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Lege Artis Medicinae - 1991;1(09-10)
Content
Lege Artis Medicinae
MAY 29, 1991
[Intendation: the principle hypothesis for conductive education]
[The Conductive Education System has got special attention in the recent decade as an alternative form of integrating disabled persons to society (normalization). The primary goals of the system are costruction of an active life pattern, improvement of the cognitive functions and fulfilment of requirements of a complex and unified programme. This process is special in the (re)habilitation of the motor disabled. Instead of the sensomotoric teaching of orthofunction, its cognitive approach serves the learning of intendation and makes possible the development of orthofunctional spontaneity. Between 1968–88. 9772, 0–14 year old disabled children were registered, and 71% of them admitted. 80% of the younger age group, and 60% of the elder succeeded in integration. In the first half of 1989 80% of 268 children suffering mainly from cerebral palsy were admitted. The special formation of the groups, preparing for work and life, planning of the special education and running the program need well trained conductor staff. ]
Lege Artis Medicinae
MAY 29, 1991
[Diagnosis and treatment of neck pain]
[Neck pain is a frequent syndrome; numerous diseases may stand in its background from a transient myalgia to vertebral malignoma. Thus its diagnostics has a great importance in the everyday practice of the general practicioners. After a short summary of the anatomic features and aetiopathogenesis, the article analizes the anamnesis and physical examination as well as the elements of radiology and laboratory tests. The most important characteristic features of the cervical syndromes, according to leading symptoms are summarized. ]
Lege Artis Medicinae
MAY 29, 1991
[Clinical aspects of congenital thrombophilia]
[In the recent decades the name ,,thrombophilia" has been accepted to denote the congenital, mostly inherited susceptibility to thromboses. The increased coagulability (hypercoagulation) is supposed to be the main cause of the evolution of congenital thrombophilia. Antithrombin III has an outstanding importance to neutralize the active factors developing in the course of the coagulative process, and heparin-cofactor 11 has become known recently. Protein C and protein S are also important regulators. The increased coagulability can be caused by congenital disturbances of the formation of fibrinogen and plasminogen and also by the decreased activity of the fibrinolytic system. Recently, we recognised several cases, where the cause of thrombophilia was simultaneous absence of two inhibitors of coagulation. We attach importance to those cases as well when the inherited defect of one inhibitor and a congenital metabolic disturbance occure together. The diagnosis of congenital thrombophilia needs a long series of laboratory tests. In the course of the treatment results can be expected from thrombolysis, probably from vascular surgical interventions and – in non recent cases – from anticoagulation. The substitution treatment is getting more important in these inhibitor deficiencies.]
Lege Artis Medicinae
MAY 29, 1991
[Predictive value of allergic rhinitis for bronchial asthma in childhood]
[Asthmatic manifestations can be expected in 20 to 30% of children with allergic rhinitis. Risk factors were searched to predict later bronchial asthma in time. In a prospective study family history, clinical symptoms and laboratory signs, bronchial hyperreactivity (to histamine and to adenosine) and the lymphocyte beta-adrenergic receptor affinity and number were investigated. 31 of 40 patients responded with bronchoconstriction to histamin and 20 to adenosine. In 16 patients both provocation tests were positive. There was no significant difference in lymphocyte beta-adrenergic receptors between the patient group and the controls. It is suggested that children with allergic rhinitis who show bronchial hyperreactivity and a decreased number or affinity of lymphocyte beta-adrenergic receptors are more at risk to asthmatic manifestations. The risk is higher as the number of receptors decreases with age. The prognostic value of the above mentioned methods will be demonstrated by a subsequent retrospective study.]
Lege Artis Medicinae
MAY 29, 1991
[A consultation program for planning insulin therapy]
[This paper describes a decision support system aimed to assist the day-to-day management of insulin treated diabetic patients based on blood glucose measurements. The therapeutic advices are generated by a multistep procedure involving qualitative reasoning to determine the direction of adjustments and numerical simulation of insulin effect on glycaemia to quantify the extent of control actions to achieve glucose control corresponding to the pre selected targets. The qualitative reasoning module uses meal time oriented glucose balances and distances from the glucose target values to guide the search for appropriate control actions. The simulation module contains a physiologically based glucose-insulin model which generates a 24 hour prediction of the patient's blood glucose profile based on these adjustments which allows the doctor to select the optimal control action from alternatives. The results of a preliminary study to compare the advices given by the system to that of an independent diabetologist are also presented for 11 patients.]
Lege Artis Medicinae
MAY 29, 1991
[A new tool for the spectroscopic measurement of the living tissues: "erlangen microlightguide spectrophotometer"]
[The authors describe the principle, structure, handling and utilization possibilities of a new spectrophotometer (EMPHO) developed in the Institute of Physiology and Cardiology of the Erlangen-Nürnberg University. The EMPHO permits a rapid, high capacity and precise non-invasive qualitative determination of the intracapillary hemoglobin oxygenation and concentration on the living tissue surface and operative fields as well as that of the local blood circulation, oxygen consumption and capillary permeability.]
Lege Artis Medicinae
MAY 29, 1991
[Bacteriological response to pulmonological diseases]
[This guide describes the bacteriological diagnosis of respiratory diseases in adults, with the exception of tuberculosis and mycobacteriosis ( many of them), for pulmonary specialists. Laboratory procedures are not described, but only those details that are of interest to the clinician. Viruses and parasites are not discussed. Mycoplasma and fungal serology may be performed in bacteriology laboratories and are discussed in a separate chapter. The rules for the collection and submission of test material are described in an appendix.]
Lege Artis Medicinae
MAY 29, 1991
[Clinical research, education and patient care; Some reflections on today's aspirations and requirements Part II]
[There are several aspects to consider when assessing the quality of medical activity and, closely related to this, the competence of the clinic. These include various clinical qualities, which relate to specific services and activities, and social qualities, which relate to the health needs of society. In modern medicine education, the clinical-technical aspects are generally given more emphasis than the social tasks and prevention. It often seems that technical progress, together with specialisation, is developing at the expense of primary care. In other words, we focus more on acute care than on chronic care. ]
Lege Artis Medicinae
MAY 29, 1991
[Correspondence]
[I hold in my hand LAM issue 5-6. My sincere congratulations to both the previous issues and this double issue. The "outside" and the "inside" are equally valuable. It is a journal with a very fine exhibition. No country much richer than ours can boast of anything like it. The content is also impeccable. The exhibition stands up to all criticism.]
Lege Artis Medicinae
MAY 29, 1991
[Possible links between nutrition and malignancies, chances of prevention Part 3]
[After the natural substances in food, let's look at the arteficial, chemical substances that are intentionally introduced into our food during its preparation, preservation, storage, cooking and preparation. One of the most common of these is salt (table salt, NaCl). The association between high salt intake in food and the incidence of gastric cancer has been found in an analysis of comparative geographic pathology data. It is lowest in the USA and Australia and highest in East Asia and Japan.]
Lege Artis Medicinae
MAY 29, 1991
[Reflections on the background to family medicine funding]
[The problem of introducing a family medicine system in Hungary is complex. Developed countries have very different solutions. For reasons of space, I do not intend to deal with the whole issue in this paper, but only with the issue of financing primary care doctors. Of course, this means that some general issues have to be touched upon, but it is not my intention to provide a complex analysis of the whole problem.]
Lege Artis Medicinae
MAY 29, 1991
[Certain issues of medical liability]
[The detailed elaboration of the liability system is one of the most lively areas of Western European and especially American legal literature and practice, but in Hungary the foundations of differentiated legal regulation have not been elaborated. A lawyer outside the field of health care is unable to assess the limits of professional competence and the risks of medical activity, so we would like to publish legal aspects of this issue in the preparation of the new legislation, so that representatives of the specialised fields can help us to work out the liability provisions. ]
Lege Artis Medicinae
MAY 29, 1991
[Can the health care reform be expected to improve mortality rates?]
[A few years ago, a study was carried out in the USA and the Czech Republic, the results of which contain a number of interesting elements for the Hungarian health situation (1). The researchers hypothesised that a healthy lifestyle is shaped by modern Western culture and is not influenced by the structure of the health and social security system. ]
Lege Artis Medicinae
MAY 29, 1991
[Regime change?]
[Finally, the first law of the comprehensive reform of the health care system, the Law on Public Health and Medical Services, has just been passed! Live long and fulfill the hopes of its creators! There must be tens of millions of us for whom this is a vital necessity.]
Lege Artis Medicinae
MAY 29, 1991
[Speech by András Kelemen, State Secretary]
[Dear Mr President! Honourable House! The organisation of preventive medicine differs from country to country. But whatever the organisational structure, two basic features are the same everywhere. One is that the whole system is run by national medical officers. The second is that, in addition to public health and epidemiology, health protection is also part of all systems. In Hungary, the medical profession has had a century-old grievance that it was not independent of local authorities and had no authority. The former was helped by the 1936 decree on the medical officers, which nationalised the medical officers but did not give them any authority.]
Lege Artis Medicinae
MAY 29, 1991
[Dear State! Do you govern?]
["The Local Government Act is a very bad law..., in Hungarian legislation there has never been a worse law", stated one MEP during the debate on the bill, which is perhaps not the worst, but certainly the longest. More than a thousand amendments were tabled to Bill No 981 on the duties and powers of local authorities and their bodies, the representatives of the Republic and certain central subordinate bodies, of which the committee had to discuss and give its opinion on more than a hundred amendments, including those relating to social and health issues.]
Lege Artis Medicinae
MAY 29, 1991
[Difficult to open the zipper]
[Much has been said in these pages about the reform of our social security system, less about its conditions. It would be useless to have a modern law, a progressive, decentralised, 'profile-cleaned', purely contributory, insurance-based system entrusted to local authorities, if the organisation and administration behind it remains of the Stone Age standard. The tasks of the organisation are immense: Around 25% of Hungary's population depends on the social security system for payments, which means two and a half to three million pensions, sickness benefits, childcare and child benefit payments every month.]
Lege Artis Medicinae
MAY 29, 1991
[More pains of labour]
[No luck for the Hungarian Medical Chamber's Bureau draft law to discuss the draft law with MPs. About six months ago, the Social Affairs Committee wanted to put the draft on its agenda for debate, but was thwarted by the question of form, which was only apparently a question of form, but in fact of substance: if it is a draft law, who submitted it to the parliamentary committee. A professional body is not entitled to do that. On this basis, the Members did not wish to discuss it at the time - at least now, and let us be precise here! - the draft chamber bill. Since then, the Presidency of the Chamber has revised the drafting in a public debate, has thoroughly liberalised it and would have liked to present it to the Members of Parliament who are doctors, and discuss it, now wisely calling it a working document. Such a meeting is not a statutory forum, has no agenda, and is not intended to be a lobbying exercise in the good sense.]
Lege Artis Medicinae
MAY 29, 1991
[OIRT General Assembly in Dobogókő]
[Report on the 1991 General Assembly of the Oncology Interventional and Regional Tumour Therapy Section and the associated scientific conference .]
Lege Artis Medicinae
MAY 29, 1991
[On doctors' sickness and mortality Part 2]
[It is a sad statistic that the number of ischaemic vascular diseases has increased significantly. Every second Hungarian citizen dies of cardiovascular disease. Coronary heart disease is the cause of one in five deaths in Hungary; Hungarian men have 'trained' themselves to be world leaders. Among the predisposing factors to coronary heart disease and heart attacks, there are some that have been clearly shown to play a role. These include high blood pressure, high blood fat levels and smoking. Their combined effect is multiplied. The adverse effects of other factors may not occur alone, but in combination with each other, they may cause a risk (Pados, 1983). ]
Lege Artis Medicinae
MAY 29, 1991
[Spring Bathing]
[Bathing is not just an important part of our lives today, it was for people of the past too. Without it, we would hardly be able to maintain our health, but we would be reluctant to give up the pleasures it brings.]
Lege Artis Medicinae
MAY 29, 1991
[The emergence of professional medical dominance]
[The curing of diseases and the systematisation of healing procedures are old with man, while alternative (or marginal) medicine is relatively new. Quackery has been around for centuries, and some activities have been classified as such for centuries. They can only be called alternative or marginal since the dominance of medicine in society has been established. ]
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