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Journal of Nursing Theory and Practice

OCTOBER 30, 2016

[Prenatal care and the role of midwifery in Europe and in Hungary]

SZÖLLŐSI Katalin, KÖVI Rita, SZABÓ László

[Aim of the study: To provide a picture about the prenatal care practice and assess the attitude of obstetrics and midwives about the new prenatal care system in Hungary. To compare the Hungarian prenatal care system with that of other countries in the European Union (Finland, England). Procedure and Sample: We used self-developed questionarre with 50 midwives, 40 pregnants and interview with 5 midwives and 5 obstetricians. To compare the prenatal care systems in the EU we used the experienses of a study trip in Finland and informations from international databases. Results: 8% of the midwives work in prenatal care, 32% of participants are not interested in this field. In their view the new system is not elaborated yet, they need more professional survellance. Obstetricians acknowledge the competence of midwifery, however they suggest to gain more practical knowledge on the field. 75% of participating pregnant women would have chosen the prenatal care of obstetricians. The role of midwives in prenatal care is significant in Europe. The Hungarian system is unique, which is approached to the european practice by introduce the new prenatal care system. Discussion: The new Hungarian prenatal care system has several loops in its structure and effectiveness from the view of midwives and obstetricians.]

Journal of Nursing Theory and Practice

AUGUST 30, 2016

[The evolution of skull reconstruction surgical techniques and it’s impact on patient’s care and the effect on patients from the nursing perspective]

VARGEK Anikó

[Background: Facts support that decompressive craniectomy allaviates life-threatening acute high intracranial pressure and it is performed worldwide. Less attention has been paid to the late negative consequences of the widely open cranium. Hence there is a need for timely closure of the defect and precise cranioplasty. Objective: The goal of the present study was to compare the clinical results and patient care data gained by a novel cranioplasty method, the so called computer-aided design and computer-aided manufacturing (CAD/CAM) technique, versus conventional operative procedures. Patients and Methods: Seventy patients were operated on by conventional reconstructive methods (n=70) in our department between 2004 and 2006. These patients served as the control group. Sixty patients had got cranioplasty with individually prepared cranial implants using the CAD/CAM technique (n=60) in 2011 to 2013. The total number of the investigated patient population was n=130. Age distribution of the group varied from 17 to 80. Retrospective neurological and patient care data were collected and compared at the two surgical technique. Results: More precise coverage of the cranial defect and acceptable cosmetic result were achieved in every case operated on with the CAD/CAM surgical technique. The ratio of patients with persistent vegetative-state decreased, and the neurological outcome improved following surgery using the CAD/CAM method. The patient care was easier and rehabilitation procedure was more favourable at the CAD/CAM population. Iatrogenic infection and wound- healing complications were less frequent at the department between 2011 and 2013. The quality of patient care have been improving considerably by regular education and continuous development of nursing standard. Patients need for hospital stay decreased, therefore health economic aspects and cost-benefit ratio improved at the Department of Neurosurgery in the Péterfy Hospital. Conclusion: This study demonstrates an improvement in neurological outcome and easier patient care following CAD/CAM reconstructive surgery of cranial defects in status of normalized intracranial pressure. Results support the extended use of the method in the XXI. Century. ]

Clinical Neuroscience

NOVEMBER 30, 2016

[Ketamine administration in case of severe, therapy resistant depressed patient, case report]

MORVAI Szabolcs, NAGY Attila István, BÁLINT-SZÖLLŐSI Adrienn, MÓRÉ E Csaba, BERECZ Roland, FRECSKA Ede

[Objective - In our case report we present the treatment of a female patient suffering from therapy resistant depression. This procedure is not in practice in Hungary at present, the aim of our work to reproduce the findigs of international studies in domestic circumstances. Matter - Major depression is a common, chronic and severe mental disorder, with 16.2% lifetime prevalence. Many international randomized, placebo controlled trials found administration of ketamine infusion effective in depressed patients. Methods - Since ketamine is an anesthetic agent, its administration was performed in the post-operative monitoring room of our hospital operating-room, supervised by an anesthesiologist. According to formerly published data, a dose of 0.5 mg/kg of body weight was administered intravenously in 40 minutes by perfusor. The drug was administered in a same manner fifteen days later. Subject - The patient was admitted to our inpatient ward with severe depression. During two months of combined antidepressant therapy her condition has not improved significantly. Approval for off label drug indication was granted with urgency by the National Institute of Quality and Organizational Development in Healthcare and Medicines. Results - During the two treatments the Hamilton Depression Rating Scale 21 items rating scale score was reduced to 8 from the baseline 28, the Hamilton Anxiety Rating Scale score was reduced to 6 from 25, Beck Depression Inventory was reduced to 9 from 20. Upon administration of the drug no severe adverse event was detected, the mild dissociative state related to ketamine was ceased in a short period of time. Discussion - With administration of 0.5 mg/kg ketamine the authors managed to achieve rapid improvement in a therapy resistant depressed patient, without permanent side effects. Our future plan is to repeat the use of the drug within a double-blind, placebo controlled trial in order to prove its efficacy in hospital settings. ]

Clinical Neuroscience

SEPTEMBER 30, 2016

[Our experience with the use of Active-C cervical prosthesis]

MISIK Ferenc, BÖÖSI Martina, PAPP Zoltán, PADÁNYI Csaba, BANCZEROWSKI Péter

[Objective - The most widely used surgical procedure in the treatment of cervical spine disc hernias have been the anterior cervical discectomy and fusion for decades. The usage of cervical disc prostheses enabled us to preserve the movements of the affected segments, hereby reducing the overexertion of the adjacent vertebrae and discs. Our goal is to follow our patients operated with Active-C prosthesis (which is used in the Institute since 2010) to gather information about the change of their complaints and about the functioning and unwanted negative effects of the prostheses. Question - Is the usage of Active-C prosthesis an efficient procedure? Methods - Between 2010 and 2013, performing the survey of neurological conditions and functional X-ray examinations. We measured the complaints of the patients using the Visual Analogue Scale, Neck Disability Index and Cervical Spine Outcomes Questionnaire. The control group consisted of patients who were operated in one segment using the fusion technique. Results - In the study group according to the Neck Disability Index scale after 18 months, seven patients had no complaints, while twelve persons reported mild and the remaining six moderate complaints. In the control group, moderate complaints were present in four patients, while twelve patients reported mild complaints. The other eight persons showed no complaints. According to the results of the Visual Analogue Scale in the group of prosthesis, the degree of referred pain decreased from 8.6 to 1.84 one and a half years after the surgery. A decrease was observable in the case of axial pain too, from 6.6 down to 1.92 (p<0.01). In case of three from the twenty-five patients there was no sign of movement in the level of the prosthesis. Conclusions - According to the present short- and mediumterm studies, the usage of the cervical disc prosthesis can be considered as an efficient procedure, but at the same time the advantages can only be determined in the long run, therefore further following and studies are required.]

Clinical Neuroscience

JULY 30, 2016

Gray matter atrophy in presymptomatic Huntington’s patients

KIRÁLY András, KINCSES Zsigmond Tamás, SZABÓ Nikoletta, TÓTH Eszter, CSETE Gergő, FARAGÓ Péter, VÉCSEI László

Background - Huntington’s disease is a progressive disease in which neurodegeneration is on-going from the early presymptomatic phase. Development of sensitive biomarkers in this presymptomatic stage that are able to monitor the disease progression and test the efficacy of putative neuroprotective treatments are essential. Methods - Seven presymptomatic Huntington mutation carriers and ten age-matched healthy controls were recruited. Six of the patients participated in a 24 months longitudinal study having MRI scans 12 and 24 months after the baseline measurements. High resolution T1 weighted images were carried out and voxel based morphometry was used to analyse the data. Apart of group differences, correlation of CAG repeat number with focal cortical thickness and with global gray matter volume was calculated. Results - Focal cortical atrophy was found bilaterally in the superior temporal sulcus and in the left middle frontal gyrus in presymptomatic Huntington patients in whom no sign of cognitive or motor deterioration was detected. Global gray matter atrophy (p<0.048) and decreased total brain volume was found. The number of CAG triplets showed no correlation with the focal gray matter atrophy and total brain volume. Strong correlation between the CAG repeat number and global gray matter volume was found (p<0.016). Conclusion - Cortical atrophy is apparent in the early, presymptomatic stage of the disease. With further validation in large patient sample atrophy measure could be biomarker of disease progression and putatively of neurodegeneration.

Clinical Neuroscience

MAY 30, 2016

[The changes in quality of life after instrumented surgical fusion of degenerative spondylolisthesis]

SÁRÓ Enikő, MISIK Ferenc, BANCZEROWSKI Péter

[Objective - There is no internationally accepted guideline for treatment of spondylolisthesis in the literature, otherwise this degenerative disease has great social and economical impact. There is no hungarian study examining the efficacy of instrumented fusion procedure in surgical treatment of spondylolisthesis. In current study we examined the effectiveness of fusion technique focusing on the impact of quality of life. Methods - Between 1st January, 2011 and 30th June, 2012 we examined a group of patients - who were operated on by instrumented fusion technique because of spondylolisthesis -, in the National Institute of Clinical Neurosciences, using the Oswestry Low Back Disability Questionnaire. All patients were treated after ineffective conservative treatment. The question was wheather how has changed the patients’ quality of life after the operation. Paired-sample t-test was used in this study. Results - Eighty-eight of the 97 examined patients reported different levels of impovement in the postoperative period, two patient’s condition has not changed in spite of the surgery, seven patient’s condition showed progression in average one year after the surgery. The pain improved most significantly (55.5%) (p<0.0001). Using the 16 point borderline according to the Questionnaire (over moderate disability), significant improvement was detected in 50 patients (51.5%). Succesful surgical result - according to the quality of life - was seen in 77.41% of male and in 50.98% of female patients. According to the different age groups, 72.72% of the younger (before retirement), and 53.06% of the retired patients belonged to this group. At least 15 point improvement was detected 35.05% of the patients, the overall improvement was 10.5 point. Discussion - Our results proved effectiveness of instrumented surgical fusion procedure in the treatment of degenerative spondylolisthesis. According to our results the younger male population with significant symptoms is the group, where improvement in quality of life is more pronaunced after the surgical procedure. Conclusion - The instrumented fusion surgical technique provides successful clinical and surgical outcome in patients with degenerative spondylolisthesis. It could improve the quality of life. Althought multicentre follow-up studies are needed to determine the exact indication and optimal therapy.]

Clinical Neuroscience

MAY 30, 2016

[Closure of nasocranial fistulas with “bath-plug” technique and multilayer reconstruction]

PISKI Zalán, BÜKI András, NEPP Nelli, BURIÁN András, RÉVÉSZ Péter, GERLINGER Imre

[Background and purpose - In case of dehiscenses developing on the anterior scull base, complete closure resulting in the cessation of the communication between the nasal cavity and the intracranial space is mandatory as soon as possible, in order to prevent serious complications. With the development of the endoscopic techniques, the endonasal management for the reconstruction has become available in recent decades. Methods - We aim to present the reconstruction techniques applied in our department in the cases of two patients recently operated at our institute. The choice of methods primarily depends on the size and the localization of the defect. Dehiscenses under 5 mm of diameter can be closed with the so called “bath-plug” technique, while bigger defects, where the required closure of the plug is not possible, can be solved with multilayer reconstruction. We use autogenous fascia, fat and muco-periosteum in both cases. Results - Our patient, who underwent the aforementioned “bath-plug” procedure, could be discharged after a few days of uneventful postoperative period. During a tenmonth follow- up period new fistula formation was not observed. In the case of a patient who underwent multilayer reconstruction, meningitis occurred postoperatively, which was resolved after antibiotic therapy. During a 17- month follow- up period recurrent liquorrhoea did not occur. Conclusion - With suitable technical background and appropriate endoscopic skills the surgeries of the anterior skull base cerebrospinal fluid fistulas can be performed efficiently and with low complication rate. These are minimally invasive procedures accompanied by less surgical trauma, morbidity and shorter hospitalization, hence these techniques are considered to be cost-effective and well- tolerated for the patients.]

Clinical Oncology

MAY 20, 2014

[Radiological response evaluation of targeted therapy]

KALINA Ildikó, OSZLÁNSZKY György

[The objective assessment of the changes in the tumor burden along with cancer therapy has essential importance. Recently, the quantitative evaluation of the radiological tumor response was undergone several changes. For conventional chemotherapy of solid tumors the standard procedure has been RECIST since 2000. The targeted therapies trigger other pathophysiological changes in the cells than the cytotoxic agents, accordingly the morphological changes show a new picture. Therefore the targeted therapies require a new evaluation system, that takes into consideration not only the tumor size, but other changes as well, the changes of attenuation that corresponds with the proportion of the viable cells. In case of the targeted therapies in substantial clinical was experienced even without signifi cant morphological changes in the tumour size. As a consequence, the traditional, size-based criteria system can underestimate the effi ciency of the new types of treatments. To eliminate this problem new evaluation systems were created taking the tumortypes and treatment protocolls into consideration. The estimation of the early tumor response to targeted therapy also has high importance. In assessment of the response functional imaging methods are used more frequently. The role of PET has already been defi ned in numerous tumortypes, however the determination of the position of some promising functional examinations still require further studies.]

Lege Artis Medicinae

FEBRUARY 05, 2016

[Diagnostic algorythm and treatment of bilateral malignant histiocytoma in everyday medical practice?]

VANYA Melinda, SZILI Károly, KELLERMAN Péter, KISS János, KAISER László, LAJOS György

[OBJECTIVE - We report the rare case of a 47-year-old man with malignant fibrous histiocytoma, developing in the right tibia. CASE REPORT - We report a case of a 47 year-old man with chronic pain in his right leg. Magnetic resonance imaging and biopsy was performed. His pathological result was malignant fibrous histiocytoma. CONCLUSIONS - The management of malignant fibrous histiocytoma contains the combination of surgical procedure, chemotherapy and radiotherapy. The diagnosis and the total removal of the tumour is very difficult. ]

Journal of Nursing Theory and Practice

APRIL 30, 2015

[Intracystic brachytherapy of cystic brain tumors by image fusion method- intracavital beta irradiation of 90-Yttrium solution]

BALLÁNÉ PERDUK Anikó, JULOW Jenő

[Aim of the research: The authors aimed to gain acceptance, effectiveness testing and the timetable of the shrinking of the cysts for the treatment procedure of patients with cystic craniopharyngeoma. The procedure utilizes intracavitary beta irradiation by 90Y colloidal solution. Image fusion was used for the first time for the guidance and control of the intra cystic irradiation of brain tumors. The authors also examined the use of the image fusion for brachytherapy of brain tumors before, during, and months or even years after surgery and to patient follow up. Research and sampling methods: 130 craniopharyngeoma cyst was irradiated with the Yttrium-90 colloidal solution in 84 patients. The internal wall of the cyst were getting a load of 180-300 Gy. The volumes of the cysts were followed almost over 30 years by the control of CT-MRI image fusion. For the planning of the irradiation the authors developed their own software and BrainLab was used for the CT-MRI-PET image fusion. For the mathematical and statistical calculation Matlab and MedCalc soft wares were utilized. Results: The results were from 130, 90Y β stereotactic intracavitary irradiation of cystic craniopharyngiomas. As per cystic CRF volume the volume reduction exceeded 80 %. The mean survival rate following 90-Y irradiation was 7.5 years. Large-scale shrinkage of craniopharyngioma cysts were observed significantly, following 6 months. Conclusions: According to long term clinical experience the intracavitary 90 Yttrium brachytherapy is a relatively non-invasive and effective mode for the recurrent cystic craniopharyngeoma therapy. Procedures where isotope get implanted, qualify in all aspects of a minimally invasive therapy.]