[The occurrence of neuroinvasive symptoms caused by the West Nile virus at an emergency center]. / A nyugat-nílusi vírus okozta neuroinvazív tünetegyüttes elofordulása sürgosségi osztályon.

Introduction: According to the European Centre for Disease Prevention and Control, the prevalence of neuroinvasive symptoms caused by the West Nile virus (WNV) has significantly increased in the past years throughout Europe, including Hungary. The rise may be attributed to changes in precipitation and climate. The WNV zoonosis is spread by mosquitoes. It is mostly asymptomatic, flu-like symptoms occur in 20% of the cases and in less than 1% a neuroinvasive disease with a lethal outcome may develop. Aim: Our aim was to demonstrate the neuroinvasive symptomatology and the diagnosis and treatment of WNV infections by describing our patient cases as well as to resolve differential diagnostic dilemmas. Method: We report the cases of 4 patients treated at the "Moritz Kaposi" Somogy County Hospital between the 31st July and 4th September, 2018, with WNV, whose diagnoses were confirmed by serological and molecular biological methods. An epidemiological overview of WNV infections was also given. Results: Four patients were confirmed to have had WNV infection in the given time period. A wide range of neurological symptoms were observed in each patient and death occurred in one case. The patients were elderly with a number of comorbidities. Conclusions: The appearance of more severe, neuroinvasive symptoms following WNV infections is also characteristic of Hungary. The treatment of the infection is supportive, including giving pain relievers and the management of secondary infections. It is important to consider the possibility of a WNV infection in the case of a neurological disease of unknown origin, particularly if the symptoms indicate encephalitis. Orv Hetil. 2019; 160(51): 2026-2035.

[Patient turnover in a multidisciplinary emergency department]. / Betegforgalmi trendek multidiszciplináris sürgosségi osztályon.

INTRODUCTION: More than twenty emergency departments were opened across Hungary in the past years. Data deficiency on patient flow, trends and lack of knowledge of indicators could raise numerous logistical and organisational problems. AIM: Collection, analysis and provision of data to facilitate successful operations of emergency medical care services. METHOD: During a three-year period investigated, at the multidisciplinary Emergency Department of "Moritz Kaposi" Teaching Hospital, data on patient flow (n = 106,203), epidemiology, triage and international classification of diseases were analysed. RESULTS: Analysis showed 73% of patients were suitable for medical discharge within 24 hours. Predominantly internal medicine, paediatric and neurological diseases indicated hospitalisation (21%). Patients in critical condition were found to be low (<2%). Distinct diurnal, weekly, monthly variations were found. Majority of cases were injuries and intoxications (40%). Low mortality rate (0.3%) validates the effectiveness of stabilisation. CONCLUSIONS: The patient safety value of the examined emergency medical care is great, and could exempt the hospital wards from unjustified hospitalisations of the patients. Orv Hetil. 2017; 158(21): 811-822.

[COMPUTED TOMOGRAPHIC EXAMINATION OF CRANIAL LESIONS, A PALEORADIOLOGICAL APPROACH]. / KOPONYACSONT-LAESIÓK KOMPUTERTOMOGRÁFIÁS VIZSGÁLATA ÉS PALEORADIOLÓGIAI ASPEKTUSAI.

BACKGROUND AND PURPOSE: Introducing the multidisciplinary paleoradiology research at the Institute of Diagnostic Imaging and Radiation Oncology of the Kaposvár University, highlighting the cases with potential central nervous system involvement--from the scanning methods to the 3D printing--in order to draw attention to the historical background and clinical aspects of certain pathological conditions. METHODS: The authors developed the examination protocols for three different CT scanners. Among the examined archaeological remains cranial lesions were identified in 26 cases, from which 4 cases with potential central nervous system involvement are demonstrated. The scanning parameters and the advantages of secondary image reconstructions (multiplanar reconstruction, maximum intensity projection, three-dimensional volume rendering technique) are presented with the cases. RESULTS: The authors demonstrate a case with destructive skull lesions due to syphilis from the 15th century AD, a condition rarely seen or even unknown nowadays in the modern world. With the CT images of the skull base fracture from the Iron Age, signs of healing could be verified. Using the CT images a non-invasive approach is presented in the case of the craniofacial osteosarcoma in order to visualize the local status and the direct intracranial propagation. Advantages of the 3D VRT reconstructions are shown in the case of unilateral coronal suture synostosis. CONCLUSION: Paleoradiological CT examinations serve as a non-invasive, non-destructive tool for studying archaeological remains and artifacts. The special applications provided by the imaging modality contribute to the conventional paleopathological investigations.

Characterization of Individuals Taking Part in Low Dose Computed Tomography (LDCT) Screening Program.

UNLABELLED: In the past years the participation rate in conventional voluntary x-ray lung screening has been around 22 % in Somogy County in Hungary. Due to the high morbidity and mortality rates of lung cancer, low participation rate of the high risk individuals on the screening is a primary question in Hungary. To obtain an effectively high level of participation in our ongoing low dose CT screening program, we had to emphasize the benefits of participation for the targeted individuals. As a first step, our aim was to gather information on the aspects affecting the individuals' will for participation. We used the most accessible source of information: individuals over the age of 50, who attended the conventional voluntary lung screening, were approached to fill a questionnaire on their habits relating to smoking, health issues and their prior participation of lung screening. 1080 adults anonymously completed the questionnaire. Analyzing the results, beside other findings, we found a unique variable factor, which altered negatively the compliance for the screening: older individuals, who started participating in the screening in obligation to the health regulations, took part in the voluntary screening programs at a significantly lower rate. Our findings led us to better understanding the complexity of decision making affecting the individual's participation and attitudes toward health issues. TRIAL REGISTRATION: IG/03833/2012.

[Analysis of the data of patients presenting for emergency treatment with vertigo]. / A sürgosségi ellátásban szédüléssel jelentkezo betegek adatainak elemzése.

OBJECTIVE: Analyzing the medical record data of patients with the main symptom of vertigo in "Kaposi M6r" Hospital's Emergency Department. METHOD: Retrospective evaluation of patients's medical history with vertigo related diagnoses according to BNO classification. RESULTS: In the year of 2010, 18 000 patients were presented to ED. In 471 cases the symptoms were vertigo related which makes up 3% of the total. Almost half, 46% of these patients were brought in by ambulance medical car. The ratio of women was twice as high as of the men. One fifth, 19% of patients with vertigo gained admission to the ward and 81% of them were discharged in 24 hours. According to the interviews, 4 types of vertigo have been identified: "whirling style" vertigo in 37% of the cases, dizziness in 33% of the cases, presyncope in 12% and "light headedness" in 9%. The remaining 9% couldn't be classified. CONCLUSION: Vertigo is common presenting symptom in emergency department, however it rarely indicates severe condition. The diagnostic value of vertigo classification based on history and brain CT result in identifying the severity of the background condition is questionable. We found that in recognizing the cases which need prompt intervention, thorough neurological examination and the clarification of the vertigo's circumstances proved to be helpful.

[Preliminary experiences with low-dose computed tomography for lung cancer screening in Hungary]. / Alacsony dózisú CT-vel történo tüdorákszurés magyarországi bevezetésének elso tapasztalatai.

INTRODUCTION: Lung cancer has the highest mortality rate of all types of cancers both in developed countries and Hungary. AIM: To obtain experience and facilitate the application of low-dose computed tomography-based lung cancer screening as a targeted public health screening procedure. METHOD: Volunteers without thoracic complaints above the age of 40 years (n = 963) were screened for lung cancer using digital chest radiography and low-dose computed tomography. RESULTS: Two lung cancers were found among the participants screened with digital chest radiography (0.2%). After informed consent, 173 individuals with normal chest radiography findings (n = 943) took the opportunity to voluntarily participate in low-dose computed tomography screening for lung cancer. After 3 or 12 months, 65 individuals had follow up control examinations based on the size and characteristics of the detected lesions. Among them, one participant was found to have lung cancer using low-dose computed tomography. CONCLUSIONS: These results indicate that low-dose computed tomography-based lung cancer screening as a public health screening procedure can enhance the success of screening with 50% (from 0.2% to 0.3%). The cost-benefit ratio can be raised if chest radiography is performed prior to the low-dose computed tomography examination.

First result of differentiated communication--to smokers and non-smokers--in order to increase the voluntary participation rate in lung screening.

BACKGROUND: Lung cancer is the most common fatal malignancy and also the primary cause of cancer mortality. Participation in lung screening is an important step in diagnosing patient in early stage and it can promise better outcomes. The aim of this preliminary study was to determinate the differences in the participation rate of smokers and non-smokers in lung cancer screening and to determine the communication strategies to increase the participation rate. METHODS: In the given period of time (from May to August 2012) out of 1426 people who participated in the lung screening program 1,060 adult volunteers (331 males and 729 females, average age 54.0 ± 9.3 years), completed fully and anonymously author's questionnaire that contained 28 questions. 25.7% of the respondents were smokers (n=272), 64.6% have never smoked, while 9.7% were former smokers. RESULTS: Mostly former smokers considered lung screening as an effective method for early detection of pulmonary diseases (86.4%). The most important source (41.0%) of information was the general practitioner. The participation rate of non-smokers is higher in lung screening than the ratio of non-smokers in the population. The unclear data suggest that smokers need distinct, concise messages to know why they should regularly undergo lung screening and doctors have a major role in this. CONCLUSIONS: We found that smokers significantly more frequently took part in lung screening annually. It is positive that the participation rate of former smokers is higher than non-smokers, it is just a bit lower than the participation rate of smokers--both in annual and biannual participation. The participation rate of non-smokers is higher in lung screening than the rate of non-smokers in the population.

[The influence of patients' gender and education level on the incidence of chemotherapy-induced anticipatory nausea and vomiting]. / A nem és az iskolázottság hatása a kemoterápia indukálta anticipátoros hányinger, hányás kialakulására.

INTRODUCTION: The incidence of anticipatory nausea and vomiting is 30% among patients receiving repeat chemotherapy. AIMS: The aim of the authors was to investigate the influence of gender and education level on the incidence of chemotherapy-induced anticipatory nausea and vomiting. METHODS: Using a complex questionnaire 205 patients (60 men and 145 women; mean age: 63.3 years) were evaluated during an 8-months period from May 1 to December 31, 2008 in the Oncology Department of Zala County Hospital. The patients suffered from breast and colorectal cancer, treated by chemotherapy. The chemotherapy protocols contained drugs with high and moderate emetic risk. The patients were interviewed at the time of their second and third chemotherapeutical cycle. Besides clinical symptoms the questionnaires provided information about the patients' gender and education level. RESULTS: The incidence of anticipatory nausea and vomiting was 27.8% (men, 21.7%; women, 30.3%). The data obtained correlated well to those published in the literature. Alprazolam 0.5 mg twice a day was given to 21 female patients. Psychotherapy was not necessary. CONCLUSIONS: The anticipatory nausea and vomiting frequently occur among female patients, and they show correlation with the education level.

[Brain tissue water content determination based on T1 relaxation time of water and quantitative cerebral 1H MRS at 3T using water as an internal reference]. / T1-relaxációs idon alapuló agyi víztartalom-meghatározás és kvantitatív 1H-MRS 3 T téreron.

OBJECTIVE: Application of a quantitative MR-spectroscopic method for 3T clinical scanners based on tissue water content as an internal reference. PATIENTS AND METHODS: Six (22 +/- 2 yrs) volunteers were involved in the study. We performed T1 relaxation time measurements in a particular slice of the brain at 1T and 3T. Based on the validated water content measurement at 1T, the correlation of relaxation time T1 and water content was determined at 3T. The resulting water content served as internal reference for the quantification of localizated MR-spectroscopic measurement. RESULTS: At 3T our method resulted in 37.6 +/- 0.5 mol/l and 46.4 +/- 1.5 mol/l tissue water content in the white and gray matter, respectively. Calibration based on water content led to following metabolite concentrations: N-acetyl-aspartate 7.79 +/- 0.67 mmol/l; creatine 3.76 +/- 0.28 mmol/l; choline 3.68 +/- 0.47 mmol/l; myo-inositol 10.35 +/- 3.70 mmol/l in the white matter; and N-acetyl-aspartate 8.20 +/- 0.45 mmol/l; creatine 4.76 +/- 0.18 mmol/l; choline 2.64 +/- 0.35 mmol/l; myo-inositol 8.32 +/- 1.42 mmol/l in the grey matter. CONCLUSIONS: Tissue water content based on T value at 3T shows good accordance with gravimetric or other MR methods in the literature. Using it as an internal reference resulted in white matter metabolite concentrations that are in the range of previously published data. Comparing metabolite values of grey matter is more difficult because data in the literature substantially differ. The presented method is simple and easily applicable on any MR scanner without complicated correction and calibration steps.

Impact of infrared laser light-induced ablation at different wavelengths on bovine intervertebral disc ex vivo: evaluation with magnetic resonance imaging and histology.

BACKGROUND AND OBJECTIVE: Percutaneous laser disc decompression is commonly used to lower high pressure in the nucleus pulposus in degenerative disc diseases. The aim of this study was to investigate the impact of diode laser disc decompression at different wavelengths (980-nm vs. 1,470-nm, i.e., different water absorption characteristics). MATERIALS AND METHODS: To model decompression, a flexible laser quartz fiber inserted into the nucleus pulposus of ex vivo bovine spines using computer-assisted surgical navigation was utilized to vaporize tissue. The same energy (500 J) was delivered using both 980-nm and 1,470-nm wavelength lasers. To determine the different impact of the wavelengths before and after the procedure we evaluated the discs with MRI (T(1), T(2), diffusion maps) and with histopathology. RESULTS: There were no visible changes on T(1) and T(2) maps after 1,470-nm wavelength laser irradiation; however, the 980-nm wavelength caused significant changes on T(1) (decrease) and T(2) (increase) in the vaporization zone at the site of the quartz fiber. Pathological findings showed carbonization and steam-bubble formation in addition to the T(1) and T(2) changes. No significant changes were detected in the value of apparent diffusion coefficient (ADC) measurements in intervertebral disc with the 980-nm wavelength, but significant ADC and T(1) signal increase was detected with the 1,470-nm wavelength when the whole nucleus pulposus was considered. CONCLUSION: The 1,470-nm laser light had an effect in the whole nucleus pulposus and not only at the site of the quartz fiber, whereas with the 980-nm laser irradiation, significant changes were demonstrated only at the application site.

[The establishment of the Marfan syndrome biobank in Hungary]. / Marfan-szindróma biobankjának létrehozása.

UNLABELLED: Marfan syndrome is a genetic disorder of the connective tissue, which affects approximately 2000-3000 individuals in Hungary. Given its multi-systemic manifestations, this disorder is often difficult to diagnose. To date, the National Marfan Register system contains approximately 250 cases, and this number is dynamically increasing. AIMS: Collection of data from biological samples, clinical parameters, and lifestyle factors in Hungarian patients with Marfan syndrome. METHODS: In terms of the criteria used for selection, those cases were chosen where the disorder could be clearly diagnosed on the basis of the patients' cardiovascular and systemic symptoms, as well as of their family history, in line with the guidelines set by the Revised Ghent Nosology. RESULTS: For the purposes of developing the biobank used for the research, 102 cases were selected from the Marfan Register (cDNA from 55 patients, genomic DNA and serum from 102 patients). In addition to the samples, data have been obtained by using internationally validated surveys to further examine the role of physical activity, nutrition and various psychological factors. CONCLUSIONS: The establishment of the Marfan Biobank enables scientists to effectively carry out research based on genetic, gene-expression and protein analysis. The biobank also provides new opportunities to study Hungarian patients with Marfan syndrome.

["Does happiness help healing?" Immune response of hospitalized children may change during visits of the Smiling Hospital Foundation's Artists]. / "A mosoly is gyógyít?" Beteg gyermekek immunválasza is változhat a Mosolygó Kórház Alapítvány muvészeinek látogatásakor.

UNLABELLED: Psychoneuroimmunologic studies on positive emotions are few, and their clinical relevance is limited. AIMS: This "SHoRT" (Smiling Hospital Research Team) study evaluates the effects that Smiling Hospital artists have on hospitalized children. METHODS: Blood samples were taken in a non-painful way through branules in an accredited Infectology Ward, 30 minutes before and 1 hour after a visit of tale tellers, puppeteers and handicraft artists. 24 children were visited and 9 were included in the control group. Blood lymphocyte counts and Th1/Th2 cytokine levels were determined. Artists evaluated their effect on a subjective scale. RESULTS: In the visited group, the increase of lymphocytes was 8.43% higher, the decrease was 12.45% lower, and the proportion of children showing increased lymphocyte counts was more increased. Changes were more marked after more successful visits. Authors found non-significant, still considerable changes in interferon-γ level (p < 0.055) and in Th1/Th2 cytokine ratios. CONCLUSIONS: This pediatric study suggests that immunological changes may develop when more attention is given to hospitalized children.

Fatty acid composition of plasma lipid classes in chronic alcoholic pancreatitis.

BACKGROUND/AIMS: Supplementation of n-3 long-chain polyunsaturated fatty acids (LCPUFA) is considered as adjuvant therapy in acute pancreatitis. We investigated plasma fatty acid status in chronic pancreatitis (CP). METHODS: Patients with alcoholic CP (n = 56, gender: 33/23 male/female, age: 60.0 [14.0] years (median [IQR]), who reported giving up alcohol consumption several years ago and 51 control subjects were included into the study. The fatty acid composition of plasma phospholipids (PL), triacylglycerols (TG) and sterol esters (STE) was analyzed. RESULTS: The sum of monounsaturated fatty acids was significantly higher in patients with CP than in controls (PL: 12.83 [3.35] vs. 12.20 [1.95], TG: 40.51 [6.02] vs. 37.52 [5.80], STE: 20.58 [7.22] vs. 17.54 [3.48], CP vs. control, % weight/weight, median [IQR], p < 0.05). Values of arachidonic acid were significantly lower in patients with CP than in controls (PL: 10.57 [3.56] vs. 11.66 [3.25], STE: 8.14 [2.63] vs. 9.24 [2.86], p < 0.05). Values of eicosapentaenoic acid and docosahexaenoic acid did not differ and there was no difference in the ratio of n-3 to n-6 LCPUFA. CONCLUSION: Our present data do not furnish evidence for the supplementation of n-3 LCPUFA to the diet of CP patients in relatively good clinical condition.

[Nutritional status and nutritional rehabilitation of elderly people living in long-term care institutions]. / A tartós bentlakásos intézményekben élô idoskorúak tápláltsági állapota és táplálkozási rehabilitációja.

UNLABELLED: We review our studies on the most important factors related to feeding and nutrition in long-term care institutions, as well as we present the nutritional status of elderly people living in social homes, and, based on our results, we make recommendations concerning nutritional rehabilitation. AIMS: We aimed to assess the following: nutritional status of people older than sixty years (elderly) living in long-term care institutions; changes in the body mass index of elderly living in long-term care institutions; changes in the nutritional status of elderly living in long-term care institutions during the last half decade; relations and correlations between acute and chronic diseases and nutritional status; the sip feed provision for elderly living in long-term care institutions; relationship between the discovered potential influencing factors and nutritional status screened by Malnutrition Universal Screening Tool (MUST). METHODS: We screened the nutritional status of altogether 4774 (men: 28.9-30.9%, women: 69.1-71.19%; mean age: 77.8+/-8.9 years) elderly long-term care residents who volunteered to participate. In 2004 and 2006 the MUST and our questionnaire, in 2008 the nutritionDay questionnaire was used. RESULTS: Risk of malnutrition is high (26.8-77.0%) in elderly residents of social homes. Assessment of nutritional status is done four times a year or even more rarely in 29.5% of the residents. Nutritional status is multifactorial; it is influenced by immobility, fever, etc. Loss of appetite and swallowing difficulties are 2.5-fold, limited mobility, dementia and missing teeth are almost two-fold (1.6-1.7) more frequent in the group of high risk elderly than in the elderly living in social homes. Neurological diseases are in a significant correlation with nutritional status. Incidence of neurological diseases increased significantly in the last years. CONCLUSION: Nutritional rehabilitation does not end with screening the nutritional status, moreover, it begins with that. Individual diet has to follow the determination of personal nutritional guidelines.

[Therapeutic modalities in the treatment of palmar and axillary hyperhidrosis]. / A terápiás módszerek értékelése felsô testféli hyperhidrosis kezelésében.

The authors summarize their therapeutic methods of palmar and axillary hyperhidrosis in this article. They discuss the characteristics, frequency of upper limb and patho-anatomical features of chronic sweating. Authors summarized their almost 40 years experience in treatment methods, technological improvements as well as they review recent knowledge and relevant literature. The open thoracotomic desympathization applied in the beginnings was gradually replaced by a minimally invasive VATS-sympathectomy (Video Assisted Thoracoscopic Surgery). The possibilities of conservative treatments, local excision methods will also be discussed, as well as the application and efficiency of Botox-treatments that are used in plastic surgery. The mean frequency of 0.1-1.0% described in scientific literature is indicative of a significant number of unresolved cases, which thus requires more efficient diagnostic and patient orientation practices. Based on their experiences, the most efficient treatment of upper limb hyperhidrosis is the thoracic sympathectomy (ramicotomy and the relevant T(2) -T(3) ganglia) according to Smithwick-procedure and modified by others. If necessary, one-stage bilateral VATS-surgery may be applied. Another effective conservative possibility is the Botox-therapy, which they had applied individually at the plastic surgery clinic. Significant complications or compensatory hyperhidrosis were not detected.

Results of nutritional screening in institutionalized elderly in Hungary.

Dietetics contributes to life-long, sustainable health and optimal life quality of people. The knowledge of the nutritional state can be informative and normative in order to optimize personal care. The aims of this study were to summarize the relevant legislative considerations of nourishing the elderly in different long-term residential social institutions and to screen the nutritional state of those living there. No investigation of this type has ever been carried out in Hungary or in central eastern Europe before. We used the malnutrition universal screening tool (MUST) screening program for the evaluation of nutritional status. Our survey was done in 20 Hungarian nursing homes in 2006. The sample (n=1381) was representative of regional distribution and number of residents. In our study population 38.2% of the patients were endangered in point of malnutrition. The results of our survey call attention to the elevated number of elderly people at risk of malnutrition in nursing homes. As malnutrition has serious consequences regarding also quality of life, nutritional screening of nursing home residents is not only a basic economical interest, but is also in full harmony with the idea "not only to feed, but to nourish" and it is a basic moral duty.

[The use of ROMICRO set in plastic surgery]. / Romicro-szett alkalmazása a plasztikai sebészetben.

More than thousand plastic operations were performed in our departments with ROMICRO-set during the last ten years. First we applied it for reconstructive and aesthetic augmentation of the breast. Thereafter, we developed new technique for gynecomastia and reconstruction of diastasis of the m. rectus abdominis sheath. According to our experience, the ROMICRO-set is a useful tool in plastic surgery. The ROMICRO-set can be used through a small incision to achieve three dimensional views with excellent exposure and lighting.

[Sapheno-peritoneal shunt (Routte-operation) in the treatment of refractory ascites]. / Sapheno-peritonealis shunt (Ruotte-mútét) a terápiarezisztens ascites kezelésére.

We describe the results of an operative method applied in patients suffering from refractory ascites. Instead of the well-known shunt-implants we started to re-use Ruotte's method, which was published 100 years ago. According to our observations the anastomosis formed by the long saphenous vein and the peritoneal surface eliminates not only the known complications of the traditional shunt-operations but also provides an effective early and a late ascites inflow. The flow of the ascites was convincingly proven by regularly performed colour Doppler UH tests. This old/new method is applicable in patients with therapy-resistant ascites to eliminate the traditional shunt-models.