Lege Artis Medicinae - 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[New methods of plastic surgery for breast reconstruction]

GULYÁS László

[The treatment and plastic surgical reconstruction of breast tumour patients raise contradictions and unsolved problems. The approach of breast tumour surgery has been changed recently. New evidence shows that in terms of survival, free from distant disease there is no significant difference between lumpectomy and radical mastectomy. Thus breast-conserving operations as a replacement for radical mastectomy have been spreading. The most characteristic features of these operation are: the horizontal incision, the conservation of the pectoral muscles and the whole or partial preservation of glandular tissues. The quality and quantity of available tissues for the breast reconstruction have changed as, the methods of plastic surgical operations has been adopted. New methods for breast reconstruction such as muscle and musculocutaneous flaps, free flaps, different breast implants, and skin expanders have become more and more preferred. For nipple and areola reconstruction local flaps, skin grafts, external prostheses and tattoo are widely used. Nowadays the most important point of view in there the construction of the breast are accurate symmetry, aesthetic breast form and harmony of the whole body. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Results in the sclerotherapy of varicocele]

POKORNYI Lajos, BALI Ilona, NAGY Endre, VADON Gábor, SZÖLLŐSI János

[Testicular varicocele which is curable by surgical or transcatheteric methods is one of the most common causes of male infertility. In this study the success of the interventional radiological method was evaluated. Internal spermatic vein phlebographies were performed in the case of left sided varicocele. Before intervention the anamnesis, inspection, palpation, sonography, colour Doppler sonography and phlebography was evaluated and in a part of the cases spermiogramm too. Follow up examinations were performed at 3, 6 and 12 months after the sclerotherapy and the 1.5-4.5 years then later. The internal spermatic vein was succesfully occluded in 2/3 of the patients in the distal third, in 1/3 in the middle or in the upper third. Complications occurred in 10 cases as intima lesions without any consequencies and in 4 patients as scrotal thromboph lebitis. At the follow up examinations very good regression was demonstrated. Persistence or recurrence occured in 5.7% of cases. The spermiogramm usually got back to normal or showed an improvement and we registered 8 pregnancies from 23 formerly infertile marriages. The interventional radiological method is simpler, cheaper, requires shorter time and inpatient period, decreases sick-allowance, and the success rate reaches the level of the surgical method. The joint evaluation of the real time and the colour Doppler ultrasound is a very sensitive method in the interpretation of the results of the treatment. In our opinion sclerotherapy with Varicocid is the method of choice in the treatment of the varicocele. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Mapping of EEG in neurological disorders]

SZIRMAI Imre, JUHÁSZ Csaba, SUREK György, DOLOGH Ervin

[Mapping is a new way to convey the information of the mathematical analysis of the EEG in an immediately understandable form. In this article, the history of EEG mapping is surveyed. Sixteen channel EEG mapping system was programmed on an IBM-AT personal computer which constructs absolute and relative power spectra topograms on the scalp. Hemispheric asymmetry and long term changes of absolute and relative power estimates were calculated by statistical methods (Wilcoxon and Student t-test). In comparison traditional reading of the EEG the mapping has the following advantages: 1. it uses exact procedures instead of qualitative estimation; 2. in can detect minimal cortical damages; 3. it has the ability to store data for later comparison: the power ratios in selected frequency ranges proved to be a reliable indicator of post-ischemic restitution of EEG; 4. it can evaluate of event related reactions of bioelectric signals in higher resolution. EEG topography provides early information regarding the severity of ischemic lesions in the acute stage of stroke before to the CT scan can visualize the tissue hypodensity. In cases of permanent epileptic waves, the mapping visualizes the local power maxima of dominant frequency ranges and detects the post-ic talimpairment of cortical fields of epileptic foci. Probability significance mapping has reinstated the diagnostic value of EEG by the applica tion of the neuroimaging techniques.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Bidirectional Doppler investigation of the internal carotid artery]

FARKAS Katalin, HORVÁTH Péter, KUSZTOS Dénes

[The blood-flow velocity in carodit arteries was measured with a bidirectional CW Kranz bühler 761 Doppler instrument. These investigations were supplemented with special compression tests. 60 investigations were performed to study the blood-flow in the supraorbital and supra trochlear arteries, while compressing the superficial temporal, the facial and the common carotid arteries. The results were compared with 30 regularly performed angiographies. Conclusions: the sensivity of this method is 80%, the specificity is 85%, its positive and negative predictive values are 76% and 87% respectively. Therefore this method is suggested for screening the internal carotid artery. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Ultrasound examination of the knee]

CSÓKÁSI Zsolt, MORVAY Zita, VADON Gábor

[The knee is frequently injured. In addition to the phisical examination imaging methods are very important in determining the diagnosis of the disorders. Ultrasound method is useful in revealing the injuries of the soft tissues of the knee. The authors examined 350 patients with an Acuson 128 ultrasound machine, using 5 and 7 MHz linear transducer in standard positions. They analized the pathological disorders of the knee joint. They consider the examination of network of the band important. Sonography has a significant role in the diagnosis of knee disorders. That can replace more expensive or invasive examination methods.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Immunologic aspects of allogenic bone transplantation]

SZABÓ György, SCHMIDT Béla, NOVÁK László

[Immunologic reactions and their consequences are analyzed and discussed after implantation of merthiolate-banked, deep-frozen and decalcified allogenic bone. Radiographic and microscopic characteristics of consecutive immunologic changes were studied in animal experiments. Among all materials tested, deep-frozen grafts produced the most marked immunologic reaction together with bone resorption and the highest incidence of non-union. No immunologic reaction was observed after merthiolate-preservation; however, this technique evidence of microscopic foreign-body reaction. Transplantation of decalcified allogenic grafts produced only a mild response. Autologous transplants acted as controls. The authors conclude that clinical results can only be improved by optimal selection, based on experimental results, from among the available techniques.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Incidence of locomotion system disorders in miners]

MAGDICS Mária, SCHMIDT Béla

[In the introduction, home data of the affections of the locomotion system are discussed. Authors describe their screening technique performed on the workers of „Pécs-Vasas" minery. Results of 611 workers are analyzed. It is stated that spinal disorders are of highest incidence, followed by the knee and foot problems. Connections of the found alterations together with the duration of working as an underground miner, are discussed. It is stated that in 64% of the screened workers, diseases of the locomotion system can be observed. Importance of preoccupational working-ability screening is stressed out, together with the improvement of workplace circumstances, and the importance of rehabilitation.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Correspondence]

CSÁSZÁR Gyula, BRASSÁNYI Pál

["In the 17th issue of your very valuable journal this year, the much admired Dr. Pál Harmat published a communication with the evocative title: Abuse of psychosomatics: the organic dimension of psychiatry. As a psychosomatics practitioner for 20 years, I think it is legitimate for me to make a few critical comments, maintaining that I consider Paul Harmat to be an excellent doctor whose 'passing' years ago was a painful professional loss. " What will become of us, team doctors? (Open letter)]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Position of the Scientific Council for Health on professional-ethical issues in biomedical research]

[The Scientific Council for Health (SSC), aware of its responsibilities arising from the professional ethical values it represents and from the legislation it operates, considers it timely to publish the following resolution in order to ensure the uniform implementation of the current legislation in the ethical review and authorisation of biomedical research: ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Position of the Scientific Council for Health on naturopathic practices and procedures and the medical use of unproven medicinal products not recognised as medicinal products]

[At a time when our health care system is about to be renewed, the ETC plenary necessarily addressed the question of the type of system in which domestic medicine and patient care operate, and the place and role of naturopathy, which in previous decades was the only recognised and accepted form of scientific medicine, and which predominantly used only physical procedures and natural substances. This is a question of concern to health professionals and the general public alike, and one that is subject to many extreme views, ignorance and anger. The need to improve the health and health culture of the Hungarian population, the renewal of the health care system and, not least, the prestige of Hungarian medicine and medical science, make it necessary to raise the issue and to reconcile the views of the stakeholders. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Bone marrow transplantation in adults]

RÁK Kálmán, PETRÁNYI Győző

["With careful donor selection and preventive immunosuppressive treatment, including ablative chemotherapy or chemoradiotherapy if necessary, many bone marrow recipients today have a good chance of being cured of a previously incurable disease or at least of a lasting improvement in their quality of life." The main indications for bone marrow transplantation (in adults), Techniques for bone marrow harvesting, Patient (recipient) selection considerations, Donor selection, Pre-transplantation considerations, Post-transplant complications, Results of allogeneic transplantation, Current efforts, Autologous transplantation, Main aspects of the clinical use of bone marrow transplantation according to the most accepted indications, Other indications for transplantation, Organizational issues in adult bone marrow transplantation, Main areas of activity and responsibilities of the national bone marrow transplantation network]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Bon Appetit!? Letter to the Editor]

SAS Géza

[A well-behaved person in company, in a family, before a meal, wishes the others a good appetite. Even if the majority of the table is taking an appetite suppressant and chewing Abonette instead of bread. On the one hand, having a good appetite is a good thing, as it can be a sign or symptom of the onset of many diseases. But on the other hand, a good appetite can itself be the cause and trigger of many diseases. This issue is justified not only by the role of obesity in cardiovascular diseases, but also by the fact that in recent times certain misrepresentations, exaggerations and misinterpretations have 'spread' in our country, not because of concern for the health of the population, but because of the profit interests of big business (pharmacy, vegetable oil industry, etc.).]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Quality assurance in hospital services - a challenge]

EUGEN Hauke

[1. Introduction, 2. What is quality?, 3. Ways of perceiving quality, 4. Motivations for quality assurance, 5. Resistance to quality assurance, 6. Purpose of quality assurance, 7. Quality of practice of the profession, 8. Procedure to be followed in quality assurance, 9. Implementation strategy, 10. Role of the consultant in quality assurance, 11. Future of quality assurance, 12. Concluding remarks]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[A different take on people-centred medicine]

GÁBOR Zsuzsa

[Perhaps the most painful consequence of the crisis that has been deepening in our healthcare system for decades is the change in the content of traditional human-personal relationships, their emptying out. It is small consolation to know that this is by no means an isolated phenomenon, nor is it a national peculiarity, a kind of Hungarian curse. The explosion caused by the scientific and technological revolution has also caught health care unprepared in other parts of the world. The depth of the crisis and the severity of its symptoms vary only according to the economic possibilities of compensation. Yet, the dehumanisation of medicine, the very concept itself is so unacceptable that it is imperative to seek practical solutions.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Reporting from the front line]

[Parliament's Social, Family and Health Committee also found a way to meet with the head of the State Public Health and Medical Service, National Medical Officer Pál Kertai, and the county medical officers during the mad rush to pass legislation at the end of the year. This was a good opportunity for the members of the Committee to confront the functioning of the first basic public health law, which they helped to draft, and the consequences of some of their decisions and compromises, and also to gather ammunition for the budget debate and the preparation of the delayed health and social security laws.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[No lists!!! About the new rules for ordering medicines]

ANDRÁS László

[We asked Zsuzsa Matejka, Head of the Health and Pharmaceuticals Department of the National Directorate General of Social Insurance, about the recent controversial ministerial decrees regulating the prescription of medicines, who initiated these decrees? ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Faces from Parliament]

[Csaba Fáklya, SZDSZ; I was born in Budapest, the eldest son of a family with six children. Coincidentally, like so many politicians today, I graduated from Toldi High School. There were many illnesses in the family, my father was a severe lung patient and later died of cancer. It is possible that this is why I was attracted to the medical profession. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[A few sentences on sick leave]

ANDRÁS László

[Six working days ahead of its planned introduction, on 21 December, the National Assembly began its general debate on the 25-day sick leave bill. LÁSZLÓ SURJÁN, Minister of Public Welfare, introduced the general debate:]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[The advent of the computer in healthcare]

BORDÁS István

[In the following, some characteristics of "online" computer applications are analysed from a sociological perspective. Lonely online tools and the local computer network; The praise of DIY; Issues of distribution and manadgement; Foundation and concept? Observations on a call;]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[On blood transfusions - in Hungarian, 1810]

KISS László

[It is a basic fact of medical history that the first human transfusion was performed by the Frenchman Jean Baptiste Denis (?-1704) on 23 November 1667. Denis and his assistant Paul Emmerez (?-1690) transfused a severely haemorrhaged 15-year-old boy with about a quarter of a litre of sheep's blood, with reportedly good results. The haemorrhage was caused by the repeated cutting of the blood vessel after the boy had become ill with fever (5, 16, 8, 14). A couple of weeks later, in December 1667, the Italian Giovanni Riva (1627-1677) also performed a blood transfusion (13). After this brave start, and with the first fatal successes, doctors became less daring and less experimental.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Management training course in the Netherlands]

SZIJ Ildikó, JÓZSA György, VAJDA Miklós

[We attended a 7-month health course organised by the Hogeschool van Amsterdam in Amsterdam. For this course, funded by the Dutch government, ten Hungarian health workers - half of them doctors - were selected from several medical universities in Hungary and from OTE. Ten of them also came from Poland, and we attended the lectures in English together throughout.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Occupational health conference]

REICHERT Ursula

[The Austrian Society for Occupational Health holds its annual national conference, and this year the venue was the picturesque Leo bent. It is the second largest town in Styria, famous for its ore mining, mining university, metalworking industry and last but not least for Gösser beer.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Some thoughts on foreign language teaching at university]

BENEDEK György, BÖTI Zsuzsanna, DOMBI György

[Foreign language teaching in medical schools has several aims. It can be expected to: 1. enable students to acquire knowledge of specialist literature in a foreign language (primarily English); 2. enable students to communicate with colleagues who speak a foreign language at home and, where appropriate, during study trips or congresses abroad. 3. to enable students who are able to communicate their academic work orally and in writing in a foreign language. 4. to give Latin a special role in the teaching of medicine, both for the profession and for general intelligence. According to the criteria generally accepted today, the level of language proficiency can be judged on the basis of the points outlined above, or on the basis of performance in language examination requirements; I hope Professor Benedek and Adjunct Professor Böti do not misunderstand my reply, in which the passages between quotation marks, with the prefix "in the language" omitted, are near repetitions of their thoughts. ]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[Fine Art Column]

KOVÁCS Zoltán

[The importance of the Dioscorides Codex in medicine and art history.]

HUN 1992;2(02)

Lege Artis Medicinae

FEBRUARY 26, 1992

[About books]

BUDA Béla

[Review of the book "The Sorrowful Sociology of Hungarian Birth" Pregnancy - Birth - Birth]

HUN 1992;2(02)