Lege Artis Medicinae - 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[On pulmonary tuberculosis]

SCHWEIGER Ottó

[The author evaluates the epidemiological conditions of pulmonary tuberculosis in Hungary. The number of new cases decreases year after year. Being the disease infectious afterall, efforts must be continued against it adapted to the new epidemiological situation. This requires the collaboration of all the medical network systems as the pulmonological one is inefficient itself. Though the disease is rare, it cannot be forgotten and in certain cases tuberculosis must be borne in mind as well.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[The differential diagnosis of pulmonary tuberculosis]

BÖSZÖRMÉNI Miklós

[Since the number of tuberculous patients is constantly decreasing, the diagnosis of pulmonary tuberculosis is a new challenge for physicians. That produces a lifethreatening danger specially for old tuberculous patients. Primary infection – since the clinical tuber culosis of children practically disappeared in Hungary - can be established mostly on young people with general symptoms, who's tuberculin-reaction shows hyperergy. The specific etiology of pleurisy can be determined by the exclusion of other etiologies on young tuberculin-positive people, but a thoracoscopic biopsy may be needed. Tuberculous bronchadenitis is a rarity, but must be differentiated from sarcoidosis or malignant mediastinal lymph nodes. In infiltrative lung diseases, primary and se condary pneumonias (caused in first line by lung cancer) and pulmonary infarctions are much more frequent, than tbc. The most difficult is the differential diagnosis of disseminated pulmonary diseases. The author warns against the too early application of aggressive diagnostic methods (BAL and especially lung biopsy by thoracotomy). He emphasizes in these situations the advantages of an antituberculous treatment without diagnosis (especially in old patients). In coin lesions the very specific transthoracic needle biopsy should be preferated. The author refers to the new researches objecting the rapid detection of BK in the sputum of paucibacillary patients, but is meaning, that the indirect ways of diagnosis mentioned in this paper would be necessary for a long time.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[The importance of tuberculosis in childhood]

ANDRÁSOFSZKY Barna

[Nowadays tuberculosis has already become a rare disease in childhood in Hungary but the danger of the infection is still present for the several thousand (over 3500) disease manifestations among adults. The main task of the pediatricians is prevention, however the disease should be borne in mind in case of unelucidated chronic cases. In suspicion of meningitis basilaris it is necessary to start the treatment at once. Until now the maintanence of the BCG vaccination by age groups (new-born, 11 and 18 years) was justified, but it needs further restriction due to the advance in epidemic situation.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Some problems and characteristics of pulmonary mycobacteriosis in hungary]

KOZMA Dezső, VINCZE Egon, DÁVID Sándor, KISHINDI Katalin, ALEXY György

[360 cases of pulmonary mycobacteriosis caused by atypical mycobacteria were observed between 1980 and 1989. M. xenopi proved to be the most frequent pathogen (in 67% of the cases) followed by M. kansasii and M. avium intracellulare. The disease was common in urban-industrial areas. The yearly incidence of disease has not been increased during the observed period. 86% of patients were male with the mean age of 55 years. Underlying diseases such as pulmonary tuberculosis and chronic obstructive lung disease were found frequently. The symptoms of the disease were uncharacteristic. Thin-wall cavities with the lack of an infiltrate appeared in 24% of the patients. Malignancy and pulmonary aspergillosis were the two more frequent concomitant diseases. The occurence of lung cancer and also other organ cancers were significant higher among these patients than in the normal population between 40–69 years of age. Findings of histopathology were indistinguishable from tuberculosis among M. kansasii cases. A relative lack of caseousiting necrosis, forced fibrosis, foreign body reaction and abortive granuloma formation appeared among M. xenopi and M. avium-intracellulare cases. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[An update on BCG vaccination]

NYERGES Gáborné, DRINÓCZY Mária

[Tuberculosis is still a serious and wide-spread disease affecting mainly people living under poor hygienic conditions. Double infections with HIV + M. tuberculosis, however, may worsen the epidemiological situation both in developing and highly developed countries. Since its introduction, BCG vaccine has undergone several changes regarding the production strain and other characteristics. Though, the effectivity of BCG vaccination has been often questioned, it is indisputable that the vaccine protects young children against the disease. In Hungary, lyophilised „Paris" BCG strain has been safely and successfully used for vaccinating new-borns and revaccinating children for 30 years. The tbc incidence of the population under 14 years of age has been very low. Due to the relatively high tbc incidence among adults and the unfavourable tendency in the epidemiology of tbc in the world, however, no changes in the present BCG vaccination schedule are advisable. Moreover revaccination regardless to the tuberculin status should be considered. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Cardiovascular risk factors associated with albuminuria in insulin-dependent diabetic patients]

JERMENDY György, VÖRÖS Péter, STOKUM Éva, KAMMERER László

[The appearance of albuminuria could be associated with increased risk of cardiovascular morbidity and mortality in insulin-dependent diabetic patients. For assessing this relationship 81 insulin-dependent diabetic patients were investigated. Albuminuria was detected by radioimmunoassay and diabetics were classified as having normo, micro- or macroalbuminuria. In macroalbuminuric patients (n = 16) serum creatinine, total cholesterol, triglycerides, uric acid and blood pressure were significantly higher than in normoalbuminuric patients (n = 45). Values of microal buminuric patients (n = 20) were between those of macro- and normoalbuminuric diabetics. Close correlations were found bet ween albumin excretion rate and serum creatinine, cholesterol, triglycerides, uric acid, systolic and diastolic blood pressure. Cardiovascular risk factors are increasingly present in insulin-dependent, non-uraemic diabetic patients with albuminuria playing a possible role in the excess rate of cardiovascular morbidity and mortality. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Evaluation of mixed infusions in parenteral nutrition]

BODOKY György, WELTNER János, HARSÁNYI László, MEDZIHRADSZKY-SWEIGER Hedvig, ANTUS Sándor

[The authors initiate a new method of parenteral nutrition. They evaluate the clinical utility of continuously mixed infusions. The infusion glasses are connected in a row with tubes, thus the solutions are mixed before entering the blood-vessels. To prove the regularity of the process and to detect the possible chemical changes, the substrate distribution and the pH was measured and a computer model of the process was created. The regularity of mixing was proven. The change of the pH was small, but for some components it was not ideal. The use of mixed infusions offers a mixed substrate pool, which is more physiological for the body. The authors suggest using mixed solutions for parenteral nutrition as one of the possibilities. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Arteriovenous microshunt varicosity histological examinations for demonstration of microshunts]

MAGYAR Éva, BIHARI Imre

[Authors point out the important role of precapillary A-V shunts in the development of micro-varices. In 16 cases of the 18 examined ones A-V shunts were detected by histological examination. Pathomorphology of micro varicosity and A-V shunt are studied and method of histological detection is given.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Chemotherapy for pulmonary tuberculosis]

KÁROLYI Alice, BÖSZÖRMÉNYI Miklós, SCHWEIGER Ottó

[Mycobacterium tuberculosis is most abundant in human lesions in an extracellular, actively replicating form. Slowly or intermittently multiplying forms are found intracellularly in macrophages (acidic pH) and in cheesy lesions (neutral pH).]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Progress and problems in the domestic development of pacemaker therapy]

[The Pacemaker Arrhythmia Working Group of the Hungarian Society of Cardiology has repeatedly discussed the situation of pacemaker therapy in Hungary. In a public round table discussion with representatives of pacemaker implantation centres, we reviewed the possibilities for the development of pacemaker therapy in Hungary. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Future images of health care]

MATOS Lajos

[The aim of this paper is to summarize techniques and goals of health futurology. Future can be approached by two ways: one of them is the descriptive technique by which a whole range of future images can be described to make the proper plan. Descriptive methods include trend analysis, extrapolation, modelling and scenario development. In the prescriptive approach a vision of preferable future is created, considering expectable society processes as well as scientific and technical development to put forward reasonable ways to the preferable future. Future images can be categorized as possible, plausible, probable and preferable ones. To set up alternative future images health scenario writing is more and more popular. These can be classified as exploratory, strategic and resource allocation scenarios. The scenario project on cardiovascular diseases and on cancer in the Netherlands are reviewed as a good example. Futurology is concerned to be a way of thinking on the future and not simply predicting it.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Correspondence]

EMBER István

[Recently, a three-part article series by Dr. István Ember entitled "Possible links between nutrition and malignant tumours, chances of prevention" was published [LAM 1991; 165-6): 338- 344, 1(8): 506-509; 119-10): 610-616]. The aim of these papers is timely, since there is much to be done in the transformation of Hungarian dietary habits and the development of healthy eating habits. The author aims to provide a comprehensive literature review on the subject.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Correspondence]

STUMPF János

[It was a great pleasure to read the "Programme for Action" published as an annex to Lege Artis Medicinae. A concept has been born, and it seems to have been widely discussed. This in itself is a new element in our health policy, which is the most welcome sign of a change of approach. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Financing the health system in the United States]

RICHARD M. Scheffer

[The performance consists of three main parts. The first is how health spending is collected and spent in the United States. Second, what DRGs (Diagnostic Related Groups) are and the effects of DRGs. Finally, some new elements of the system will be presented. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Something like, maybe, I'm starting to get a little bit]

ANDRÁS László

[The possibility of financing the services of the KÁK, commonly known as the Kútvölgyi, on a supplementary private insurance basis was raised. Therefore, the Ministry of Public Welfare asked the State Insurance Company to prepare a proposal for the operation of a new scheme for the hospital.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Health - Disease]

BÁLINT Géza

[At turning points in our lives, we should reflect and re-evaluate all the things we have considered important in our lives. We also need to examine our concepts and sometimes redefine and redefine them. Together with the turning of the fate of the nation and the country, we are living through the turning of the fate of Hungarian health care and Hungarian medicine. A new insurance system is being created, a new doctor-doctor, doctor-patient relationship is developing, and the focus of our clinical, research and teaching work is changing. It is worth reflecting on the basic concepts of our profession and our art. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Is it performance funding? - or performance funding]

ANDRÁS László

[Members of the Parliament's Committee on Social Affairs, Family Protection and Health, and experts, frequently criticise the legislative and law-making work of the Ministry of Public Welfare. The criticism is usually due to delays, vagueness and vagueness of wording, which in itself is a source of further delays. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Faces from the Parliament's Social Affairs, Family and Health Committee]

ANDRÁS László

[Péter Bod, coordinator of the expert group on social security reform, which works alongside the Commission. The correspondent, who regularly attends the meetings of the Parliament's specialised committee, has noticed, and consequently the reader of his reports may also have noticed, the increasingly frequent and increasingly outspoken expert, Péter Bod. I was unable to find out who he was, initially among the doctors working in the LAM editorial office, and then more widely. It became clear that he is not a health worker or a party politician. Who is he, then, who, with his well-argued, effective arguments, is increasingly swaying the Members of Parliament who decide with their votes, in other words, he is increasingly influencing the social security laws that are being drafted. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Truce, peace or more?]

ANDRÁS László

[The press conference, which was jointly hosted by the Hungarian Medical Chamber and the Hungarian Association of Naturopaths, was attended by the Presidents and Secretaries General of all three organisations. In their introduction, they declared their conviction that all methods of medicine should be used in the interests of patients, and that modern medicine should be considered as a unified whole, in which the so-called modern, officially recognised methods of medicine and ancient medicine live together in symbiosis.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Legal regulation of alternative medicine]

SÁNDOR Judit

[As medical science has developed, so has the legal regulation of medical practice, with almost identical patterns almost everywhere. One of the cornerstones of this regulation was the continental European practice of limiting the provision of medical services to formally qualified medical graduates and, in a limited number of cases, to persons with other medical qualifications. The American continent has also adopted this health monopoly. This European model of university education has also spread to many Asian and African countries as a result of colonialism. It is not surprising, therefore, that health legislation has been conceived in the spirit of professional protectionism.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[About books]

NAGY Imre

[Book summary Dr. Rezső Szabó "Geriatrics in neuromedicine"]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Illness and death in munch's art]

ZENTAI Lóránd

[Recalled The Norwegian painter Edvard Munch (1863-1944), a major figure in the early days of European expressionist painting, lived the rather common life of a large family in late 19th century Europe as a young man and had some traumatic experiences.]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Address of the Semmelweis University of Medicine]

NEMÉNYINÉ Tahin Emma

[Coats of arms refer to a significant characteristic, an important feature, a worthy deed or merit of the person who wears them, and in them we honour our historical traditions. The coat of arms of Semmelweis University of Medical Sciences, its distinctive emblem, reflects not only the present of the long-established Universitas, but also its intellectual heritage. The coat of arms of our University has a tradition going back more than half a millennium. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[Old apothecaries and dermatologists in dunaalmás]

FERENCZY Miklós

[Many people have written about the history of Dunaalmás as a former bathing place, such as Istvánffy, Zeiler, Kreckovitz, Bruckmann, Hübner, Edvard Browne, who described that Dunaalmás was a popular bathing place already in Roman times. ]

HUN 1991;1(15)

Lege Artis Medicinae

SEPTEMBER 25, 1991

[1963 - in the "medical school" section]

JUHÁSZ László

[Now that the change of regime at our university is in full swing, and we have a new elected rector, dean and senate, I think it is not taboo, and in fact it is very interesting, to see what events we can discover in the medical school press. This collection, based on the "Medical Universities" published in the winter months of 1963, gives, if not a complete, then a typical picture of how and what was seen as important and contemporary in 1963. ]

HUN 1991;1(15)