Lege Artis Medicinae - 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Metoprolol treatment in dialated cardiomyopathy]

DÉKÁNY Miklós, NYOLCAS Noémi, FIÓK János, VÁNDOR László, SEREG Mátyás, BALOGH Ildikó

[Authors applied metoprolol for treating heart failure in with dilated cardiomyopathy. Patients were given digitalis, diuretics as well as ACE-inhibitor and vasodilator drugs. The grade of heart failure was according to NYHA classification in the mean 2.5 class. For assessing the effect of metoprolol clinical variables and results of non-invasive tests were evaluated and compared in 3 consecutive periods: 1) before starting metoprolol, 2) 2–4 weeks after reaching its definitive dose (short-term effect), 3) 3-6 months later (medium-term effect). Early intolerance appeared in 3 patients; signi ficant progression of heart failure in 2 and hypotension causing complaints in 1. Evaluating the actually treated 17 patients clinical signs of heart failure (NYHA class) decreased, left ventricular ejection fraction improved, though not significantly in case of every considered variables, left atrial filling pressure decreased, exercise capacity did not alter, rate-pressure product decreased at rest and at low level of exercise as well. The authors stress the significance of "up-regulation" of myocardial beta-1 receptors in the reduction of myocardial toxic catecholamin effect and myocardial oxygen demand as well as in the increase of myocardial blood supply. Referring to the data of the respective literature and to their own experiences the authors suggest metoprolol treatment in cases of dilated cardiomyopathy, where previus therapy did not prove to be efficient.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Role of oxygen derived free radicals during myocardial reperfusion]

KÓNYA László , FEHÉR János, JUHÁSZ Nagy Sándor

[Oxygen derived free radicals are now considered to be important contributors to tissue (myocardium) injury associated with ischemia and reperfusion. Normaly the tissue concentration of these toxic intermediate products of oxygen is strietly limited, but production of oxygen free radicals overwhelming the capacity of the tissue elimination may cause serious damage. Thus reperfusion has it's own danger with the extension of the injury produced by the ischemia alone. Several experi mental studies have shown that different free radical scavengers can reduce the post-ischemic tissue injury, however, there are contradictory results and unresolved problems. Further investigation is necessary to establish the relevance of oxygen free radical mediated myocardial injury and the effective antioxidant treatment. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Cure]

MATOS Lajos

[Belfast Metoprolol Study; Helsinki Heart Study]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Autoimmunity and the network of the antibody-forming cells: the "immunological homunculus"]

UHER Ferenc

[Frank M. Burnet's clonal selection theory declares the deletion and/or anergy of self-reactive clones to be the fundamental mechanism responsible for self tolerance. There is ample evidence, however, that all healthy individuals have lymphocytes and , natural” antibodies that recognize self structures. In the 1970s, Niels K. Jerne postulated the network theory. It is based on the idea that the idiotype, the region of an immunoglobulin that is unique because it comprises the antigen-binding portion of the molecule, can act as both antigen and antibody within the same individual. Network theory views the immune system as a single, highly interconnected system, through idiotypes, a web of V domains. Antonio Coutinho adressed this problem and divided the repertoire of the B lymphocytes into two parts. He suggested that a set of naturally activated cells and the immunoglobulins they secrete, is reflected in the autonomous immune activities of the self-related network as the central immune system. In contrast, immune responses to external antigens are essentially allonomous clonal activities of another set of resting, rapidly turning over lymphocytes that follow the predictions of the clonal selection theory, making up the peripheral part of the system. Finally, Irun R. Cohen suggested that some, perhaps all, major autoantigens are indeed dominant because each one of them is encoded in the organizational structure of the immune system. This picture was termed the immunological homunculus by its analogy to the picture of the body encoded in the central nervous system. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Modern therapy of intracerebral and subarachnoidal hemorrhages]

LEEL-ŐSSZY Lóránt

[The frequency of the intracerebral hemorrhages among the strokes is most commonly quoted around 10 percent. The rupture of an intracranial aneurysm is often complicated with subarachnoideal hemorrhage as well as with intracerebral hematoma therefore this latter type of intraparenchymal hemorrhage may also be discussed in this topic. The modern imaging procedures (Computed to mography, Nuclear magnetic resonance) are of crucial importance in the urgent and exact diagnosis of intracranial hemorrhages. The first essential step in the diagnosis of stroke is to distinguish the ischemic lesion from the hemorrhage by means of CT. When an intra cerebral hemorrhage threatens life and the patient's condition is relatively good there must be an urgent decision considering the choice between medical therapy or surgical intervention. Although clearcut indications for surgery are now available, the clinical and computed tomographic guidelines play indi vidually an important role in the final decision. The individual judgment is always desirable in every case of intracerebral hemorrhage as well as in the surgical intrvention of intracranial aneurysm during the acute phase (two days).]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Sonography of the shoulder joint]

MORVAY Zita, CSÓKÁSI Zsolt

[Sonography is the most simple, unexpensive and common method in the evaluation of the soft tissues surrounding the shoulder joint. 67 sonographic findings of 61 patients are discussed. Laesions of the rotator cuff, the bursa, the long head of the biceps and the deltoid muscle are demonstrated. Sonography is the first method of choice in the evaulation of the shoulder joint, though it has ist limitas well. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[The effect of (-) deprenyl monotherapy on parkinson's disease]

MÁLLY Judit

[50 de novo patients with Parkinson's disease were investigated in a retrospective study after deprenyl monotherapy and a combination of deprenyl and levodopa. The study involved subjects with different Hoehn-Yahr stages. During the treatment period the distribution of age (below or above 60 years) among the Hoehn-Yahr stages was similar to that of the baseline period, while the clinical disability for the patients starting with hypokinesis meant a more severe state compared to the cases with tremor. During the administration of deprenyl, the progression of males was slower than that of females. (-) Deprenyl was effective in decreasing hypokinesis, while rigidity improved less. The reduction of parkinson symptoms developed slowly and was independent of the severity of Parkinson's disease. The maintenance of deprenyl monotherapy showed a high individual variation but the average period was about one year. The termination of the effect of deprenyl was rapid, however, not progressive. The time of the appearance of the side effects of additional levodopa was not delayed by the deprenyl treatment. The reduction of parkinson symptoms by deprenyl and its prolongation of the introduction of levodopa therapy might involve other neurotransmitters than endogenous dopamine.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Recent aspects of temporary cardiac pacing the atrial stimulation]

SZÉKELY Ádám, KISS Róbert

[„Pacemaker syndrome" is a deterioration of the cardiac function following sometimes ventricular pacing. Atrial pacing is advantageous, that can be used in temporary pacemaker application. Long term (>2 days) temporary atrial pacing was performed in 11 patiens. The aim was the temporary stimulation before the definitive AAI implantation (4), bradyarrhythmia complicating acute myocardial infarction (3) and suppression of the drug resistant dysrhythmias (4 patients). Haemodynamic parameters of the patients with myocardial infarction complicated with bradyarrhythmia and heart failure improved using atrial pacing compared to the ventricular one. Refractory supraventricular arrhythmias and the „torsade de pointes" ventricular ones could be effectively suppressed by rapid continuous atrial pacing. The atrial position of the temporary electrode could mostly be achieved without X-ray control. The risk of the dislocation seemed to be lower using special „J” shaped electrodes. In selected patients the application of the temporary atrial (or AV sequential) stimulation is possibly advantage ous resembling to definitive physiological pacing. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Endobronchial treatment of a myoblastoma (Abrikossoff tumour) located in the trachea and both bronchi]

LAKATOS Tamara, STRAUSZ János, EGERVÁRY Márta, JÁGER Margit, REPA Imre

[The authors report a rare case of Abrikossoff's tumor located in the tachea and both in the main bronchi. CT evaluation of the lesions showed no communication among each other and no other organ involvements were proved. Tumors were excited during bronchoscopy. Similar case hasn't been reported earlier in literature. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Correspondence]

KINCSES Gyula, POGÁNY Csaba

[Small Hungarian Point System; István Szombati's mathematical skills would be hard to dispute, his calculation is accurate, and so is his logic (LAM 1991; 1(17):1257). One of the merits of the German point system is that it confronts the doctor with the value of his elementary activities. This is well perceived by my young colleague, but some of his conclusions and references call for correction and further reflection. Personal Rights in Patient Care; The modern health care system plays a decisive role in the development of the health status of the population, supported by economics, engineering, organisation, sociology and, less noticeably, law. We learn about doctors' legal knowledge primarily through their manifestations. In Hungary, hospital doctors are engaged in learning about the results of medical science and making them a reality, while fighting for the fate of patients and their own individual happiness. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Resolution of cholelithiasis and choledocholithiasis with endoscopic sphincterotomy and laparoscopic cholecystectomy]

SZÁNTÓ Imre, GAMAL E. Mohamed, METZGER Péter, CSEREPES Éva

[Laparoscopic cholecystectomy (LC) is a new method of elective biliary surgery that has been introduced in Europe (1) and the United States (2) at the same time. In Hungary, four cases were reported for the first time (3). Since 22 March 1991, 141 LCs have been performed in our clinic. In this paper we report on a new option, the combined use of endoscopic sphincterotomy (EST) and LC, which has not been reported in Hungary so far. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[A new possibility to improve the quality of life of patients with colostomy]

BARTHA István

[The basic problem in the rehabilitation of patients with colostomy is to ensure continence. A considerable step-forward is the development of the Conseal System. The device consist of a self-adhesive base plate with a flanged ring on its front surface and a plastic plug to be inserted into the stoma, which can be attached to the ring. This plug serves for keeping the feces in while allowing free passage for flatus, deodorized with a carbon filter. In the clinical trial 50 patients with colostomy tested 500 plugs, 250 base plates and 600 closed bags. 87% of the trialists found the use of the device easy and simple. With 488 plugs (97,6%) continence was perfect during the time of wear. Obstruction due to feces or mucus occurred only after the use of longer than 5 hours with 430 plugs (86%). The average time of use was 7 hours. Those performing regular irrigation could exceed 24 hours. Allergy or complication demanding medical treatment did not occur. The results of the clinical trial suggest that the Conseal System is suitable for improving the quality of life of patients with colostomy. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Parliament takes a beating]

ANDRÁS László

[Even the darkest topics in the Parliament are coloured when János Palotás, the President of the National Association of Entrepreneurs, who won a mandate in the MDF, speaks. He tries to assert the entrepreneurial mentality and interests, which are not yet sufficiently known in Hungary, usually at length but in a very colourful way. Social security - with its stifling contributions for businesses - could not escape his attention, and János Palotás was the one who made the most striking amendments to the Concept.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Call for a chamber law - in opposition]

[Gyula Kincses, Károly Mezey and Gyula Pánczél, MDF members of the MDF, have submitted an amendment to the draft parliamentary resolution on the concept of the renewal of social security, proposing that a sentence be added to the text of the resolution, stating that the draft laws following the concept should be harmonised not only with the new health and social law, but also with the law on the Chamber of Doctors and Pharmacists.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[We are not driven by an unrealistic idea]

[Speech by Dr. András Kelemen, Minister of State at the Ministry of National Welfare, on the 11th day of the autumn session of Parliament.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Browse through the votes]

ANDRÁS László

[As we have already reported, the government has asked Parliament for a Parliamentary Resolution on the 1992 State Budget. This resolution, as planned, consisted of just one sentence, calling on the government to prepare a budget that envisaged a deficit of 60-80 billion forints. To this sentence, the government attached a lengthy explanatory memorandum. The proposal for a resolution, in particular with regard to the points made in the information note, was deemed inadmissible by the Committee on Social Affairs, Family and Health.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Law management programme]

[The concept of social security reform recently adopted by the Parliament is very tight-lipped on sickness insurance, i.e. health care. The proposal only decides that in the future, sickness insurance should be insurance-based, compulsory and based on the principles of solidarity, i.e. that not only active earners and actual contributors but also their family members should be entitled to insurance-based care. Pensioners and the unemployed are covered by the sickness insurance scheme on a solidarity basis.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Commission plans, budget executes]

[The social security reform concept adopted by the Parliament was a victory for the "socially sensitive, right-wing self" of the coalition, even according to the opposition press, Népszabadság. It adequately reflected the necessary division of tasks between the state and the insurance sectors, it was able to create a proper balance between the insurance and solidarity principles in the long term and, above all, it stated by force of law that the reform should start on 1 January 1992. It also provided for the most urgent tasks, such as the separation of pension and health insurance, the provision of assets to the social security fund, the profiling of the state social functions, the financing of the state social functions from the budget, the payment of the state's debts, and so on.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Social, Health and Family Committee rejects government's 1992 budget guidelines]

MÁDI László

[Dear Mr President! Honourable House! As rapporteur for the Committee on Social Affairs, Health and Family Protection, I would like to announce the committee's position on the negotiating text before us. The committee found the parliamentary resolution proposal contained in information 3124 to be inadmissible with 6 votes in favour, 5 against and 3 abstentions. The committee took an even clearer decision on the Information Paper underlying the draft Parliamentary resolution, which was rejected with 2 abstentions and 12 votes against, and no support.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Social security government - postponed]

[The work of reforming this monolithic monster called social security is extraordinary. The World Bank vice-president, who recently visited Hungary, has not in vain called this the most unresolved area of the transformation of the Hungarian economy. The parliamentary committee that is - for the time being - entitled to lead the transformation is certainly not infrequently in an undignified position, for example, when it starts to make a farce of itself as a serious legislative and professional forum of its time. Or would you call that politics? ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[I am optimistic]

ANDRÁS László

[Interview with Ministerial Commissioner István Mikola]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[New features of medical press]

DÖRNYEI Sándor

[The political and economic, social and cultural transformation of our country has not left the medical press untouched. The changes in the content and personnel of the editorial staff can only be evaluated on the basis of a very in-depth analysis, so in the following we will only try to summarize a few striking, new, "external" phenomena and trends of change. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Dreams of passion]

CSÁKY Lajos

[László Csomor is not a professional artist. Until the age of forty-three, his life was exclusively occupied with his medical profession. As a "result" of a sudden choice, he started painting in 1987. But he did not embark on the traditional academic path. He experiments with twentieth-century materials (multi-colour sprays, binders) and the resulting technical processes, which lead him to a shortened path of pictorial expression.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Dream images in medieval and Renaissance art]

BODNÁR Szilvia

[On the title page: a Czech miniature of Jacob's dream in the T inicale, a fragment cut from the page of a graduale (a ritual book containing the sung parts of the mass). It is one of eight miniatures dating from around 1414 in the Museum of Fine Arts, some of which are from the pages of an antiphonale, now in the University Library in Brno, and others from a graduale, also in the State Archives in Brno, and are outstanding examples of late Gothic miniature painting.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Lege artis paramedicinae]

BÁLINT Géza

[We have been reading and leafing through LAM for a year. We study its excellent educational articles, its original communications, ponder the Reflections, eagerly dive into the Parliamentary Reports, the Reform column, learn about the thoughts of Medicus Immaturus, enjoy the history and fine arts columns.]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[The advent of computers in healthcare Part I]

PÉLI Gábor

[The paper reports on the experiences of a recently completed sociological research conducted by SOTE staff in the framework of the OMFB theme "The social impact of electronisation". ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[The state of Hungarian medical literature in the 19th century]

KAPRONCZAY Katalin

[The scientific life of the first decades of the 19th century was also paralysed by the current political situation in the country. The measures of the police state following the suppression of the Jacobin movement had a negative impact on the functioning of educational institutions, censorship hindered publishing activities, and social gatherings, forbidden by police measures, did not even allow the establishment of scientific societies and associations. The compulsory use of Latin and German in public and academic life hindered the cultivation of the sciences in their mother tongues. Thus, the Hungarian medical and natural sciences language did not develop. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[Student government at the SOTE]

GAÁL Péter

[In the autumn of 1989, the students of SOTE UAS elected a Student Self-Government for the first time, so that their interests would be represented by a legitimate body and not by the Hungarian Communist Youth Federation. Even then, the main goal was clear to us: to become, with the help of European thinkers, a university with a European atmosphere and standards, and with the help of European thinkers, we SOTE-S students could become recognised and respected doctors all over the world. ]

HUN 1991;1(18)

Lege Artis Medicinae

DECEMBER 25, 1991

[About books]

UHERECZKY Gábor

["Cystic fibrosis" dr. Kálmán Gyurkovits Book review]

HUN 1991;1(18)