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Lege Artis Medicinae

DECEMBER 21, 2020

[30 year history of surgery and the surgeon’s future ]

KUPCSULIK Péter

[During the past 3 decades, laparoscopic surgery has launched a revolution in operative medicine. The German gynaecologist Kurt Semm transformed the diagnostic laparoscopy for therapeutic procedure, as he performed the first laparoscopic ap­pen­dectomy. The surgeon Erich Mühe contributed with laparoscopic cholecystectomy to the set of surgical instruments. All over the world, a wide spectrum of laparoscopic procedures has been app­lied. Several laparoscopic procedures are now preferred over open approaches. Morbid obesity is associated with significant comorbidity and mortality. In­suffi­ciency of dietary measures lead to development of surgical interventions that resulted in unexpected excellent outcomes. “Metabolic surgery” was born. New methods and rising market of socio-medical requirements inspired progress in plastic surgery. Thanks to innovations in technology, reconstructive breast surgery has opened new ways. In the 1990s the prototype of “mas­ter–slave” robot controlled by a surgeon was constructed. Future of robotic surgery depends on cost reduc­tion, development of new technologies and creating the best applications. Coo­pe­ra­tion with partner medical specialities is essential for further development in surgery. Despite of obvious impact of new technologies the surgeon's way of thinking, personal qualities decision-making and professional knowledge remain cru­cial for further evolution. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[Focus on quality of life: Reconstruction in Vascular Surgery ]

AGÓCS Gábor, VÁRADYNÉ HORVÁTH Ágnes, SZEBENI-KOVÁCS Gyula, ROZMANN Nóra, PAKAI Annamária

[The aims of the study: The aim of our research was to gain deeper insight into the quality of life of patients after reconstructive vascular surgery of the lower limb. Material and method: The Vascuqol questionnaire survey was performed at the PTE KK Vascular Surgery Clinic on the day before the surgery and 3-6 weeks after surgery (N=54). Statistical analysis was carried out with Microsoft Office Excel 2013. Results: In summary it can be stated that following surgical intervention the quality of life of patients significantly improved, this finding ephasises the importance of invasise therapy. As the extent of pain decreased after surgery, patients’ ability to walk started to improve, as well as their overall physical state and ability to carry out certain household activities. There was also an improvement in their social life, more time was spent with family and friends. Conclusions: Although the VascuQoL-25 questionaire is senstivie device to measure quality of life, it is difficult to apply in clinical practice beacause of its length.]

Clinical Neuroscience

MAY 30, 2020

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Oncology

AUGUST 28, 2020

[The indication for surgical resection in secondary liver malignancies - New therapeutic approaches]

LUKOVICH Péter, PŐCZE Balázs

[During the last decade liver surgery underwent major improvement: mortality rates reduced meanwhile new surgical approaches converted surgeons’ consideration on many advanced cases likely to be resectable. Liver is the most frequent site for tumor metastases and liver metastasis surgery experienced major changes as well. As long as liver resection related mortality rates have decreased indication for operative treatment of liver metastasis with certain primary tumors (stomach, pancreas) gained reconsideration and became reasonable. New surgical methods and approaches (laparoscopy, portal vein embolization) came into everyday application meantime several researches were completed enabling oncological aspect interpretation. Laparoscopy is a proven rational way of approach not only in cases of primary but metastatic liver tumors too: short and long term survival rates and oncological results are comparable with the results of open surgery. Although reports on large number series have not yet been published, it seems that practice of laparoscopy can bring increased number of cases where resection of primary tumor and synchronous liver metastasis can be performed simultaneously. Treatment strategies including surgical procedure overwhelm results of schemes planned with chemotherapy lines only even for patients suffering from advanced metastatic disease with necessary extended liver resection together with major vessel resection or for those who require liver resection following portal occlusion method. Consent opinion in best therapeutic option by oncologist and surgeon is essential to reach optimal liver metastasis patient treatment.]

Lege Artis Medicinae

JUNE 20, 2018

[“Vires unitae agunt” - way of the unification: medical professionalization in 18-19. centuries Hungary]

SIMON Katalin

[European and Hungarian medicine and its representatives changed a lot between the sixteenth and nineteenth centuries. The varied ’medical market’ altered significantly from the eighteenth century. The acts of the enlightened absolutism, which were attentive to the health of the citizens and the public, set up those processes, which led to modern medical education and medical professionalization. During this process, some kind of healers were raised out of craftsmen, folk healers (such as surgeons, pharmacists, midwives, veterinarians), others were supplanted (for Example sellers of essential oils). After the initiation from above, doctors of medicine and masters of surgery became self-conscious in the Hungarian Reform Era, first forms of self-organization, as so the demand of professional retraining and discussions appeared via the new journals, associations and assemblies. The biggest question was the liquidation and the unification of the dual education of doctors of medicine and masters of surgery, which descended from the Middle Ages, but became obsolete, thanks to the new achievements of the medicine and surgery. The two were united in 1872, when the title doctor medicinae universalis set up. The Public Health Act of Hungary in 1876 (Art. XIV) and the independent la­bour organizations of doctors (for Example the Associations of Doctors in Budapest and in the countryside, which were established in 1897) promoted the formation of the modern medical profession. ]

Journal of Nursing Theory and Practice

APRIL 30, 2020

[Evaluation of the Quality of Life of Patients with Malignant Breast Cancer after Surgery]

TÓTH Enikő, KIRÁLY Edit

[In the morbidity statistics, breast cancer is ranked first in both developed and developing countries. To map the quality of life after surgery of women with malignant breast cancer, which mainly involved the comparison of different age groups and changes in social relations. The survey was conducted in November 2017 at the National Institute of Oncology using a questionnaire method, in which 70 people participated. Based on age-disaggregated data, the over-60s reported more psychiatric symptoms than the younger group. During the course of their illness, many of the socially altered women in their lives were living alone and reporting a lower quality of life. In the absence of family support, it would be extremely beneficial to increase the opportunities available for women to reintegrate into society as soon as possible. ]

Clinical Oncology

FEBRUARY 28, 2020

[Non-surgical treatment of ovarian cancer]

PIKÓ Béla, LACZÓ Ibolya,, MARIK László

[The primary surgery with an optimal cytoreduction is an essential step during the treatment of the epithelial ovarian cancer because it determines the effectiveness of other therapeutic options as well. Immediately after the surgery a cytostatic infusion typically 40-42.5 degrees Celsius is pumped directly to the abdomen. During the systemic therapy the main point is the 6 months progression free survival because beyond this time the disease could be considered as platinum sensitive, inside this time as platinum refracter or resistant disease. The cytostatic treatment improved during the years from the alkylating agents through the platinum derivates to the administration of paclitaxel with several combinations of them and with more and more signifi cant results and less side effects. The most signifi cant targeted agents are the angiogenesis inhibitors (mainly the bevacizumab) and the PARP-inhibitors which prevents DNA repairs. In order to a PARP-inhibitor could be administered a platinum sensitivity is required while BRCA mutation not. Recently there are promising clinical researches with immunotherapy as well. The main benefi t of the hormonal therapy is the tolerability. Besides the signifi cant improvement in the systemic agents the role of radiotherapy is more and more decreasing, however the treatment of the whole peritoneal surface – mainly with the modern radiation techniques – could be an alternative solution for the chemotherapy. The palliative irradiation which relieve the symptoms could extend the drug-free period and the combination of radiation and chemotherapy could provide further possibilities.]

Journal of Nursing Theory and Practice

DECEMBER 30, 2019

[Perfusionist’s status in Hungary and the application of the low prime in coronary artery bypass]

DEÁK András, FUSZ Katalin, PRÉMUSZ Viktória, RAPOSA L. Bence, VÁRADYNÉ Horváth Ágnes, MADARÁSZ Ildikó, OLÁH András

[With the development of the equipments of extracorporeal circulation, international studies underline reducing the amount of filling fluid. Our retrospective study was conducted at the Heart Surgery Clinic of the University of Pécs between 1 January 2017 - 31 December 2017 with ECC cardiac operated patients. During the document analysis, data were collected from 157 patients between 50 and 70 years who underwent CAB surgery. They were classified into Low- (n=47) and Standard-prime (n=110) group. Medium negative correlation (r=-0.28; p<0.001) was found between prime/body surface area and haematocrit during last perfusion. As inflammatory parameter, the last measured CRP values were 36.00 mg/l (low) vs. 70.62 mg/l (standard). Our research justified the use of low-prime during ECC. The implementation of the method requires the scientific advancement of perfusionists, the preparation of national protocols and the improvement of the perfusionist’s training and legal background. ]

Lege Artis Medicinae

MARCH 10, 2020

[Nutritional status, realizing sarcopenia and the importance of prehabilitation in surgical departments]

CSIBA Borbála, NAGY Ákos, LUKOVICH Péter, BAROK Bianka

[INTRODUCTION - Malnutrition can significantly influence the surgery’s outcomes. Currently, patients risk grouping is based on the body mass index (BMI), and the preparation for surgery is concerned only as nut­rients administration. PATIENTS AND METHODS - The Nutrition Support Team established in our Department is assessing first the patients’ nutritional status (BMI, MUST), sarcopenia (skinfold measure, handgrip strength) and fitness status (6 min step test, sit to stand test). Risk group patients were suggested nutrients and physiotherapy prior to the surgical operation. In order to follow up our patients we created an online interface and repeated the tests immediately before the operation. RESULTS - 135 cancer patients (76 male and 59 female) were operated. Their average age was 69.6 years. 33 patients had weight loss before the first consultation (average=8.7 kg). Their average BMI was 26.3. 21 patients had gained weight in the last 6 months (average=7.8 kg). Patients with left descending colon, liver - and also pancreatic tumors had overweight BMI values while the rest of pa­tients ill with right colon and stomach neo­plasm had normal weight. Those patients who we enrolled to the online system had better results at the second assessment. CONCLUSIONS - According to our survey, most of the patients had overweight BMI values but had sarcopenia based on anthropometric tests. Therefore, the importance of in time recognized and preoperatively started nutritional therapy must be coupled with the parallel applied physiotherapy. ]

Journal of Nursing Theory and Practice

JUNE 30, 2019

[Postoperative pain management today in Hungary - Part 2 ]

LOVASI Orsolya, LÁM Judit

[According to the literature, the practice of postoperative pain relief in Hungary is an area to be developed. Postoperative pain is a key issue for patients. Surveys show that more than 59% of patients are worried about postoperative pain. Their concerns are not baseless, as recent studies have consistently shown that pain has not been properly treated after surgery. It has also been shown that postoperative pain can lead to a deterioration in the quality of life of patients. The aim of our study was to assess the degree of postoperative pain in patients and their satisfaction with pain relief. We conducted interviews based on personal inquiries with a total of 168 patients, with the involvement of certain surgical departments of three Hungarian institutions. Based on our results, we found that patients report remarkable pain after surgery, so the practice of postoperative pain relief is in many cases unsatisfactory. Comparing the results and the international literature, postoperative analgesic practice can be considered as an area to be developed. ]