calicivirus infections at hospitals accumulation, which was conducted in 7 (a mix of invasive and non-invasive track) ward nurses skilled and unskilled workers. Aim of research: to find out which questions need to put the emphasis on nurses hospital hygiene education to subjects of age, prevention and early detection of infections from spreading which is an important part of the hospital wards enteric outbreaks may occur. Research and sampling methods: The research used an anonymous questionnaire method. The survey was conducted between January 04 2016 and whether 29 or not. The target population for the selection of the author of the favored classes of patient care, on which the last 6 years due to Calicivirus outbreak occurred, which was reported in the NNSR database. Results: 158 nurses participated. The obtained results show that nurses have the knowledge and experience to an infection caused by a Calicivirus, but there are also gaps in knowledge, particularly in the event of hospital infections overlapping actions to be taken to curb the epidemic. Conclusion: Keep the enteric infections also with regard to the knowledge acquired basic education level, especially since the hospital departments favor the spread of these infections are due to sanitary facilities shared by the patient’s condition resulting from lower personal hygiene and multi-bed wards. ]

Lege Artis Medicinae

JULY 20, 2015

[Effect of mycophenolate sodium therapy on quality of life of renal transplant patients]

LÁZÁR György, SZENOHRADSZKY Pál, SZEDERKÉNYI Edit, SURMANN Ágnes, TORONYI Éva, TÖRÖK Szilárd, FÖLDES Katalin, KALMÁR-NAGY Károly, SZAKÁLY Péter

[Enteric-coated mycophenolate sodium (EC-MPS; Myfortic®, Novartis Pharma AG, Basel, Switzerland) is an enteric-coated formulation delivering MPA. Enteric-coated MPS has been developed with the aim of improving the upper GI tolerability of MPA while providing a therapeutical equivalence. The primary objective of the study was to measure the quality of life of kidney transplant patients, with special attention to gastrointestinal symptoms during mycophenolate sodium therapy. The secondary objective was to measure the mean daily mycophenolate sodium dose during routine therapy. These two parameters can significantly influence long-term graft survival of the patients. The study was a multicentric, non-interventional, 12 weeks, single arm, cohort, observational study, in which 251 adult, kidney transplant patients were enrolled in 4 study centers. As part of the study, the patient completed a questionnaire to assess the gastrointestinal status: the Gastrointestinal Symp­tom Rating Scale (GSRS). The patient’s average age was 51.03 years by the time of the inclusion. 61% of the patients were male and 39% female. Kidney transplant was performed averagely 6.3 years (SD: 4.3 years) prior to the screening visit. At the first visit the average intensity of gastrointestinal side effects was 0.87, at the final visit was 0.28. The change of the average number of gastrointestinal side effects between the first and last visit was examined by Wilcoxon test, and it was significant (p<0.0001). Patients had to complete the GSRS questionnaire aiming at five gastrointestinal symptom groups. In all five symp­tom-groups significant (p<0.0001) improvement was observed between the visits. Our results support that, in renal transplant patients with gastrointestinal undesirable effects due to MMF, using enteric-coated mycophenolate sodium may increase the maximum tolerated dose of MPA and reduce GI disorders.]

LAM Extra for General Practicioners

FEBRUARY 20, 2015

[Insertion of percutaneous peritoneal dialysis catheter using Seldinger technic with assistance of image amplifier ]

PETHŐ Ákos Géza, SZABÓ Réka, SZŰCS Attila, BALLA József

[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

Lege Artis Medicinae

DECEMBER 20, 2014

[Insertion of percutaneous peritoneal dialysis catheter using Seldinger technic with assistance of image amplifier]

PETHŐ Ákos Géza, SZABÓ Réka, SZŰCS Attila, BALLA József

[INTRODUCTION - Continuous Ambula­tory Peritoneal Dialysis (CAPD) treatment is widespread used over the years as a result of technical progress. As with any renal replacement therapy, in hemodialysis patients in time made vascular access, also the success of the CAPD depends on the in time inserted catheter for peritoneal dialysis. PATIENTS AND METHOD - Inserting a catheter for chronic peritoneal dialysis in Hungary is currently exclusively surgical procedure. The successfully CAPD treatment is so essential to insert the peritoneal dialysis catheter by dedicated surgeon. The intervention is often not a priority in the surgical tender, and in many places queues delaying the surgery. Proposed as an alternative to the percutaneous technique introduction. If nephrologist are familiar with basic surgical procedures by providing appropriate means, the percutaneous catheter insertion technique can be performed. RESULTS - In the spring of 2014, we introduced in Hungary first this procedure, which reported in the international literature as percutaneous PD-catheter insertion method. The technique was modified to the primary entry point determined by the typical abdominal puncture site. Puncture of the abdomen is performed by physicians as a routine intervention, which is widely accepted. After selecting the appropriate patient population and detailed medical information, patients are prepeared, under x-ray fluoroscopy imaging the implants were made. So far 10 catheter were implanted under this technique, all of them successfully. Thanks to the minimal invasive intervention, the patients healing was significantly faster, after the day of catheter-insertion we were able to start drainage. By the traditional surgical implantation the recovery time is six weeks. CONCLUsiONS - In all cases, when a surgeon not willing to insert the peritoneal dialysis catheter, the percutaneous technique can be safe. All of the catheters made by us are working well. Of course, the surgical procedure is still indispensable, however, and this is the percutaneous technique’s advantage, the CAPD treatment can be started after the intervention. ]

Hungarian Radiology

APRIL 20, 2002

[Atypical diaphragmatic herniation causing bowel obstruction]

ERDŐSI Éva, MÉSZÁROS Anikó, GREXA Erzsébet

[INTRODUCTION - A 21-year-old woman presented with iatrogenic diaphragmatic hernia causing bowel obstruction. CASE REPORT - Plain abdominal X-ray and barium swallow examinations showed a diaphragmatic hernia causing partial gastric obstruction. Surgery confirmed the radiological diagnosis. The hernia was located atypically at the centre of the diaphragm. CONCLUSION - The cause of the hernia was probably related to a pyogenic necrosis due to subphrenic abscess after cholecystectomy performed 2 years earlier, treated by drainage and repeated surgical interventions.]

Hungarian Radiology

OCTOBER 20, 2007

[Pancreas transplantation: Indication, surgery, complications, diagnostic imaging and outcome]

NÉMETH Andrea, DOROS Attila, HARTMANN Erika, WESZELITS Viola, DABASI Gabriella, LANGER Róbert, MÁTHÉ Zoltán, JÁRAY Jenő

[Diabetes mellitus is often leading to chronic microvascular and macrovascular complications. At present time, wholepancreas transplantation is the only option to achieve long-term insulin independence. Therefore, simultaneous kidney-pancreas transplantation has become the preferred treatment option for selected patients with type I diabetes mellitus and renal failure. In this review authors describe the indications and main types of pancreas transplantation: simultaneous pancreaskidney transplantation, renal transplantation first then pancreas transplantation, pancreas transplantation alone, islet-cell transplantation, and deal with surgical technical aspects. The immunological, metabolic, inflammatory, technical and late complications are also datailed as well as the outcome of the operations. The importance of the various imaging techniques is emphasized. The rate of mortality and complications are significantly higher after simultaneous kidney-pancreas transplantation than those after kidney transplantation alone. The role of the radiologist is to promote a successful outcome by early detection of the complications.]

Lege Artis Medicinae

FEBRUARY 20, 2009

[Treatment of acute pancreatitis, with special regard to pharmaceutical therapy]

DÖBRÖNTE Zoltán

[Treatment of acute pancreatitis is mainly supportive, including the correction of any factors causing or sustaining the disease process, efforts to limit complications, as well as treatment of complications. Pharmaceutical efforts to influence the pathophysiological events with protease inhibitors or by influencing the release of the pro-inflammatory cytokine cascade did not prove to be effective, so there is no known effective and specific drug therapy for clinical use. Adequate pain control is an important component of pharmaceutical management, and - although yet controversial - early antibiotic prophylaxis and effective antimicrobial treatment of the inflammatory complications (infected necrosis or fluid collection, SIRS, sepsis) have probably a determining role in the outcome of severe necrotizing pancreatitis. Carbapenems proved to be the most potent antibiotics. For the prevention of the not infrequent fungal superinfection in acute pancreatitis, early administration of fluconasole can also decrease mortality. Surgery is indicated in the first stage of infected necrosis and infected pancreatic and peripancreatic fluid collections. In certain patients with a high operative risk, endoscopic or percutaneous drainage with lavage can also be worth trying. Optimal conditions for the treatment of severe necrotizing pancreatitis, as well as adequate management of multiple organ failure can only be warranted at an intensive care unit. In the chemoprevention of pancreatitis complicating endoscopic retrograde cholangiopancreatography (ERCP), non-steroidal anti-inflammatory drugs promise a new therapeutic option. There are insufficient data about the beneficial effects of the protease inhibitor ulinastatin, and results with nitroglycerin are contradictory.]

Hungarian Radiology

JUNE 20, 2006

[CT enteroclysis in small bowel Crohn’s disease]

TÓTH Géza, MAGYAR Péter

[PURPOSE - The aim of this paper is to demonstrate morphological changes of Crohn’s disease observed by CT enteroclysis and also to evaluate the role of the method in the diagnosis and the follow up of patients with known or suspected Crohn’s disease. PATIENTS AND METHODS - We evaluated retrospectively 50 typical cases who were examined earlier. Crohns’s disease was diagnosed in 42 patients before CT enteroclysis. Histological confirmation was available in 36 cases after colonoscopy and in six cases after surgery. In eight patients had a high suspicion of the disease, histological examination was not performed. CT enteroclysis findings were read by two radiologist independently and results were compared. RESULTS - CT enteroclysis showed typical signs of Crohn’s disease in all patients. Different degree of wall thickening was seen in all cases, pathological enhancement of small bowel wall (in cases 35), multilayered appearance (n=29), fibrofatty proliferation (n=33), enlarged lymph nodes (n=37), entero-enteric fistula (n=6), entero-cutan fistula n (=5), mesenteric abscess (n=5) was found. CONCLUSION - CT enteroclysis is an accurate method to detect mural and extramural abnormalities in patients with Crohn’s disease. CT enteroclysis proved highly accurate in detecting small bowel involvement and it also provides an estimation of clinical activity of the disease. CT enetroclysis can be considered as the first imaging method in patients with clinical signs of Crohn’s diseases and also in the follow up of patients with known disease.]

Clinical Neuroscience

AUGUST 20, 2002

[Cerebellar venous anomalies with symptomatic vascular malformations]

KOVÁCS Tibor, PAJOR Péter, BODROGI László, FARSANG Marianna, JUHÁSZ Csaba, SZIRMAI Imre

[Cerebral and cerebellar venous anomalies (previously known as venous angiomas) form the alternative venous drainage of the surrounding nervous tissue because of the un-development of the normal venous system. They are made up of veins with abnormal structure: thick walls, lumens dilated and of irregular calibre that converge radially towards a wide draining vein (caput medusae). They are thought to be a benign condition although they are sometimes associated with cerebellar hemorrhages. Authors report three patients with cerebellar venous anomalies associated either with pontine cavernoma, cerebellar arteriovenous malformation or cerebellar infarct. They illustrate that cerebellar venous anomalies are benign conditions, but their presence might be a marker for additional, pathogenic malformation. It might be difficult to detect the associated malformations even by sophisticated imaging methods, but their presence can modify the treatment options.]