The combined effect of psychotherapy and fluoxetine on obesity]

Obesity as psychosomatic disease is a mass phenomenon. The number of obese males (BMI > 30) became doubled in the last ten years. In the etiology of obesity play an important role the reactive obesity. In the background of "yo-yo syndrome" often could be found depression, or other psychotic disorder. The low self-esteem, body dissatisfaction, tension, anxiety disorders is well-known in a slimming diet. Obese subjects (n = 29) who were admitted on their request with a view to losing weight were examined (Hamilton Depressive Scala, Hamilton Anxietas Scala, Eating Attitude Test) Physical Conditioning and internal Medicine Department of National Sports Medicine Institute, Budapest. Among obesities with mild and severe depression as treatment of somatic complications was used fluoxetine, in severe cases and depression with severe anxiety was associated with supportive or cognitive-behavioral treatment. The prevalence of binge eating disorders were at 57% and bulimia nervosa was at 3% in using population (n = 29). Decreasing of anxiety and grade of depression significantly correlated with body mass index (p < 0.023, F = 1.997, p < 0.034, F = 3.131). The treatment of fluoxetine significantly correlated with body mass index (T1: p < 0.023, T2: p < 0.03, T3: p < 0.004). The patients indicated their well being as fluoxetine reduced eating, satiety and lower binges.     

Virologic aspects of juvenile laryngeal papillomatosis

Juvenile laryngeal papillomatosis is the most common benign tumor of the larynx in childhood. The specific etiological factors are non-oncogenic human papillomavirus types 6 and 11. In the present study two cases (a 6-year-old male and a 5 and a half-year-old female) operated five times each and harbouring type 11 DNA in papillomas excised in the first operations are analysed from the following virological aspects: 1. the examination of vertical transmission by general primer-polymerase chain reaction of maternal cervical exfoliation; 2. sites of papilloma predilections in the larynx; 3. histopathology; 4. viral DNA detection from the formalin-fixed and paraffin-embedded archive tissues and from a fresh papilloma tissue in one case by polymerase chain reaction applying type-specific primers. We did not find any signs of maternofoetal transmission in the anamnesis and the maternal cervix proved to be negative for viral DNA. However, the vertical route of transmission can not be excluded due to the special natural history of papillomavirus infections. Papillomas usually localised in normal squamociliary junctions of the larynx. The histopathologic review did not reveal any signs of malignancy. Koilocytosis referring to productive viral infection and the signs of abnormal keratinisation were present in each tissue. All tissues of the patients proved to be positive for the short amplimer deriving from the genome of human papillomavirus type 11.     

Morphological parameters of breast cancers detected by mammography with and without organized screening; a comparative study]

Some pathological findings and prognostic indices recorded in breast cancer cases, detected, on one hand, by a provider-initiated mammography screening program (Group 1), and, opportunistically, in self-referred symptomatic women (Group 2) on the other, are compared. In 8877 symptom-free women, aged 50-65 years, individually invited to attend the screening offered for the residents of the III., XII. and XIII. districts of Budapest, 67 cancer cases were detected (7.5 in 1000 screenees), in accordance with the cancer detection rate of the first, "prevalence" round of organised screening programmes. In the other group of 1593 symptomatic, self-referred women of the same age, 113 cancer cases were diagnosed by mammography. As far as the pathological parameters are concerned, the number of cases with invasive cancer less than 15 mm in diameter, and those with axillary nodes present was found to be significantly higher in the screened group as compared to the self-referred one (p < 0.01). In "small" cancers (i.e. less than 15 mm in diameter), no significant difference was found in the proportion of histologic grade III tumours among the two groups. In screen-detected cancers both the morphometric prognostic index (as calculated by Baak et al.) and the Nottingham Prognostic Index (NPI) proved to be more favourable, as compared to those in the self-referred group. The p-value as determined by Mann-Whithey test was 0.000003 in the screened group, and 0.000015 in the other one. These findings provide convincing evidence in support of the public health importance of provider-initiated, organised mammography screening for breast cancer, therefore, the introduction on service basis of organised breast screening into the health care system in Hungary is strongly recommended by the authors.     

Our experience with Transjugular Intrahepatic Portosystemic Shunt (TIPS)]

The transjugular intrahepatic portosystemic shunt is a relatively new interventional procedure for the treatment of portal hypertension. It helps to stop the hemorrhage from varices. Decreases the risk of rebleeding and the quantity of ascites. 32 patient underwent the intervention from the May of 1995 until October of 1998. Majority of cases belong to Childs'B and C type. In the anamnesis there were 24 alcoholic cirrhosis. Shunt patency, complications and survival were analyzed. TIPS was successfully placed in 27 patients (84%). Portocaval pressure gradient decreased from 22 mmHg to 10.3 mmHg. There was no treatment related mortality. The average follow up was 14 months. In two patients the stents are patent for 36 months. Two stents became stenotic and there were nine occlusions within three years. Hepatic encephalopathy occurred in two cases. The TIPS is a safe, alternative interventional radiological therapy in the cure of portal hypertension without the mortality and morbidity of an open surgical procedure. By the use of TIPS the portosystemic gradient decrease successfully and can be ruled.     

Carotid atherosclerotic lesions in stroke patients with diabetes mellitus]

The aim of the study was to assess the incidence of atherosclerotic lesions on carotid arteries among diabetic subjects suffering from cerebrovascular accident. A further aim was to investigate the relationship between the severity of the carotid lesion, the stroke subtype and the fatal outcome. One hundred and sixty eight patients treated because of cerebrovascular accident at the Dept. of Neurology University Medical School of Debrecen were studied. The age of the patients, the duration of diabetes and hypertension were registrated. Base on duplex scanning carotid lesions were divided in 6 groups of severity (normal, intimal sclerosis, slight, moderately severe, severe stenosis and occlusion). Based on clinical signs and CT results stroke subtypes were divided into five groups (lacunar and non-lacunar infarctions, hemorrhages, normal CT and others). The relationship between severity of carotid lesions, stroke subtype and lethal outcome was assessed using statistical tests. Carotid stenosis of different severity was detected in 60% of the cases. Severity of stenosis was independent from duration of diabetes, but it was positively related to duration of hypertension (p = 0.016). In 1/3 of the patients lacunar strokes, in another 1/3 non-lacunar strokes were observed. No significant relationship was found between severity of carotid stenosis, stroke subtype and lethal outcome of the patients (p = 0.53 and p = 0.26 respectively). Diabetic patients suffering from stroke have a higher incidence of carotid artery atherosclerotic lesions than diabetics without stroke. A special attention should be paid to the carotid duplex sonography in order to detect diabetic cerebral macroangiopathies in early, asymptomatic stage.     

Hairy cell leukemia: authors' own experience (1977-1998)]

Hairy cell leukaemia (HCL) is a rare, clinically and haematologically well characterised entity. The prognosis of patients with hairy cell leukaemia has significantly improved due to the new therapeutic approaches. Development of diagnostic and therapeutic methods, together with the analysis of their own hairy cell leukaemia patients, is reviewed by the authors. Between 1977 and 1998 twenty five patients (16 male, 9 female) were treated. The malignant cells were usually analysed by morphological and cytochemical methods and recently flow cytometric analysis could be performed in eight patients. Splenectomy with lethal outcome in six patients was performed in 21 cases. Approximately one third of patients received interferon, while 2-chlorodeoxyadenosine was given only to three patients. Favourable experiences obtained by splenectomy and efficacy of interferon treatment are emphasised, but according to the literature and their own results administration of purine analogues can be highly recommended in the future.     

Pesticide exposure in a farming village in Venezuela--a developing country

This study was designed and performed by the Universidad de Carabobo, Centro de Investigaciones Toxicológicas, Venezuela, and the University of Cincinnati Department of Environmental Health. The authors tested methodology and analyzed preliminary data on demographics, pesticide use, health, environment, and lifestyles in a farming community in Venezuela (population = 386; sample size = 81) to determine if pesticide misuse might have been contributing to public health problems. Questionnaire and geographic information were collected. There were statistically significant incidences of pesticide-related symptoms (p < .01) in farmers versus nonfarmers (odds ratio = 5.7; 95% confidence interval = 2.9, 18.8). In addition, in one area there was a cluster of farmers who experienced symptoms that appeared to be the result of foul air and proximity to farms where there was pesticide use. The results of the study indicated that this public health problem may have been associated with pesticide misuse; however, additional studies are needed to corroborate the findings.     

Using patient surveys to measure the quality of outpatient care in Kraków, Poland.

OBJECTIVE: To test the feasibility of using patient reported information to create indicators of quality (access, patient experience--including satisfaction, and clinical quality) with the goal of providing Kraków city clinic managers (and potentially other audiences) with information about the quality of outpatient care in selected clinics. Setting and methods. Almost 2,000 patients from 19 outpatient clinics in Kraków, Poland were surveyed in November and December 1997 and January 1998. We prepared a self-completed questionnaire to capture data about the patient's experience with access to services, interactions with registration staff, communication with the doctor, information received from the doctor, and receipt of preventive services. RESULTS: Access varied across clinics. For example, 84% of patients waited less than 10 minutes at registration, whereas only 53% of patients waited less than 30 minutes to see the doctor. Among those who tried to register by telephone, only 72% were successful. Satisfaction was highest with the doctor visit (satisfaction=79, on a scale of 1-100) and lowest with telephone registration (satisfaction = 59). Preventive health care screening was generally disappointing, particularly for Papanicolaou smear and clinical breast examination, although frequent users of a clinic (with more opportunities for screening) generally had higher rates of screening. CONCLUSION: We demonstrated the feasibility of constructing indicators of multiple dimensions of the quality of outpatient care using patient-reported information. Quality dimensions captured by survey included access, patient experience and clinical quality. Results were successfully summarized in easy to read and understand formats for clinic managers and city health department officials.     

Nordenfelt,L.: 1997, Talking About Health. A Philosophical Dialogue

Medicine, Health Care and Philosophy -