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Lege Artis Medicinae - 1992;2(06)
Content
Lege Artis Medicinae
JUNE 30, 1992
[Immunological aspects of granuloma formation]
[The process of inflammation can be classified as acute, subacute and chronic, as well as the special category of granulomatous inflammation. Classification of granulomatous inflammation based on morphologic criteria. These are epitheloid, histiocytic, foreign-body, necrobiotic and mixed inflammatory granuloma. The current knowledge suggests the following sequences for the mechanisms of granuloma formation in sarcoidosis (Fig 2): 1. T-cells are locally activated and proliferating 2. These activated T-cells release lymphokines that recruit and activate monocytes/macrophages 3. These activated monocytes/macrophages may differentiate into granuloma cells such as epithelioids cells and multinucleated giant cells and release pro-inflammatory profibrotic mediators that modulate the granulomatous and fibrotic process. It is hoped that further studies in sarcoidosis will help not only in clarifying the pathogenic mechanisms leading to granuloma formation, but also in eventually revealing the etiology of sarcoidosis. ]
Lege Artis Medicinae
JUNE 30, 1992
[Transvaginal ultrasound examination of embryo development in early pregnancy (sono-embryology) II. central nervous system]
[In the second part of their paper, the authors look over the most important phases of the development of the central nervous system during the first trimester of pregnancy - especially considering the stages, which can be differentiated with a high resolution transvaginal transducer. The closed neural tube is developing at days 40 to 44 by the closure of the posterior neuropore, however at this time no brain structures can be detected by ultrasound. During the 7th week the three primary brain vesicles (prosencephalon, metencepha lon, myelencephalon) can be identified – a single ventricle can be seen by ultrasound. During the 8th week the secondary brain vesicles (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon) can be separated. During the 9th week the lateral ventricles are filled out by the choroid plexus, which are retracted to the occipital horn by the 13th week. The appearance of the brain structures also takes place according to an accurate „calendar". The structures recognized by ultrasound can be compared to those of the central nervous system known from embryology. The problem of the primary prevention of the cerebrospinal malformations, which are among the most frequent congenital disorders, is not yet solved; therefore the early prenatal diagnosis of the structural anomalies has great importance. ]
Lege Artis Medicinae
JUNE 30, 1992
[Laparoscopic varicocelectomy]
[ With the spreading use of the laparoscope in the urological surgery laparoscopic varicocelectomy may become an alternative treatment of varicocele. The method can be advantageous mainly for patients with bilateral cases compared to the open operation. The authors report on two cases that have been the first urological laparoscopic operations in Hungary.]
Lege Artis Medicinae
JUNE 30, 1992
[Vascular surgical aspects of small bowel ischaemia]
[A brief account is given of acute and chronic diseases underlying the disorders of blood supply to the small bowel. In cases of acute disorders, considering the diagnostic difficulties involved, the author stresses the importance of commencing of a vasodilatator treatment immediately after the tentative diagnosis has been reached based on the first suspicious symptomes, and also requiring angiography to render the accurate diagnosis. This is the only possibility to increase (without irreversible tissue damages) the number of successful early vascular reconstructions which are the prerequisites to reducing in lethality. Finally, based on his own extensive experimental work, the author proposes to make allowances for the augmented local postischaemic vasoconstrictor trends of vascular reactivity in the complex therapeutic regimen of these diseases. ]
Lege Artis Medicinae
JUNE 30, 1992
[Cardiovascular effects of sleep-related breathing disorders, a review]
[The acute and chronic cardiovascular effects of sleep related breathing disorders are summarized in this review. Obstructive sleep apnoea syndrome is characterized by recurrent upper airway collapse during inspiration. The resulting asphyxia causes hypoxia and arousal. The vigorous inspiratory efforts produce falls in blood pressure coinciding with each effort (pulsus paradoxus). A rise in blood pressure is seen concurrently with each termination of apnoea and arousal. Bradycardia induced by hypoxia in each obstructive period and increased frequency at time of arousals could lead to arrhythmias. This may result in a high prevalence of hypertension, acute myocardial infarction and arrhythmias in sufferers of obstructive sleep apnoea syndrome have. ]
Lege Artis Medicinae
JUNE 30, 1992
[Evaluation of one hundered cancer cases in the practice of a general practicioner]
[The author, working as a general practicioner in Czecho-Slovakia, gives an analysis of one hundred malignant tumour patients. In 31 cases the tumours have been in favourable position, and it would have been possible to set up early diagnosis in the general practice. The early diagnosis has actually happened only in 15 cases. The tumor has been verified at an advenced stage in 16 cases (2 of them have been inoperable). Delay has occured in two cases because of the nature of the cancer; in one case the general practicioner and in two ones the specialist missed the diagnosis; in the rest of the cases (11) the patient appeared too late. The author expresses that development in early cancer diagnosis is based on effective health education beyond the permanent on cological vigilance. ]
Lege Artis Medicinae
JUNE 30, 1992
[Predicting restenosis after coronary angioplasty by very early dobutamine stress test]
[Increasing dose of intravenous dobutamine infusion and bicycle exercise test was used in patients with angina pectoris before and after successful coronary angioplasty to predict the development of restenosis. Ten patients were enrolled (mean age 55.9). Before PTCA, DST was positive in 9 of the 10 patients. This was similar during maximal bicycle exercise test. After successful PTCA, DST remained negative in one, became negative in four, and remained positive in five patients. The day after PTCA (and DST), repeated coronary arteriography did not disclose significant residual or restenosis in any case. In one patients with positive early DST, symptomatic restenosis developed three days later. Follow-up coronarography was performed 6 months later. There were two patients with significant restenosis and one patients with remote progression of CAD. All of them had demonstrated a positive early DST. There was no restenosis at 6 months in the group of patients with negative early DST. The authors concluded that DST is suitable for detecting myocardial ischemia in single vessel disease; DST is safe immediately after PTCA; the risk of the development of restenosis is low if DST is negative after PTCA, while a positive recoronarography and redilatation may be advised in the latter group of patients. ]
Lege Artis Medicinae
JUNE 30, 1992
[Somatostatinoma of the duodenum]
[A malignant endocrine tumor of the middle part of the duodenum is reported in a 58-year old male patient. The tumor was examined with immunohistochemistry and was found to contain predominantly somatostatin-immunoreactive cells with rare cells showing glucagon and HCG immunoreactivity. Microscopically, the tumor had mixed architecture, with a trabeculo-glandular pattern. The first (frozen section) examination suggested a moderately differentiated adenocarcinoma. ]
Lege Artis Medicinae
JUNE 30, 1992
[Ethical positions on new methods of human reproduction]
[Report of the ad hoc Committee appointed by the Scientific Council and the Scientific Committee on Research Ethics in Health; The ad hoc Committee appointed by the Scientific Council and the Scientific Committee on Research Ethics in Health has prepared two versions of its position papers. One version summarised the committee's position after more detailed explanations and a list of arguments and counter-arguments (this material was published in the Medical Journal 10-13 1992 in a continuation form). The other, abridged version only lists the final conclusions of the committee according to the individual topics. The latter has been discussed and adopted by the Scientific and Research Ethics Committee and approved by the Bureau of the Scientific Council for Health, and is now published as the final resolution on the issue. ]
Lege Artis Medicinae
JUNE 30, 1992
[Theses]
[I have narrowed down the questions I received in advance: what are the main challenges facing the Hungarian health sector? I could only formulate additional questions as answers or in part instead of answers. ]
Lege Artis Medicinae
JUNE 30, 1992
[Correspondence]
["Let's play cards"; you could say it's a collective gamble that costs a lot of money and the payoff is as uncertain as a dog's dinner. Everyone expects a lot from it: we, the primary care doctors (at present, district, general practitioners and family doctors in the process of metamorphosis), and the patients, who are increasingly waiting outside the doors of our surgeries. ]
Lege Artis Medicinae
JUNE 30, 1992
[Reflection]
["Money or Life!?" Our work as doctors has always been closely linked to philosophical and social problems, but often - unfortunately - even to daily politics. I am thinking here, for example, of the debates surrounding abortion or euthanasia, where only one thing can be said for sure: there is no solution that is acceptable to everyone.]
Lege Artis Medicinae
JUNE 30, 1992
[About the same thing elsewhere, in a different tone]
[It was a gesture of thanks and appreciation that a few days after the publication of the 1992/6 regulation on general practitioners, senior staff from the Ministry of Public Welfare and the OTF presented and discussed it with their colleagues at the LAM Club. Naturally, this was done only after the regulation had been published. They did not receive the same recognition and thanks when they made the same gesture to their colleagues sitting as Members of Parliament in the Committee on Social Affairs and Health. ]
Lege Artis Medicinae
JUNE 30, 1992
[On behalf of the majority]
[Presentation by Béla Doktorits at the conference "Entrepreneurial health care-insured society" (15 May 1992)]
Lege Artis Medicinae
JUNE 30, 1992
[Recommendation of the Public Relation Committee of the Hungarian Association of Pharmaceutical Manufacturers]
[The paragraphs of the forthcoming new Medicines Act dealing with information and information on medicines.]
Lege Artis Medicinae
JUNE 30, 1992
[Health care and general practice in South Africa]
[With the establishment of diplomatic relations and the start of economic cooperation, the Republic of South Africa has come to the fore. Public opinion at home has been watching President De Klerk's political reform efforts with a similar interest, which were endorsed by a large majority of white voters in a referendum held in mid-March.]
Lege Artis Medicinae
JUNE 30, 1992
[Premises and standards in medical ethics]
[The definition of medical ethics seems simple: 'the right conduct of medical life' (in more modern terms: the rules of medical behaviour in professional situations). It follows József Imre's Medical Ethics, published in 1925; a problematic that pervades the principles and practice of medicine as a whole, an expanding repertoire, in the sense of 'humanistic medicine', as advocated by László Levendel (also), in which the focus is on patient-centredness rather than disease-centredness.]
Lege Artis Medicinae
JUNE 30, 1992
[Pantaleon the doctor, patron saint of doctors]
[The spread of the cult of Pantaleon in the world; Traditions in Hungary; Places bearing the name of Pantaleon; The monastery of Saint Pantaleon; Memories of Pentele]
Lege Artis Medicinae
JUNE 30, 1992
Lege Artis Medicinae
JUNE 30, 1992
Lege Artis Medicinae
JUNE 30, 1992
[I dissected the whole country]
[Every student hears a lot of interesting stories in the various lectures during their university years. Most of the stories are, of course, about the successes and failures of medicine. But the stories you hear in forensic medicine lectures stand out somewhat. ]
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