Lege Artis Medicinae - 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Entrepreneurial healthcare - an insured society]

[The Ministry of Public Welfare and the Hungarian Public Relation Association have started to organise a three-day international congress under the above title. We asked Tamás Barát, Secretary General of the Hungarian Public Relations Association, about the aims of the congress. ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[At the Table]

[The name of Fraternité Rt. became known to the professional public through the summary volume on social security, The Social Security Report. Little else is known about this public limited company of institutions and individuals, the only one in Eastern Europe to provide knowledge and advice to decision-makers in the field of human services. Its CEO, István Bánfalvy, said:]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Biological and Pathological Significance of Apoptosis (Programmed Cell Death)]

SZENDE Béla

[Programmed cell death (apoptosis) basically differs from necrosis regarding its biological significance, the morphological signs and biochemical events. Apoptosis is the result of an active cell function, so-called cell-suicide and it is observable in several biological as well as pathological processes. Enhancement of apoptosis can be achieved in malignant tumors by hormonal treatment. This explains the mode of action of hormones in tumor therapy and also contributes to the alterations in gene regulation leading to apoptosis.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[The use of BCG immunotherapeutic for the treatment of superficial bladder cancer (carcinoma in situ and papillary tumor)]

CSIZÉR Zoltán

[BCG Immunotherapeutic (BCG IT) is the first immunomodulator to be licenced in Canada, Germany and the United States for the use in the treatment of carcinoma of the urinary bladder. The product licence was granted following the conduct of a well designed efficacy study. The study was multicente red, independent and controlled with well defined end points and a long follow up period. The results clearly shows that BCG immunotherapy is significantly more effective than Adriamycin chemotherapy. There is no evidence to suggest a difference in severity of toxicities between BCG and Adriamycin treatment groups.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Transesophageal and transthoracic echocardiography in aortic dissection]

LENGYEL Mária

[ The severe prognosis of aortic dissection can only be improved by early diagnosis. The role of echocardiography was assessed. Echocardiographic findings were analysed in 32 patients in whom aortic dissection was confirmed by other methods between September 1984 and July 1991. In 19 of them only transthoracic echo (TTE), in 13 patients both TTE and transesophageal echo (TEE) was performed. Control group consisted of 21 patients in whom the clinical suspicion of dissection was ruled out. The DeBakey classification was used. Among 14 acute and 18 chronic cases type I was confirmed in 9, type II in 15 and type III in 8. The sensitivity of clinical suspicion, TTE, TEE and angiography was 34, 72, 92, 94% resp. TEE correctly identified the types, entry and reentry sites, false lumen and left coronary ostium. TTE was valuable in the detection of complications and of etiologic factors of dissection. Hypertension (12) and Marfan's syndrome (7) were the leading etiologic factors. As previously has been reported in the diagnosis of aortic dissection TEE was a safe and reliable technique. It was superior to TTE and was as correct as angiography. The combined use of TTE and TEE is recommended in each case of clinically suspected dissection. The importance of the echocardiographic detection of cardiac complications and etiologic factors is emphasized in the management and prevention.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Oral symptoms in the early diagnosis of leukaemias]

GYURKOVICS Csilla, BÁNÓCZY Jolán

[Diseases of the haemopoetic system are often preceeded and/or accompanied by clinical changes in the oral cavity, which, as first signs of the disease, might be of important diagnostic value. Primary oral findings are characteristic mainly of acute leukaemias, such as haemorrhagies, petechias, ecchymoses, ulcera, gingival hy pertrophy, painful gingiva, tooth mobility, candidiasis, herpes simplex infection, lymph node enlargements. Oral manifestations of chronic leukaemia may also arouse the suspicion of a haemopoetic disease. Applied cytostatic therapy might aggravate the condition of oral manifestations. ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Peritoneal dyalisis in hungary]

KARÁTSON András, MAKÓ János

[Traditional intermittent peritoneal dialysis in patients with chronic uremia lasts for 8 to 10 hours three times a week. In 1976 Popovich et al. outlined the principle of CAPD (Continu ous Ambulatory Peritoneal Dialysis), a technique giving good results in the removal of water and toxic substances. The procedure is used in 19 000 patients in US and in 9600 patients in Europe. In early 1991 the technical conditions and the number of patients receiving peritoneal dialysis were surveyed in the Hungarian nephrological and dialysing units. Not only the number of patients with chronic uraemia (those undergoing dialysis + transplantation) is lower in this country as compared to the European average (106 versus, 236 per million people, respectively) but the distribution of patients according to the type of treatment they receive is also different. In Hungary intermittent peritoneal dialysis has been used in more than 10% of the cases for several years whereas the number of those receiving continuous peritoneal dialysis has been under 2%. (In Europe < 2% and 4–43%, respectively). The survey also included the types of solution, desinfection and connecting devices used in peritoneal dialysis, as well as the incidence of peritonitis and the administration of antibiotics . The principles of biocompatibility, the function of interleukin as well as the effectiveness and the conditions of home treatment are summarized. ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[The role of bone morphogenetic protein in bone healing]

CSÖNGE Lajos

[The discovery of bone morphogenetic protein (BMP) in the last two decades emphasized the molecular-histogenetic mechanisms of cartilage and bone genesis and healing. Good experimental and clinical results have been obtained with application of new type bone allografts (freeze-dried, antigen extracted, de calcified, chemosterilized) which contain active BMP. Excellent osteoinductive effect and bone healing was detectable by implantation either of these grafts or pure BMP in non-weight bearing defects (bone-cysts, skull defects). Despite of the fact, that a lot of articles have been published on this field internationally, this is the first detailed review in the Hungarian literature which summarizes the most important reported information on the structure, role and clinical application of the bone morphogenetic protein.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Acute volume load and atrial natriuretic peptide (ANP) secretion in endocrine disorders]

DE Chatel Rudolf, TISLÉR András, BARNA István, TÓTH Miklós, RUDOLF F. Lang

[The diuretic response to an acute volume load (2000 ml saline iv. in 4 hours), and systemic atrial natriuretic peptide (ANP) levels, measured by a radioimmunoassay were investigated in 57 patients with various endocrine disorders and the results compared to data obtained in 16 control subjects. In all groups post-infusion ANP levels were higher than pre-infusion levels. In hypothyroidism, and streak gonad syndrome basal ANP levels were lower (p<0.001) than in the control group. In both groups ANP increased significantly but remained significantly lower than the postinfusion value of the control group (p<0.001). Despite this, sodium and water excretion increased appropriately. In patients with disturbed Ca metabolism changes in ANP in response to saline infusion correlated with basal Ca levels (r=0.689, p<0.05). Basal ANP levels in diabetics did not differ from that of the control group. ANP increased more in the NIDDM group than in the other two (p<0.05), however, the natriuretic response was blunted in these patients. The results indicate that ANP is a hormonal mediator of the natriuretic and diuretic response to an acute saline load. In hypothyroidism low ANP levels are associated with normal natriuretic and diuretic responses. In patients with extreme serum Ca concentration the endocrine activity of the heart depends on Ca level. In NIDDM the endocrine responsiveness of the heart is increased, while peripheral sensitivity to the action of ANP is reduced. ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Depression in Parkinson's disease, experiences with PK-MERZ infusion]

TAKÁTS Annamária, BERGHAMMER Rita, THOMKA Magdolna, SZOMBATHELYI Éva

[It is accepted that depression is the most frequent psychopathological finding in Parkinson's disease. Recently has been proved that this depression is mostly of major nature according to DSM-III criteria. It may be due to the altered serotonin metabolism. A possible subgroup of Parkinson's disease has been suggested including the decreased serotonergic activity. So it seemed to be evident that drugs of serotonergic activity – like amantadine - may influence the depression in Parkinson's disease. 27 patients of Parkinson's disease with depression were given PK-Merz infusion. After the infusion treatment over 3 weeks – without changing the previous antiparkinson therapy – 18 of 27 patients improved, and this improvement was mathematically significant in all the depression scores. Amantadine results in inhibition of storage and endogenous release of biogen amines, that of serotonin, too, further the serotonin binding capaticy changes, as well.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Correspondence]

CSÁSZÁR Gyula

[I always read with great interest and enjoyment the writings of Dr. Géza Bálint. This time he reflected on the topic of Health and Disease. This time, too, a doctor who practices his profession to a high standard has spoken. My comment is rather an addition, perhaps a formulation that represents a more subtle knowledge of the problem, stemming from the doctor-psychologist's deeper insight. ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Cooperative North Scandinavian Enalapril Survival Study]

MATOS Lajos

[The primary endpoint was 6 months: at this time, mortality was 26% in the active agent-treated group and 44% in the placebo-treated group, a 40% reduction (p<0.002). After one year, mortality was 31% lower in the enalapril group (p<0.001) and at the endpoint of the study this represented a 27% reduction (p=0.003). The treated and untreated groups did not differ in the incidence of sudden death. NYHA functional stage was significantly reduced in the group taking enalapril, as was heart size and the need for additional medications.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[One year of LAM]

SAS Géza

[Where did we start, where are we, where are we heading?]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Quality assurance in healthcare institutions]

BAKSAI László

[The title, the content and the use of words here and there in the following communication will certainly sound new to many. It is a managerial issue: quality - in the everyday life of professionals in the healing profession. Health, sickness, pain, suffering and death, although they depend on many circumstances, are, above all, the work of health care and health education. Health managers, health workers and insurance companies seem to be discovering a new common theme: the need for quality. The interesting thing is that almost everyone agrees, and quality in health care is a challenge everywhere and at all times.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[On primary care reform again]

LÁSZLÓ András

[Discussion with Gyula Kincses on the reform of primary care ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Mohammed at the mountain, or "the minister is like an apple: it ripens"]

ANDRÁS László

[It is a rare occasion when Mohamed goes to the mountain, i.e. when the Minister of Welfare László Surján meets with members and experts of the Parliament's Committee for Social, Family and Health Protection, even though Parliament - primarily with the help of this committee - is also responsible for "supervising and monitoring the government's activities" (Pusztai Erzsébet - MDF). The meeting of 27 November, initiated by the Committee, took place at an unusual time, since the Committee had days earlier rejected the government's explanatory memorandum on the 1992 budget guidelines in the strongest terms and declared it unsuitable for general debate, and in the coming weeks there will be no less stormy debates on the big budget, the new additions and amendments to the 1975/II law and the 1992 Social Security Fund budget.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[The latest rules on prescribing medicines]

LÁSZLÓ András

[No lists! Medical rights or economic constraints? We asked Béla Doktorics, Secretary General of the Hungarian Medical Chamber, whether the Ministry of Public Welfare had consulted the Chamber on the controversial legislative package, even if not with the Parliament's health committee?]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[On the concept of individual and social health Part I ]

KOVÁCS József

[Is old age a disease? As it is a natural process, it is not usually considered as such. Is presbyopia a disease? In England, when a non-medical company was accused of engaging in unauthorised medical activity by prescribing glasses to presbyopes, it defended itself by claiming that its activity was not medical because presbyopia is a natural process and as such is not a disease. (1). Is smoking a disease? Many people consider it to be a disease, just like alcoholism or drug addiction. However, when some people in England tried to get the public health service to pay for smoking cessation treatment, they were told that smoking is not a disease, but merely a bad habit, like picking one's nose at the table, and that, just as stopping smoking is not a health service responsibility, neither is stopping smoking (2). Is homosexuality a disease? Naturalistic definitions of health, Healthy as the statistically most common, Health as a species, Typical and natural]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Von Willebrand meets Alzheimer's]

[I. Congress of the Hungarian Society of Thrombosis and Haemostasis]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Patient groups - in a healthy system]

STUMPF János

[In developed industrialised countries, it is common practice for people with certain diseases to form groups, societies or clubs. Especially when being together can significantly help recovery or rehabilitation, such as in the case of alcoholics, but also when the mental strain of a chronic illness is easier to bear when shared. The basis for clubbing can be a condition related to recovery (e.g. stoma patients). ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[The Doctor with the Patient's Eye]

NÉMETH István

[The title page shows the first of a series of four engravings from 1587, with a large figure of Jesus in the foreground, examining a bottle of urine in his hand. At his feet are various medical books and instruments. In the background are several small life-like scenes depicting the treatment of seriously ill patients. To the left, the doctor is checking the pulse of a figure lying in a four-poster bed who, judging by the gestures of his relatives, must be in a very critical condition. To the right, the doctor is about to splint the broken leg of a man with a pain-ridden face, while in the background, a helpless patient is being trephined.]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Against quacks in the first half of the 20th century]

HEGEDŰS Katalin

[The great medical ethicist of the century, Ágoston Székely, cited a French case: a man was arrested for quackery, who admitted to having a valid medical diploma, but who could not make a living as a doctor, but who made a good living as a quack. New attack - with draft law, Quackery as a misdemeanour, Some convictions,]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[Scholarship increase, yay(?)]

SZ. A.

[The government is generous. Make no mistake, I'm not writing as a coalition party recruiter (I'm not affiliated with either party - thankfully), I just want to inform the audience that... So after a long struggle and even longer waits, the big, big scholarship increase is back! (If our informants are correct.) BUT... ]

HUN 1992;2(01)

Lege Artis Medicinae

JANUARY 29, 1992

[About books]

SVASTICS Egon

[Summary of the book "The Big Health Book"]

HUN 1992;2(01)