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Clinical Neuroscience

SEPTEMBER 30, 2019

Acute bilateral drop foot as a complication of prolonged squatting due to haemorrhoid

KOKSAL Ayhan, DOGAN Burcu Vasfiye

Drop foot is defined as difficulty of dorsiflexion of the foot and ankle due to weak anterior tibial, extensor hallucis longus and extensor digitorum longus muscles. Cauda equina syndrome, local peroneal nerve damage due to trauma, nerve entrapment, compartment syndrome and tumors are common etiologies. A 32-year-old male patient was applied with difficulty in dorsiflexion of both of his toes, feet and ankles after he had squatted in toilette for 6-7 hours (because of his haemorrhoid) after intense alcohol intake 2 weeks before. Acute, partial, demyelinating lesion in head of fibula segment of peroneal nerves was diagnosed by electromyography. This case was reported since prolonged squatting is an extremely rare cause of acute bilateral peroneal neuropathy. This type of neuropathy is mostly demyelination and has good prognosis with physical therapy and mechanical devices, but surgical intervention may be required due to axonal damage. People such as workers and farmers working in the squatting position for long hours should be advised to change their position as soon as the compression symptoms (numbness, tingling) appear.

Journal of Nursing Theory and Practice

OCTOBER 30, 2018

[Postoperative Pain Management Today in Hungary Part 1 ]

LOVASI Orsolya, LÁM Judit

[According to the results of relevant publications the practice for providing effective postoperative pain relief needs to be improved in Hungary. The inadequate pain management can occur several complications resulting prolonged recovery and increased cost of care. Providing adequate analgesia is not only a regulated activity, but a professional, ethical and moral obligation to diminish patients’ suffering. The current practice of pain management was evaluated in several Hungarian hospitals with questionnaires and interviews, analyzing the local pain protocols, and identifying the deeper causes of problems founded. After the comparison of our findings with the suggestions founded in the literature we identified numerous issues to be enhanced. The suggestions based on the results of our study are worth to be reconsidered to improve the current pain management practice of the health care providers performing surgical procedures. ]

Clinical Neuroscience

JANUARY 30, 2019

[Multiple ischemic stroke in Osler-Rendu-Weber disease]

SALAMON András, FARAGÓ Péter, NÉMETH Viola Luca, SZÉPFALUSI Noémi, HORVÁTH Emese, VASS Andrea, BERECZKY Zsuzsanna, TAJTI János, VÉCSEI László, KLIVÉNYI Péter, ZÁDORI Dénes

[Hereditary hemorrhagic teleangiectasia (HHT, Osler-Rendu-Weber disease) is an autosomal dominantly inherited disorder caused by the mutation of several possible genes and characterized by malformations of the arteriovenous system in multiple organs. The clinical diagnosis is based on the Curaçao criteria ((1) spontaneous, recurrent epistaxis; (2) teleangiectasias in characteristic sites (lips, oral cavity, nose, fingers); (3) visceral lesions (gastrointestinal, pulmonary, cerebral, spinal); (4) affected first degree relative). The aim of this study is to present the first genetically confirmed Hungarian case of hereditary hemorrhagic teleangiectasia with multiple ischemic strokes. Our 70-year-old woman has been suffering from severe epistaxis since her childhood and presented gastrointestinal bleeding during her adulthood as well. The characteristic skin lesions developed in the 5th decade of life. She was admitted to our department with loss of consciousness and fluctuating speech and swallowing problems. MRI of the brain supplemented with angiography revealed multiple arteriovenous malformations and multiple subacute ischemic lesions. The EEG demonstrated slowing of electric activity in the left frontal lobe. The neuropsychological assessment showed deficits in anterograde memory and executive functions. The diagnostic work-up for other characteristic alterations identified an arteriovenous malformation in the left lung. The genetic analysis demonstrated a heterozygous mutation in the 7th exon of the ENG gene at position 834 resulting in a thymine duplication and an early stop codon by a frame shift. The present case is largely similar to those already described in literature and draws the attention to the importance of multidisciplinary collaboration in the care of HHT patients.]

Lege Artis Medicinae

DECEMBER 10, 2018

[IgG4-related gastropathy mimicking malignancy]

NAGY Pál, KASZÁS Ilona, PÁK Gábor, TIBA Imre, FELFÖLDI Éva, HAMVAS József, BAGDI Enikő, KRENÁCS László

[The Immunoglobulin G4-related disease (IgG4-RD) along with its synonyms is recently a popular topic in the medical literature. This illness can affect almost every organ in the body therefore it is frequently discussed in any type of interdisciplinary forums. We presented an instructive case of IgG4-RD with gastric involvement in 2016. Hereby we share our pertinent experiences. We are not dealing with the IgG4-RD in general including its terminology problems, epidemiology, pathogenesis, detailed clinical/pathological appearances, diagnostic criteria and treatment. A 63-year-old male presented with symp­toms of pylorus stenosis. The endoscopic findings and CT images were interpreted as those of a malignant tumour in the antrum of the stomach. So a subtotal resection was performed although the biopsy showed reactive proliferation of plasma cells without evidence of malignancy. Pathological examination of the surgical specimen confirmed an IgG4- associated sclerosing inflammation. The patient had an uneventful recovery. Our case is an example of rare, isolated formof IgG4-RD. ]

Journal of Nursing Theory and Practice

APRIL 30, 2018

[Safe Handover - Opportunities to improve Patient Handover]

SINKA Lászlóné Adamik Erika, BÖCSKEI Anna, VASS Zsolt, GÖBÖLY Ágnes

[Mistakes, errors made in the patient handover process can result in severe outcomes, but with appropriate measures it is possible to decrease their numbers. Therefore, we considered it important to develop a methodology which would help us analysing our internal processes. Getting to know the current situation well provides the opportunity to implement those changes into our daily work which focus on the actual problems, and which could lead to measurable improvements in our everyday work processes. ]

Hypertension and nephrology

APRIL 29, 2021

[Current evidence on the accuracy and precision of non-invasive cardiac output monitoring]

VÉGH Anna, REUSZ S György

[Purpose of review: Assessing cardiac output (CO) is an important part of monitoring the hemodynamically unstable patients. Different non-invasive CO measurement devices are currently available, that can be useful in various clinical situations. The purpose of this article is to review current literature on commonly employed methods especially regarding their accuracy and precision. Results: Most of the devices, especially the non-invasive ones have the disadvantage of questionable accuracy and precision. Generally speaking, the more a method is based on assumptions and mathematical models, the less precise it will be. There is also significant heterogeneity between individual studies. Clinically it is important to consider the purpose of the measurement before choosing a method. In terms of accuracy the most reliable ones are, the ones that are based on simple physical principles and minimal assumptions, for example transthoracic echocardiography, and thermodilution. Conclusions: To have better comparability between individual studies it would be imperative to have standardized study protocols regarding the number of cardiac cycles assessed, the used method, the clinical environment, the age and clinical condition of the study population.]

Lege Artis Medicinae

APRIL 23, 2021

[The significance of hypertension in preventing cardiovascular mortality]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[High blood pressure as a separate disease, contributes absolute substantially to the cardiovascular mortality, thus its prevention, early diagnosis, adjusted treatment and primarily its lifelong care make it a pre-eminent public health issue. This comprehensive study concerns the specific aspects of hypertension care. First, we present the different screening programs of the Hun­garian Society of Hypertension, then overview the actual protocols of pharmaceutical treatment and finally we concern the related skills of doctor-patient collaboration. Since our mortality statistics are significantly lagging behind the Western-Eu­ro­pean nations, the widest possible spreading of knowledge is of paramount importance. ]

Clinical Neuroscience

MARCH 30, 2021

Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon: not known vascular malformation of the brain or a posthemorrhagic entity?

KULCSÁR Zsolt, MACHI Paolo, VARGAS Isabel Maria, SCHALLER Karl, LOVBLAD Olof Karl

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed.

Lege Artis Medicinae

FEBRUARY 20, 2021

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]