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Lege Artis Medicinae - 1991;1(14)
Content
Lege Artis Medicinae
AUGUST 28, 1991
[Laparoscopic surgery]
[In the recent years abdominal surgery has developed quickly. Laparoscopic operating procedures have spread worldwide. These techniques have reached Hungary as well, though there are only few articles in this topic. Since last December - date of the first laparoscopic cholecystectomy – more than 200 operations have been done, among them the first appendectomy. These procedures are less troublesome for the patients with better cosmetic results, and the shorter period of hospitalisation and unability for work make economical advantages. First, the technical instruments and their usage, then personal coditions and the preparation programme are described. In the second part the usage of the new technique is summarized in cholecystectomy as well as in appendectomy. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Report of the American Society of Gastrointestinal Endoscopic Surgeons Postgraduate Course and Scientific Meeting]
[This year's congress of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was held in Monterey, California. As a fellow of the Department of Gastroenterology at the University of Southern California, I was able to attend the congress with the support of Dr. Berci, Professor of Surgery at Cedars-Sinai Hospital.]
Lege Artis Medicinae
AUGUST 28, 1991
[Quo vadis chirurgia biliaris?]
[Mankind has suffered from the agony of gallstones for thousands of years. Until the second half of the last century, there was practically no cure, the only relief being spontaneous internal and external fistulas in the midst of great pain.]
Lege Artis Medicinae
AUGUST 28, 1991
[Renal cell carcinoma in a horseshoe kidney treated with radical nephrectomy]
[A horseshoe kidney is diagnosed usually after the onset of its complication or the symptoms caused by an arising tumor from it. A tumour was diagnosed in the right half of the horseshoe kidney in a 68 year old female patient by excretory urography, ultrasound examination and renovasography. The tumour was removed by radical nephrectomy. The kidney was exposed through a horizontal abdominal approach. Special attention was given to the separate renal arteries supplying the right half of the horseshoe kidney and to the resection of the isthmus and also regional lymphadenectomy. In the diagnosis of a horseshoe kidney excretion urography had exclusively been used earlier but nowadays ultrasound is playing an increasingly important role. Reno vasography is usually needed only before resection or nephrectomy. The appropriate treatment of a horseshoe kidney tumour - in case of a well functioning contralateral kidney - is radical ablastic tumour nephrectomy including regional lymphadenectomy. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Recommended principles and strategies for pre-surgical evaluation and surgical resolution of epilepsy]
[I. General principles before surgical treatment of epilepsy; II. The surgical investigation process; III. Indications for surgery]
Lege Artis Medicinae
AUGUST 28, 1991
[The present and future of external fixation]
[The author details the main indications of external fixstion, as well as the professional and socioeconomic causes of recent trends. He also describes the management of extremity injuries in wartime. There is an emphasis of attainment and maintenance of transportability of the injured. For the first fixation procedure external fixation, plaster or their combination should be applied. The author's new method combines the use disposable and the sophisticated dynamic axial fixation device that can be attached onto the same common pin system. The cheap disposable device is applied for the time of the transportation and is replaced later with the definitive device later if needed. The new Manuflex Maxi single use fixators are cost effective and can be used with good results even in peace time surgery. It has shown excellent biomechanical characteristics compared to Orthofix.]
Lege Artis Medicinae
AUGUST 28, 1991
[Color doppler sonographic study of subcutan arteriovenosus (Cimino) shunts]
[The color Doppler method is very useful for examining the arteriovenosus fistules, the patency of anastomoses, the diagnosis and follow-up of the stenoses and for the evaluation of the lesions developed around the anastomoses. Using an Acuson 128 color Doppler ultrasound equipment, the authors have examined the subcutan arterio venosus shunts of 50 patients treated with chronic haemodialysis. 46 patients had Cimino fistulas on the lower arm, 2 had on the forearm, while two patients had graft on the forearm. In each cases the artery, the anastomosis, the vein of the shunt and the site of the punction were examined. The authors have found normal, well functioning anastomoses in 11 cases, while 29 dilatations, 8 stenoses, 2 occlusions, 1 infection, 5 haematomas and in one case dilated collateral vessels were diagnosed. The authors consider the color Doppler sonographic technique reliable for examining the function of the anastomosis, the morphologic changes, stenoses, dilatations, and the lesions developed around the shunts. The color Doppler examination is a non-invasive alternative diagnostic method opposed to angiography, which is more troblesome for these patients. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Hungarian surveillance of indicator conditions caused by germinal mutations]
[Authors report the results of a ten-year study of genetic epidemiology to detect the phenotypic manifestations of germinal mutations. Three types of indicator conditions (expected to reflect appearance of new environmental mutagens) have been monitored continouusly between 1980–1989. Cases were registered in the Hungarian Congenital Abnormality Registry. The indicator conditions were: (1) sentinel anomalies as indicators of germinal dominant gene mutations. Birth prevalence of such 15 anomalies was 3.8/10,000 total births. 90% of them proved to be sporadic thus 31 new mutations in 10^5 total births was detected with no significant increase during the study period. (2) Down syndrome as an indicator of germinal numerical chromosomal mutations. Birth prevalence of it was 11.7/10,000 total births that means 110 new mutations in 10^5 total births. There was no significant change in occurrence of Down syndrome during the study period. (3) Unidentified multiple congenital abnor malities evaluated by the help of „pairwise analysis of component congenital abnormalities" method. In 1985 there was a highly significant increase in the occurrence of congenital abnormality pairs. It appeared one year before the nuclear powerplant accident in Chernobyl, the Soviet Union, and after that no significant change was detected in prevalence of indicator conditions. Cause of this has remained unexplained. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Dilemma of the use of ionic or nonionic contrast media]
[The conventional contrast media are cheaper, the newer contrast media - apparently more favourable for the patients – are more expensive. On the basis of large clinical and experimental material authors are analysing the effects and usability of the different contrast agents. The examinations were performed on 812 patients and on 140 dog kidneys. On the patients different angiographies were carried out. After the injection of the contrast medium we registered the the subjective sensations, side effects, complications as well as the changes of blood pressure, pulse rate, UN, Se Bi, SGOT and the qualitative changes of the protein content of the urine. On the dogs selective renal angiographies were performed, 3 and 24 hours later histological examinations were made. The patients tolerated better the new low osmolality contrast media, the number of side effects was significantly smaller. In experiment we saw the fewest irregular angiogramms and the fewest histological changes after the use of the new nonionic contrast media. According to the calculations of some authors it would be worth to use the nonionic contrast media of new type in all examinations because of not requiring general anaesthesia, medicaments to fight off complications and decrease the nursing period. In today's economical situation we can't afford in our country not to use the cheaper, conventional contrast media. Use of the new low osmolarity contrast media intravasculary is justified, but it is imperative on the patients of high risk groups, in the examination of children and sensitive organs (nervous system, coronary vessels, kidney).]
Lege Artis Medicinae
AUGUST 28, 1991
[The prestige and freedom of university education]
[It is hardly disputed that the fundamental characteristic of university education is constant renewal. However, successive educational reforms over the past decades have not only reflected this natural process, but have also sent a clear signal to all interested and concerned that medical education is sick, to the point where it needs radical remedial action. However, there has been no significant improvement, despite permanent reform. It is true that the results of the changes introduced were never properly evaluated, which in itself casts doubt on the real purpose of the reform attempts. A good example of this is the integrated education that started in the early 1970s at the University of Pécs Medical School. During the debate between supporters and opponents, hundreds of medical students benefited from this education, but neither the university nor the ministry leaders were interested in whether it had actually made medical education better or worse.]
Lege Artis Medicinae
AUGUST 28, 1991
[Guidelines for the surgical treatment of epilepsy]
[Epilepsy is a common disease. The American of the American population will experience a seizure at least once in their lifetime. Most of them have only one or a few seizures and never have another. About 70% of people with recurrent seizures can be treated satisfactorily with antiepileptic drugs. Every year, 150 000 Americans develop epilepsy, 10-20% of whom cannot be controlled with medication. Many patients and family members have to live with a chronic disease that diminishes the quality of life for all.]
Lege Artis Medicinae
AUGUST 28, 1991
[The key to real change: management with IT]
[I regretted the new electoral system. Forgive me for not running for office - I don't think we've got the point this time either. What I miss in the somewhat over-politicised (albeit democratic in appearance) system is a set of criteria and examination system that meets international standards. What are the main tasks of a director, what knowledge, qualifications and qualities does he or she need to have to perform them; how and by whom is the performance of his or her work measured? Of course, these last questions will be answered more precisely by the expected reform of the health sector, when it will become clear what external standards a hospital must meet.]
Lege Artis Medicinae
AUGUST 28, 1991
[The contradictions of the organisational restructuring of public health care]
[Our current institutional system of public health medical care has evolved over several decades. Before 1950, medical care was quite broadly organised. Primary care was provided partly by private doctors and partly by doctors from various insurance companies. Specialist and in-patient care was provided by various medical institutions (hospitals, clinics, sanatoria), which were mainly public (state and municipal hospitals, university clinics, sanatoria), partly church-run and only exceptionally private (e.g. private sanatoria). Some of the larger sickness insurance institutions (e.g. OTI, MABI) had their own hospitals, but these were not suitable for all insured patients. There was also no standardised sickness insurance. The most extensive network was that of the National Social Insurance Institute.]
Lege Artis Medicinae
AUGUST 28, 1991
[The Hungarian medical writers and fine arts]
[The Circle is a registered member of the International Union of Medical Writers (UMEM). The UMEM - XXXVth Congress was held in August 1990 in Hungary, at the Silver Coast in Siofok. It was the third international congress of this kind in Hungary. Initially, the UMEM only included medical writers, but a few years ago, following the Hungarian example, it also included medical artists. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Is there a pressure for change in medical science?]
[As a natural function of the previous state system, the medical profession has also been subjected to "reliable limits" over the past 45 years. As in other scientific fields, the MOTESZ was set up and, in the absence of the law on companies typical of civil democracies, it placed the activities of the individual scientific professional societies under its 'protective wing' and supervised them.]
Lege Artis Medicinae
AUGUST 28, 1991
[What to do and when?]
[Pathetic and amusing is the man who, after long months, after years of siege, after saying "yes", finds himself in the position of having to start the process of fulfilling his love, and does not know how to begin. The poor man is not in an easy situation, he has enough problems: should he hug first and kiss afterwards, should he kiss at all, should he have children or not, should he first relieve his own love fever or should he establish a long relationship without any passion?]
Lege Artis Medicinae
AUGUST 28, 1991
[The insurance principle may not be a panacea]
[Putting a twist on the well-known saying, Gábor Balogh (KDNP) would have thrown up a storm, but he'll probably only reap the wind when he reaps it. He was the protagonist of the parliamentary committee meeting on 25 June. The main item on the meeting's agenda was the continuation of the general debate on the government's report on the reform of social security and the related draft parliamentary resolution. ]
Lege Artis Medicinae
AUGUST 28, 1991
[Call of the IOC to the medical community]
[The Presidium of the Hungarian Medical Chamber, in agreement with the Chairmen of the Standing Committees, feeling its responsibility for the Hungarian medical profession, declares that in the past two years it has not been able to fully fulfil its professional, ethical and advocacy duties due to the lack of a Chamber Act and the lack of appropriate legal powers. The prepared Chamber Act has not been submitted to Parliament.]
Lege Artis Medicinae
AUGUST 28, 1991
[On doctors' sickness and mortality Part 3]
[One of the hypotheses of our sociological research among physicians in Budapest was that the family background of physicians also has a psychosocial double function: on the one hand, it compensates for the strain of the profession in many ways, but on the other hand, it can also be a source of additional strain.]
Lege Artis Medicinae
AUGUST 28, 1991
[Reflections on the European integration of Hungarian medicine]
[EUROPE... It must have been a dreamed goal for over a thousand years. Our squatters achieved it. Since the last century, the achievements of more than one distinguished Hungarian physician have been considered groundbreaking. In addition to Semmelweis, the life's work of several Nobel Prize-winning Hungarian scientists has proved our European existence. In our narrow field of rheumatology, too, Móric Kaposi earned worldwide recognition in the last century with his description of SLE, and is still quoted daily as the first author of the first report on AIDS-related sarcoma. Have we moved away from Europe in this century? Wouldn't we have had hopeful, knowledgeable doctors? Hardly.]
Lege Artis Medicinae
AUGUST 28, 1991
Lege Artis Medicinae
AUGUST 28, 1991
[The role of caring for the dead in the development of organised lifesaving]
[The year 1835 is a turning point in the history of salvage in Hungary. This is when Ferenc Flór's book, The Doctrine of the Revivals of the Lousy, was published. We agree with Tamás Felkai: it would be inaccurate to interpret the title of the book, as we know it today, as "Resuscitation Knowledge". In fact, Flohr was very precise. He is indeed writing about the lunatics, and about reducing the risk of burying them alive. The fear of the 'horrible burial alive' is a red thread running through the relationship between man and death, from our cave-dwelling ancestors to the present day. ]
Lege Artis Medicinae
AUGUST 28, 1991
[The anatomy lesson]
[In addition to the works depicting members of the shooting clubs and the heads of various bodies and institutions, a third important type of Dutch group portraiture of the 17th century was represented by the so-called anatomical lessons. In the Theatrum Anatomicum in Leiden, Delft and Amsterdam, there were annually public dissections were held annually. The professor of anatomy, surrounded by his students and lay visitors, gave his lecture during the dissection of the body of a public criminal, usually during the winter months when the body remained in good condition.]
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