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Lege Artis Medicinae - 1992;2(05)
Content
Lege Artis Medicinae
MAY 27, 1992
[Treatment of endodermal thyroid cancers]
[Following staging procedures, differentiated thyroid cancers i. e. papillary and follicular carcinomas, are surgically treated with intra- or extracapsular total thyroidectomy (depending on the anatomical extent of the disease) and selective lymphnode dissection. Postoperative complementary use of adjuvant external and systemic radiotherapy is the general practice. External irradiation decreases local/regional relapses in all cases. Radioiodine treatment decreases local/regional/ distant recurrences in cases of tumour cells capable of iodine uptake. Life-long thyroxine medication is required, with a TSH-suppressive dose for relapse prevention and hormone substitution. This treatment regimen, a careful follow-up, and adequate rescue therapy are the prerequisites of the generally excellent patient prognosis, i. e. a survival probability measurable in decades. In anaplastic carcinoma following extracapsular total thyroidectomy and lymph node dissection, external irradiation is always indicated. Chemotherapy has a benefical effect on survival. Hormone replacement therapy is necessary to substitute for the missing metabolic effect of the thyroid. This combined modality treatment leads to some improvement with regard to the prognosis of this poor-risk type of cancer. ]
Lege Artis Medicinae
MAY 27, 1992
[Correspondence]
["Programmed cell death" I read with great interest and attention Dr. Béla Szende's excellent communication on the biological and pathological significance of programmed cell death (apoptosis). Although the phenomenon of apoptosis (albeit under a different name) has been described for more than twenty years, its importance in the regulation of tissue homeostasis has only been recognized in the last few years. In 1991, for example, Jean Claude Ameisen and Andre Carpon of the Pasteur Institute in Lille put forward their hypothesis that apoptosis explains the qualitative and quantitative deficiency of helper T cells in HIV-infected patients.]
Lege Artis Medicinae
MAY 27, 1992
[Malnutrition syndrome in childhood part II.]
[Malnutrition is a chronic nutritional disorder resulting from insufficient intake of caloric energy and/or some fundamental nutrients. Since it is the most common public health problem in the world it has a great impact on pediatric morbidity and mortality. The etiology is extremely complex. When one considers the less severe symptoms and signs caused by vitamin-, mineral-, and trace element deficiencies, it is apparent that not only children living in underprivileged countries are affected. In the course of making the diagnosis an assess ment of the nutritional status should also be made, especially considering the above-mentioned marginal nutritional deficiencies. The most common manifestation of nutritional disorders is anemia, which is mostly caused by lack of iron, vitamin B12, folic acid and can be complicated by infections. Nutritional requirements can be affected by several drugs. That is why this medication-nutrition interaction has to be kept in mind during treatment. The interaction of malnutrition and infection is very important, primarily for three reasons: mechanisms by which infection complicates the metabolic and nutritional status of the host; importance of suboptimal nutritional status on susceptibility and severity of intercurrent infections; clinical and therapeutic implication of these interactions. ]
Lege Artis Medicinae
MAY 27, 1992
[Operative Hysteroscopy]
[Many thousands of hysterectomies are perfor med each year in women suffering from menorrhagia resistant to medical treatment but having, no demonstrable uterine abnormality. Hysteroscopy, the up to date diagnostic and therapeutic method can help to get advance in the diagnosis and therapy in these situations. In addition to permitting more precise diagnoses to be made, hysteroscopy allows the endometrium to be treated selectively under direct vision. The full thickness of the endometrium may be ablated using laser or resectoscope. The benefits of selective endometrial destruction versus hysterectomy are enormous. Patients undergoing endometrial ablation are frequently delighted with the short hospital stay, and the cost of this procedure is lower than the cost of hysterectomy. Many Müllerian fusion defects are amenable to hysteroscopic treatment. Patients with certain types of Müllerian defects undergoing hysteroscopic septotomy will enjoy as high a rate of reproductive success as those receiving more traditional procedures while avoiding the risks, the subsequent caesar sections, and the high cost. ]
Lege Artis Medicinae
MAY 27, 1992
[Transvaginal ultrasonography of embryo development in prematurity, sono-embryology I. The embryo and its appendages]
[The authors performed serial examinations by a high resolution transvaginal transducer during the first trimester of pregnancy to show the most important stages of the early embryonal development. This is a preliminary study to a prospective, detailed screening programme in the first trimester of pregnancy. The earliest sign of pregnancy can be detected at the 29–31st days of menstrual age using vaginal transducer. During the 5th week the (secondary) yolk sac can be seen, which is an unambiguous evidence of an intrauterine pregnancy. The living embryo can be de monstrated on 36–38th days with the help of the pulsation of the embryonic heart tube. Certain embryonic structures appear in a defined order (developmental „calendar"). The physiologic midgutherniation can be observed during 7–11th weeks. Transvaginal sonography has gained popularity only recently due to technical advances. The main fields of use became gynaecology and early pregnancy, for there is no need to have a full bladder, for the lack of disturbing tissue layers. This method is essentially a combination of the bimanual gynaecological and the ultrasound examination. ]
Lege Artis Medicinae
MAY 27, 1992
[Effects of drugs on permanent pacemakers]
[Several antiarrhythmics can alter pacing thresholds. Especially, the Class 1 C drugs may increase the threshold. Corticosteroids and sympathomimetic agents lower the threshold. Some drugs must be avoided in pacemaker dependent patients. The potential pacemaker-drug interaction must always be considered when prescribing a new drug. Significant clinical sensing problems have not been recognized with antiarrhythmic drugs. The sensor function of rate responsive pacemakers can be altered by concomitant drug therapy. ]
Lege Artis Medicinae
MAY 27, 1992
[Diagnostic possibilities in giardiasis]
[Giardia lamblia is the most commonly found pathogenic parasite in the Western World. Recently cysts of Giardia lamblia were isolated from drinking water in Hungary. Giardiasis is an infection that is often not promptly suspected and diagnosed because of the greatly variable expression of the disease. The spectrum of presentation is broad: there are asymptomatic individuals and patients showing gastroenteritis or hepato-biliary syndrome as well as gastritis-duodenitis syndrome. Giardia alters the absorbtive function of the villus tip in the upper small bowel resulting in noninflamatory diarrheal illness. The traditional microscopic examination of stool samples yields low diagnostic sensivity compared with light microscopy of duodenal aspirate, endoscopic brush cytology, mucosal inprint or biopsy. Sensitive immunological detection methods like immunodiffusion indirect fluorescent antibody and ELISA tests might greatly enhance the possibility of detec ting anti-Giardia antibodies. Most of these serodiagnostic assays are not available for routine diagnostic purposes. Our data suggest that the light microscopic examination of duodenal aspirate and endoscopic brush cytology together are fast, cheap and reliable methods for detecting Giardia trophozoites. When these methods fail to reveal Giardia infection electronmicroscopy could help reaching the correct diagnosis. ]
Lege Artis Medicinae
MAY 27, 1992
[Clinical prognostic factor of breast cancer]
[The authors are of the opinion that the investigation and determination of prognostic factors in breast cancer, like in any other malignant disease, are important. The data of their 744 breast cancer patients were studied by biostatistical methods. According to the results the state of nourishment, data of patient's reproductive life, number of abortions, cancer in the family and the localization of the tumor do not have any impact on survival. Concerning the age, the survival probability of post menopausal patients are better, while the premenopausal patients have the worst prognosis. The size of the tumor and especially the number of positive lymph nodes have the most significant influence on survival probability. The influence of estradiol receptor (ER) and progesteron receptor (PR) content of the primary tumor on survival was studied with respect to the other variables. The death rate decreases according to the increase of the receptor content, and the number of ER positive patients in the group with more than three positive lymph nodes is significantly lower. According to the results, the higher the ER content the less the number of local recurrences and metastases. ER positive patients are likely to have metastases in the bones. Most of the ER negative patients' metastases occurred already in the first three postoperative years. It is important to know the receptor content in order to determine the prognosis of the disease and establish adjuvant therapy and treatment in case of a later potential recurrence.]
Lege Artis Medicinae
MAY 27, 1992
[Bulimic features in obesity]
[Obesity, which has great significance in public health, can often be regarded as a psychosomatic disorder. Its connection to the classic forms of eating disorders (anorexia, bulimia) can be conceptualized on the basis of a continuum hypothesis stressing the continuity among these forms. About half of obese subjects also show bulimic symptoms (binges, vomiting, laxative abuse) according to the data in the literature. The authors examined this subgroup of obesity (or bulimia) with various eating disorder test methods and interviews in a population of 172, and in part of 254 obese subjects in a local slimming cure sanatorium. The prevalence of bulimia meeting clinical criteria was 7.3 per cent in 55 males, and 19.7 per cent in 117 females. On the basis of test conducted in the population of 254 subjects, the proportion of pathological eating attitudes is very high, e. g. bulimic predisposition can be found in 41.2 percent of males and in 73.0 per cent of females. Because of these high proportions, the sub group of bulimic obesity deserves attention, and psychotherapeutical help is required in its treatment.]
Lege Artis Medicinae
MAY 27, 1992
[Treatment of gallstone disease]
[Cholecystectomy is the most common operation performed in surgical departments in Hungary. In Hungary, 17,000 cholecystectomies are performed every year. The mortality of the operation without opening the bile ducts is 0.4 - 0.7%.]
Lege Artis Medicinae
MAY 27, 1992
[Proposal for the short and medium-term health programme of the Hungarian Socialist Party]
[In order to define the tasks and capacity of the health care system, we must start from the current situation, which is characterised primarily by the health status of our inhabitants and the quality of care provided by health care institutions: surgeries, hospitals. In assessing these, we must also take into account the government's efforts to make changes and the consequences of these so far. In this context, the health of our people and our health care can be characterised by the following facts.]
Lege Artis Medicinae
MAY 27, 1992
[Abortion]
[- What will become of this? In health, in the church, in society, in legislation? I feel a moral basis for reflection, not because I am averse to such interference as a human being and as a doctor - that is natural - but because my children have been born, and even more so because in some cases, when young and older couples, friends and acquaintances have honoured me with their trust, asking for advice in a conflict situation, they have decided, as a result of their joint deliberations, to keep the child they did not expect.]
Lege Artis Medicinae
MAY 27, 1992
[Report]
["...our government..." conversation with Erzsébet Jantsky, Secretary of the Christian Medical Association]
Lege Artis Medicinae
MAY 27, 1992
Lege Artis Medicinae
MAY 27, 1992
[Faces from Parliament]
[In our previous issue Endre Pokony talked about his career and life, now we publish part II of his interview. ]
Lege Artis Medicinae
MAY 27, 1992
[The state of alternative medicine in Europe]
[In the last decade or two, alternative healing practices have emerged and spread rapidly throughout the "western world" and recently in Hungary. In almost all Western European countries, it is now legal - even for lay people - to practise healing activities that were previously forbidden. Legalisation has taken place formally in some places or is in the process of taking place, but in others the situation is similar to that in Hungary: the existing law has been implicitly repealed. ]
Lege Artis Medicinae
MAY 27, 1992
Lege Artis Medicinae
MAY 27, 1992
[On student evaluation of the teaching work in the department...; Specialist examination in internal medicine]
[A draft of the student evaluation of the teaching work in the department has been prepared, which tries to standardise the questionnaires published by the different institutes every now and then, and offers a series of tests that include the evaluation of lectures, exercises, exams and teachers. This evaluation system has become necessary as a result of the education reform, and is an essential part of it, since it would finally provide factual material for the future selection of teachers, while at the same time providing a snapshot of the evaluation of teachers' work.]
Lege Artis Medicinae
MAY 27, 1992
Lege Artis Medicinae
MAY 27, 1992
[ICDS Congress Report]
[The 6th Congress of the International Cardiac Doppler Society (ICDS) was held in Budapest, Hungary, 1-3 May 1992. This was the first meeting of the Society in an Eastern European country. The congress was preceded by 1 year of preparatory work by the Hungarian organizing committee, as a result of which 31 invited speakers, including 5 Hungarians, presented 37 papers in 9 plenary sessions. In addition to Doppler echocardiography, the congress also covered modern examination techniques which, although not closely related to it, are an integral part of echocardiography.]
Lege Artis Medicinae
MAY 27, 1992
[About Books]
[A review of the book written by: Alfred H. Katz, Eugene I. Bender: "Helping One Another: Self-Help Groups in a Changing World"]
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