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Clinical Neuroscience

NOVEMBER 30, 2020

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Oncology

AUGUST 30, 2019

[The American Society of Clinical Oncology 2019. Annual The most important news of the congress]

ANDRÁS Csilla, BÉGÁNYI Nóra, DEMETER Gyula, HARISI Revekka, HIDEGHÉTY Katalin, LAKATOS Gábor, MARÁZ Anikó, NIKOLÉNYI Aliz, OLÁH Judit, OSTOROS Gyula, PETÁK István, RÉVÉSZ János, SIPŐCZ István, SZENTMÁRTONI Gyöngyvér, TÍMÁR József, TORDAY László, VAJDICS Tímea

Clinical Neuroscience

JULY 30, 2020

Extraskeletal, intradural, non-metastatic Ewing’s sarcoma. Case report

OTTÓFFY Gábor, KOMÁROMY Hedvig

Intracranial localization of Ewing’s sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing’s sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re­gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima­ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.

Clinical Neuroscience

NOVEMBER 20, 2015

[Novel strategy in the radiotherapy of metastatic brain tumors: simultaneous whole brain radiotherapy and integrated stereotactic radiosurgery]

KALINCSÁK Judit, LÁSZLÓ Zoltán, SEBESTYÉN Zsolt, KOVÁCS Péter, HORVÁTH Zsolt, DÓCZI Tamás, MAGNEL László

[Background and purpose – Treatment of central nervous system (CNS) tumors has always played an important role in development of radiotherapy techniques. Precise patient immobilisation, non-coplanar field arrangement, conformal treatment, arc therapy, radiosurgery, application of image fusion to radiation planning or re-irradiation were first introduced into clinical routine in the treatment of brain tumors. Methods – A modern multifunctional radiation instrument, Novalis TX has been installed at the University of Pécs two years ago. New methods, such as real time 3D image guided therapy, dynamic arc therapy and ultra-conformity offer further progress in treatment of CNS tumors. Whole brain irradiation and simultaneous fractionated stereotactic radiosurgery or integrated boost seem to be an optimal method in the treatment of not only soliter or oligo, but even a higher number (4-9) and not typically radiosensitive brain metastases. The new treatment strategy is illustrated by presentation of four case histories. Results – Treatment protocol was completed in all cases. Treatment period of 1.5 to 3 weeks, and treatment time of only a few minutes were not stressful for the patients. A quite remarkable clinical improvement as to general condition of the patients was experienced in three cases. Follow-up images confirmed either remission or a stable disease. Conclusions – Simultaneous whole brain radiotherapy and integrated stereotactic radiosurgery is a reproducible, safe method that offers an effective irradiation with delivery of definitive dosage even in cases with radio-insensitive brain metastasis.]

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[How to break sensitive news in the Ophthalmology, specifically at diabetic retinopathy ]

TÓTH Lívia, BÁLINT Zsófia, MÁTÉ Orsolya

[The aim of the study: To investigate the circumstances of breaking bad news by health care professionals and the conditions of communication at the Ophthalmology Clinic of the University of Pécs, among diabetic retinopathy patients. Material and method: Quantitative and cross-sectional examination, February-December 2018. Statistical methods: descriptive and mathematical statistics (χ2-test), SPSSv22, (p<0,05). Results: Most of the examined medical professionals working at the clinic (20 persons/90.90%) can’t be supported by a protocol for breaking bad news, however, the need for a protocol is formulated as more than half of the respondents (11 persons/59.09%). Conclusions: Health care professionals would need to develop a protocol to break bad news in health care institutions, also in the Clinic of Ophthalmology, furthermore, attention should be paid to improving the circumstances during providing information to patients.]

Journal of Nursing Theory and Practice

JUNE 30, 2019

[The role of nurses and their tasks in early sepsis management]

VÁRADI Annamária, FEHÉR Gábor, FÖMÖTÖR Péter

[The Surviving Sepsis Guideline (SSG) is a document that proposed new solutions in the diagnostics and treatment of sepsis. The methods identified were the 100% oxygen therapy, fluid resuscitation, blood culture and microbiological analysis, empiric combination antibiotic therapy, lactate monitoring, comparison of PCT and CRP, and surgical opening. Using the above mentioned methods has proven to improve the quality of sepsis treatment and the safety of patients. Sepsis -6 protocol has been highlighted by the authors as a process that is easy to implement in terms of cost while remaining highly beneficial. This recommendation should also be well known for nurses that do not work in emergency units. This will help recognise sepsis at an early stage, and provide guideline in the analytical examination and the possibilities within the competence. ]

Lege Artis Medicinae

DECEMBER 10, 2019

[Why did I survived? Treatment of acute stress reaction after a road accident]

SZABÓ József, SIPOS Mária

[INTRODUCTION - Survivors and witnesses of traffic accidents often experience an acute stress reaction. Immediate or at least fast psychological support, relieving the subjective suffering is very important in the respect of preventing psychological crisis, post-traumatic stress disorder or depression and the associated increasing risk of suicide. CASE REPORT - We present the case of a 27-year-old male patient who was the victim of a traffic accident and was partly responsible for it. He lost his mother in the accident, his sister was injured, and there was a casualty in the other affected car. He applied for a psychiatric appointment one week after the accident. He complained of insomnia, loss of appetite, sadness, weakness, anxiety. The treatment consisted of low-dose anxiolytic therapy, recommended in case of need, and a psychological support via acute stress protocol (G-tep) of EMDR therapy. Both short-term feedback from his family doctor and psychiatry outpatient follow-up after three weeks showed significant symptomatic improvement. CONCLUSIONS - In the last one and a half year, he has not applied for psychiatrical treatment. According his general practitioner there were no new psychological problems during this time. Our work has been successful in terms of immediate relief of suffering and prevention of psychological crisis and PTSD.]

Lege Artis Medicinae

NOVEMBER 15, 2019

[Specialists’ opinions about the introduction of colorectal cancer screening ]

MAGDA Lilla, TEREBESSY András

[ INTRODUCTION - The number of new cases of colorectal cancer is over 10 000 and there are around 5000 deaths per year in Hungary. A nationwide colon cancer screening program was launched in 2018. AIMS - Concerning the upcoming national screening, our aim was to explore attitudes, preferences and knowledge of specialists (family medicine, gastroenterology, surgery, oncology, pathology) who will be engaged in screening, diagnosis and treatment of colorectal cancer. METHOD - Before the start of the program we conducted semi-structured interviews with 20 representatives of specialties mentioned above. Interview-questions focused on knowledge (epidemiology, screening methods, program-related), preferences (screening method, protocol) and impact of the program on medical practice. Quan­ti­ta­tive and qualitative methods were used for analysis. RESULTS - Incidence of colon cancer was well known but its mortality in Hungary was underestimated. The public health significance of colorectal cancer scored 7 on a 10-point Likert scale and all participants agreed with introduction of the program. 12 people knew the chosen protocol (two-stage), only a single person mentioned one-stage (colonoscopy), and 7 had no information. 16 people prefer colonoscopy as the best screening method. 11 support two-stage protocol, 5 do not support but accept it, 4 would only accept the one-stage approach. 13 people think their duties will increase considerably. CONCLUSIONS - Our review partners consider colorectal screening in Hungary as an initiative to be supported. They expect increase of workload in their everyday medical practice and assume that the current endoscopic capacity will be overburdened. The majority prefers two-stage protocol because of cost-effectiveness while arguing that the colonoscopy has a bad reputation among the general population, nevertheless they consider colonoscopy as the best method of screening. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2019

[Faces from the Hungarian Nursing Hall of Fame: the exemplary career of Katalin Durgó recipient of the Henry Dunant Meda]

BOROS Károlyné, FEDINECZNÉ VITTAY Katalin, PERKÓ Magdolna, SÖVÉNYI Ferencné

[In this part of their series on outstanding figures in Hungary’s nursing history authors present the life of Ms. Katalin Durgó, a Red Cross volunteer nurse-midwife, whose lifelong services to promote the humanitarian cause of the Red Cross were acknowledged by awarding to her, at the age of 83 years, the Henry Dunant Medal, the highest award of the Red Cross Movement. Ms. Durgó was the 5th awardee globally, the first ever Hungarian recipient and the second person to have been decorated in their lifetimes. Following her self-sacrificing and fearless work in the war theatres of WWI, Ms. Durgó worked as a local midwife in rural Hungary delivering one thousand babies as testified by her Midwife’s birth logbook. She carried out her work with a strong sense of conscientiousness, punctuality, untiring diligence, devotion and solid professional knowledge and skills; her personal and professional lives are shining examples for today’s nursing generation. ]