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Lege Artis Medicinae - 1992;2(07)
Content
Lege Artis Medicinae
JULY 29, 1992
[The role of prostacyclin in the function of the gastric mucosa]
[The intracellular effect of exogenously admi nistered prostacyclin in the gastric mucosa seems to be a polyphasic one, namely: 1. effect on the cyclic nucleotide (CAMP, CGMP) turnover, 2. effect on the calmodulin-content, 3. DNA and RNA changes 4. influence on protein synthesis 5. new cell formation. Besides the endogenous prostacyclin exerts a natural protection against damaging noxae, thus maintaining the physiological integrity of the mucosa. ]
Lege Artis Medicinae
JULY 29, 1992
[What is the cause of delay in the diagnosis of the primary sjögren's syndrome?]
[Primary Sjögren's syndrome is the most frequent polysystemic autoimmune disease after rheumatoid arthritis. Keratoconjunctivitis sicca and xerostomia are characteristic of primary Sjögren's syndrome but the evolution of these signs may exist for years, and only one of them may be observed for a long time. Arthritis and enlargement of the parotid and submandibular glands are rarely observed as first symptom. The diagnosis of primary Sjögren's syndrome is based on the evaluation of the obligate signs. Clinical experience shows that there are many patients with undiagnosed Sjögren's disease. The authors would like to demonstrate the importance of the characteristic sings of primary Sjögren's syndrome, and the clinical and immunoserological tests which are useful in the diagnosis of the disease.]
Lege Artis Medicinae
JULY 29, 1992
[Clinical principles in the diagnosis and therapy of disseminated intravascular coagulation]
[Psychologically intravascular coagulation of the blood is hampered by the endothelium, the inhibitors of the coagulation system and the circulation as well. Various pathological events may the diffuse activation of the blood coagulation factors causing disseminated intravascular coagulation. The two main consequences of the DIC are ischaemia in the organs concerned and the consumption of the blood coagulation factors. The activation of the fibrinolytic system improves the former though aggravates the latter pathological events. In the prevention and therapy the effective treatment of the basic disease is of primary importance. Thorough evaluation of the clinical symptoms and the laboratory data can help in the diagnostics. Heparin can be administered only in the hypercoagulative-consumptive forms of the DIC if bleeding does not exist actually. In recent years, the administration of the anti thrombin concentrate has come into prominence because it can promote the restitution of the coagulation system without increase of bleeding. Antifibrinolytic (Gordox) therapy is advised only in cases of extreme hyperfibrinolytic activity. ]
Lege Artis Medicinae
JULY 29, 1992
[Laboratory diagnosis of disseminated intravascular coagulation]
[Disseminated intravascular coagulation (DIC) is a highly dynamic process with a broad spectrum of clinical manifestations and laboratory findings. There is no specific laboratory test for the diagnosis of DIC. For the reliable diagnosis of DIC we recommend a test-panel which can be divided into three groups: 1, The screening tests include the measurement of prothrombin time, activated partial thromboplastin time, trombin time, platelet count and detection of fibrin monomers; 2, The diagnosis of DIC can be confirmed with the help of additional assays, such as the determination of fibrin degradation products, antithrombin III or the detection of fragmentocytes in peripheral blood smear; 3, Special tests such as determination of clotting factors, reptilase time, activation peptides and thrombin-antithrombin III complexes may serve as useful tools in the differential diagnosis and in the scientific evaluation of the mechanisms of DIC. In this paper the advantages and disadvantages of different laboratory tests used in the diagnosis of DIC are also critically evaluated. ]
Lege Artis Medicinae
JULY 29, 1992
[Tissue banking: possibility and challenge]
[The development of the tissue banking techniques has made possible the production of wide range of differently preserved collagen based tissue grafts (skin, bone, dura mater, fascia lata). Excellent clinical results have been obtained by the application of allogeneic and xenogeneic grafts. The article summarizes the activity fields of tissue banks in the USA and in Europe. The review presents the most important aspects of tissue banking, antigenicity, sterility, preservation and storage of different grafts. ]
Lege Artis Medicinae
JULY 29, 1992
[Cardiac Arrhythmia Suppression Trial]
[ Arrhythmia-related death and non-fatal cardiac arrest were 4.5% in the encainide and flecainide group (33 out of 730 patients), compared with only 1.2% in the placebo group (9 out of 725). The relative risk was found to be 3.6%. The overall mortality rate was also higher in the group treated with active agents (7.7%) than among those treated with placebo (3.0%). The relative risk in the latter group was 2.5%.]
Lege Artis Medicinae
JULY 29, 1992
[Clinical efficacy of daily once given netlimicin + ceftriaxon vs twice given netilmicin + ceftazidim in the treatment of severe nosocomial infections]
[The combination of a beta-lactam and an aminoglycoside antibiotic is widely accepted in the treatment of severe nosocomial infections. In our study we compared two antibiotic regimens: the clinical efficacy of ceftriaxon + netilmicin once-a-day vs ceftazidim + netilmicin twice a-day. Patients: suffering from severe nosocomial infections and characterized by APACHE II, sepsis and injury scores. Dosage: Group | (n=30) – ceftriaxon 2 g iv. + netilmicin (2–7 mg/kg/bw) in one single dose. Group II (n=30) – ceftazidime 2 g bid + netilmicin (2–7 mg/kg/bw) divided in two doses. Laboratory parameters, netilmicin concentrations and cochlear function were checked regularly. 70% of pneumonias were cured or improved, while in the other infections (urinary tract, abdominal, soft tissue) the response rate was 90%. The lowest response rates were observed in Pseudomonas infections in both groups. Response rate in bacteremia was slightly higher in Group I. (5/7 vs 4/8). Four of 7 patients with Staphaureus infections failed to respond in Group II. Both methods of netilmicin administration proved to be safe. Both antibiotic regimens are effective in the treatment of severe nosocomial infections, however once-a-day administration is more convenient for the patients and saves cost.]
Lege Artis Medicinae
JULY 29, 1992
[Metoprolol Atherosclerosis Prevention in Hypertension]
[The two treatments achieved the same blood pressure. Both cardiovascular mortality and all-cause mortality were lower in the metoprolol-treated group. Smokers in the metoprolol group also had significantly lower mortality than those treated with diuretics (p<0.01).]
Lege Artis Medicinae
JULY 29, 1992
[Cases of the aspiration of iron containiny tables]
[Oral administration of ferrous salts is common in infancy and childhood in curing iron deficiency anaemia. The damage in the bronchi caused by the widely used iron containing tablet, Tardyferon bébé and its consequences are discussed through three cases and reviewing the literature. The children were jounger then half year at the time of aspiration. The observation time lasted from the aspiration 35, 44 and 74 month respectively. The right side was attached, mainly. The course of the illness was complicated with a vascular ring anomaly in one case. After the reconsturction revealed the severe stenosis of the stem bronchus, the resection of the right lower and middle lobe seems to be the possible solution. The stenosis of the right main bronchus, the stem bronchus and lower lobe bronchus has shown the signs of improvement in the other two cases. Besides the case histories the possibilities of the therapy and the need of other forms than tablets and capsules in iron treatment are to be discussed. In conclusion it seems to be evident that iron containing tablets and capsules should not be indicated for the treatment of iron deficinecy anemia under 3 years. ]
Lege Artis Medicinae
JULY 29, 1992
[Basic training in psychotherapy for district doctors (future family doctors)]
[As an extension of its psychotherapy courses, the Psychiatric and Psychotherapy Clinic of the SOTE Nap Street Mental Health Department - going back to the clinical training tradition created by Professor Pál Juhász - organised a basic psychotherapy course for rural district doctors. The aim of the training course is to prepare district doctors to perform complex family medicine tasks to a high standard. ]
Lege Artis Medicinae
JULY 29, 1992
[Measuring the quality of life of breast cancer patients]
[After a review of quality of life studies the author describe a questionary worked out by Schipper in 1984. The quality of life of 118 breast cancer patients was measured during adjuvant chemotherapy. We have got information about physical concerns, future orientation, social functioning and emotional well being of our patients. We could detect the changes in their quality of life, so we could improve it with therapeutic interventions. The survey can influence the attitude of health care personnel favourably. ]
Lege Artis Medicinae
JULY 29, 1992
[Ethical reflections on the practice of artificial insemination with husband's sperm]
[The authors survey the judgement of the arteficial insemination by husband (arteficial insemination with partner's sperm) by the great religions of the world. After expounding the main ethical guidelines they analyse the present situation in Hungary. Based on the legal rules and the medical practice they draw up the ethical arguments both in favour and against the use of AIH (AIP). Finally a list of practical guidelines is given according to which the AIH (AIP) is ethically acceptable and meet the accepted professional standards]
Lege Artis Medicinae
JULY 29, 1992
Lege Artis Medicinae
JULY 29, 1992
[Interdisciplinary quality assurance of hospital infrastructure Part I]
[Quality assurance has become a common and frequent concept for doctors and nursing staff, with studies and practical examples in many countries. However, progress in practical measures varies widely (1); What is the infrastructure of a hospital?; The importance of organisation; The importance of doctors in quality assurance; Why quality assurance is needed in direct patient care; How to ensure quality in indirect patient care;]
Lege Artis Medicinae
JULY 29, 1992
[Dilemmas of the holistic systems approach]
[Certainly one of the finest thinkers of the twentieth century, Martin Heidegger († 1976) accused Western thought since Plato of losing its sensitivity to ontological differences. It has become indifferent to being as the universal basis of existence. In 1950, in his Holzwege, Dead Ends, he sketches existence as a mysterious forest in which different systems of interpretation (logging roads-Holzwege) try to explore the fundamental questions of man and science from different angles. These paths, although approaching the problem from different angles, hold together, but in the end do not yield any relevant information about existence, about the whole. The universal basis is lost in their investigation. The paths are slowly overgrown with vegetation and the mystery of the forest remains unexplored. ]
Lege Artis Medicinae
JULY 29, 1992
[Report]
[Interpellation of György Danis to Dr. László Surján, Minister of National Welfare, on "The working capacity of the health care system"]
Lege Artis Medicinae
JULY 29, 1992
[The point is elsewhere]
[For months, health workers and the health press have been preoccupied with what is happening around the cards, the wage demands - and the fact that they are not being met - the change in the rules for sick pay, the introduction of doctor ID stamps and who knows what else important developments in the reform. All the while, little attention is being paid to the transformation of social security, which is the financial backbone of health care, the financier and the determinant of all this, apart from the substance. News has just come to light that the Social Insurance Fund closed last year with a deficit of 22 billion forints. We started this year with virtually no guarantee of public spending. How do we finish? ]
Lege Artis Medicinae
JULY 29, 1992
[Report of the Health Insurance Supervisory Committee]
[Recent activities; Main tasks facing the EFB; Joint decision]
Lege Artis Medicinae
JULY 29, 1992
[The age of jurisdictional disputes]
["I notice that the parties have been deflated on the social security issue. The best election manifestos could be competed: on the future of social security, its fate, its self-government. I would urge the parties to debate these issues again and again, asking new questions." - said independent MEP Károly Eke. There have been many reports about tensions between the new players in health and social policy and the old ones - the OTF and the Ministry of Welfare. Accordingly, the unusually large number of experts and ministry and social security leaders gathered to hear the first report of the Health Oversight Committee was tense. ]
Lege Artis Medicinae
JULY 29, 1992
["Third Way" hospice care in France]
[At the beginning of the year, I spent a month in Paris studying hospice care. The hospice movement in the English Saxon countries has a history going back several decades. Christopher Hospice was founded by Cicely Saunders in 1967, but the work of Elisabeth Kübler-Ross and Mother Teresa of Calcutta is also well known in Hungary. In France, this movement only began to develop in the 1980s, so the relatively recent experience there can be very instructive for us too. ]
Lege Artis Medicinae
JULY 29, 1992
[Jan Radlica, physician to King Louis the Great]
[The famous doctor Jan Radlica was Polish by birth. He was born in Radliczyce, a village near Kalisz, in Greater Poland. His parents were Michal and Krystyha. He showed great interest towards medicine from an early age, but it was not until 1361, when he was an adult, that he travelled to France to study at the University of Montpellier, famous for its medical faculty, where he obtained a baccalaureate in theology and medicine.]
Lege Artis Medicinae
JULY 29, 1992
[The Prophet Elisha and the Sunamite woman]
[Very little is known about the life of Gerbrandt van den Eeckhout (1621-1674), the painter of the picture on the title page. Arnold Houbraken, in his collection of biographies from the early 18th century, reports that the artist was a pupil of Rembrandt sometime in the second half of the 1630s, but remained on friendly terms with his master afterwards. Eeckhout, like Rembrandt's other pupils, often captured lesser-known Old Testament scenes, including the Budapest picture painted in 1664. ]
Lege Artis Medicinae
JULY 29, 1992
An Englishman in Szeged
In the last 2 weeks of April, I hosted a couple from England. The male member of the couple is a fifth year medical student in Sheffield. During their visit we talked a lot about the situation of Hungarian doctors and medical students. It occurred to me that it would be worthwhile to present what's new on this front in the UK. Of course, only a short extract from these long conversations is given here. I hope that no one will have any difficulty in understanding the English version.
Lege Artis Medicinae
JULY 29, 1992
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
21. MAY
2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]
21. MAY
3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
27. NOV
4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
27. SEP
5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
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