Lege Artis Medicinae - 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Echocardiography in the management of acute myocardial infarction]

LENGYEL Mária

[The author presents a detailed review of the role of echocardiography (echo) in the management of acute myocardial infarction (AMI). The echo diagnosis of AMI is based on segmental wall thinning and akinesia with a 90% accuracy. Echo has made a major impact on the immediate diagnosis of mechanical complications in the hemodynamically compromised patient with AMI. These mechanical complications which include myocardial rupture of the free wall or the septum or the papillary muscle, may be successfully treated by prompt surgical intervention. Echo diagnosis has an important role in the management of other complications of the acute, subacute and chronic phases of infarction as well, such as pericardial effusion, left ventricular thrombus, left ventricular aneurysm and pseudoaneurysm. Therapeutic strategies are thoroughly affected by systolic and diastolic function assessed by echo. Echo has a basic role in the algorithm of postinfarction anticoagulant treatment. Besides rest echo, early stress echo has a definite prognostic value in predicting multivessel disease and identifying viable myocardium which requires revascularisation procedures. The indications for echo in the acute phase and before discharge are summarized according to recent American recommendations. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Clinical and immunological aspects of polymyositis and dermatomyositis]

DANKÓ Katalin, ZILAHI Zsolt, SZEGEDI Gyula

[Polymyositis and dermatomyositis are autoimmune diseases characterized by muscle weakness, tenderness, occasionally pain, and ultimately atrophy and fibrosis of the muscles. The extraskeletal manifestations, particularly the cardiopulmonary, oropharyngeal, gastrointestinal involvement, are described. Studies of autoantibodies and cellular immune function support a central role for disordered immunity in the pathogenesis. The myositis-specific autoantibodies, expecially those directed at certain enzymes important in protein synthesis are found in a clinically distinct subset of patients. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Right ventricular infarction]

KISS Gabriella

[Right ventricular infarction (RVI) may occure as isolated or, more often, associated with left ventricular – inferior or occasionally anterior - infarction. The diagnosis of RVI is based first of all on the characteristic clinical symptoms, on the ECG pattern and on the results of 2D-echo-cardiography. The exact localisation of the infarction has vital significance in the therapy of the acute phase. The mortality can be substantially decreased with adequate therapeutic measures even in severe cases. The prospective prognosis of RVI is more favourable than that of left ventricular infarcti on. The author presents the most important diagnostic and therapeutic features related to RVI. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Role of platelet function in the pathogenesis of alzheimer's disease]

HASITZ Mária, LIPCSEY Attila, RÁCZ Zoltán

[Dementias, especially those of Alzheimer type represent very serious types of disease in the elderly. Amounting evidence suggests that Alzheimer's disease is reflected in the platelets of the patients. Our results and the data of scientific literature have been summarized. In vitro parameters of platelet shape and aggregation were compared. Platelet shape, characterized by aggregometer oscillation amplitude, and the initial rate of 50 uM ADP-induced aggregation have been recommended for supporting the diagnosis of Alzheimer's disease or Alzheimer-type senile dementia. Our results and those of others revealed that the function of the Alzheimer platelet is influenced by two effects: the plasma medium and the genetic background resulting in the change of the platelets. The results suggest that both effects are involved in the vitro functions detected.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[The role of ultrasound in the diagnosis of septic hip prosthesis loosening]

FÖLDES Károly, BÁLINT Péter, GAÁL Marianna, KISS Csaba, BÁLINT Géza

[The aim of the authors is the application of non-invasive ultrasound examination to the detection of complications after hip joint arthroplasty. Their recent work has been a trial to explore the kind of diagnostic assistance of ultrasound in case of suspected endoprosthetic infection. 39 patiens have been examined after hip joint arthroplasty. Out of this sample there was a suspected clinical infection in 20 cases. The rest 19 patients had no complaints and made the control group. Out of the patients with complaints effusion was detected around the neck of the prosthesis by means of US in 7 cases. Out of these in 10 cases reoperation in 6 cases US guided joint aspiration verified our US results. The authors made conclusion that as to patients having complaints of pain after hip joint arthroplasty very useful assistance in avoiding infection may be given by quided ultra sound aspiration.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Endoscopic "limited" resection of early gastric cancer theorethical approach and the first steps of clinical practice in hungary]

SIMON László, DOMJÁN Lajos, BALOGH István, DEÁK György, FEHÉR István

[Recently – based upon Japanese experiences - a new method was applied in the surgical strategy of early gastric carcinoma resection: endoscopic („limited”) resection of the lesion optionally in selected cases. Methods of endoscopic interventions are outlined, „mucosal strip biopsy" in details. The first Hungarian application of this method was successfully performed in case of II.a type early gastric cancer developed in an old patient of high operational risk. Two cases of early gastric carcinoma are analysed, summarizing the indications and contraindications of the operative endoscopical intervention, criteria of the selection of suitable cases, and the needs of the oncological-histological evaluation.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Vaccinations in the world the expanded programme on immunization]

LELKES Miklós, VEDRES István

[The Expanded Programme on Immunization (EPI) began in 1974 as a WHO-programme, later joining the UNICEF and other organizations. The original target diseases of EPI were tuberculosis, diphtheria, pertussis, tetanus and neonatal tetanus and morbilli. The WHO advises that yellow fever vaccine should be incorporated into EPI and routinely adminis tered to children in all countries at risk for yellow fever. The EPI is dealing now already with the problem of hepatitis B and rubella (congenital rubella syndrome) also. A great achievement of EPI for 1990 of 80% immunization coverage among infants world wide with BCG and measles vaccine and the third dose of DPT and of oral poliovirus vaccines. Some short term goals of EPl: global eradication of poliomyelitis by the year 2000, reduction of measles death by 95% by 1995 and reduction of measles cases world wide by 90% compared to pre-immunization levels as a major step towards the global eradication of measles. Also by 1995, case fatality rates from measles should be reduced to less than 1% in all countries. The WHO European Region has adopted the target of no indigenous measles by the year 2000. Concerning the EPI diseases, the epidemiological situation in Europe including Hungary is generally favourable. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Psychoterapy as medical activity]

SZŐNYI Gábor

[In the clinical practice we can use the medical model, the algorithm of examination, indication, choice of therapy, therapeutic process, outcome, control also in case of psychotherapies. Because the location and the cause of the disorder, the place and the tool of the therapy are the same, namely the human psyche and the human interpersonal relati onships the psychotherapies demand differing attitude from the somatic medicine at several points. The basic position should be summarized under the psychotherapeutic attitude. Main common parts of the psychotherapy methods are the therapeutic contract and the therapeutic relation. The different components influence the process through the person, the inner world of the patient and the therapist. Therapeutic interventions cannot be judged if we pick them out from these interrelations hips. The psychotherapeutic methods can be evaluated on the basis of the therapeutic contract, of the goal and method of the therapy. To find our way among the psychotherapeutic methods we rely on the differentiation between autonomous theoretical schools, basic therapeutic settings, specific forms created of time-parameters and spheres of application. The basic unit of the psychotherapeutic delivery service is the therapy session. There are special methods of training. The most specific one, unknown in all other medical training is the so called personal therapy (,,self experience therapy"). ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Is the planned health reform feasible within the current framework of social security?]

GYARMATI László

[I see my thoughts and experiences listed here as a thesis to launch a necessary and cross-cutting debate. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Systolic Hypertension in the Elderly Program]

MATOS Lajos

[Over the five-year study period, the incidence of stroke was 5.2% in the active treatment group and 8.2% in the palcebo group. The relative risk for the secondary endpoint (myocardial infarction, coronary mortality) was 0.73 and for all-cause mortality 0.87. Among patients with isolated systolic hypertension aged 60 years and older, low-dose chlorthalidone treatment as therapeutic step 1 reduced the incidence of stroke by 36%. In the active agent-treated group, the incidence of all coronary events was also reduced by 32%.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Can we believe scientific reports?]

FENYVESI Tamás

[Essentially, the editor-in-chief of Chest asks the question in the title (1). The question is justified. Over the past ten years, there have been a striking number of cases of fraud in medical publications. In the mid-1980s, the Darsee and Slutsky case (2) received a lot of publicity. Most recently, the forced resignation of Nobel laureate Baltimore as President of Rockefeller University over a communication by a close colleague falsifying scientific results (3).]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Who is the man of the house?]

ANDRÁS László

[The National Assembly's Committee for Social, Family and Health Protection invited senior officials from the Ministry of Public Welfare and the National Social Insurance Directorate General to a consultation on the Government Decree 19/1992 on the social security financing of health care. The aim of the consultation is "to examine the extent to which the Government Decree follows the law and, more importantly, the extent to which day-to-day practice in its implementation follows the Government Decree and, through it, the law" (President Gyula Kis - MDF). ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Funding at every level]

ANDRÁS László

[Interview with Gyula Pulay, Deputy State Secretary for Public Welfare]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[With a bad taste in the mouth]

ANDRÁS László

[On the budget support for social organisations]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Tools of modern medicine]

BROOSER Gábor

[As strange as it may sound, modernity in the clinic does not always coincide with the new performance of the automated devices that are being designed. Rather, it means strategies that can most effectively influence and restore functioning systems in the shortest time and with the least energy, based on the values that are closest to reality. This applies to drug and surgical therapies, and a similar approach could be taken to basic and applied research, to the criteria of modern diagnostics, including imaging. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[In memory of Sándor Lumniczer on the 100th anniversary of his death]

KAPRONCZAY Károly

[Sándor Lumniczer, one of the "founders" of the Pest Medical School, the founder of the Hungarian surgical school and Semmelweis' young friend, died in Budapest 100 years ago, on 30 January 1892.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Fine Art Column]

VÉGH János

[Saints Cosmas and Damian; the history of the two physicians venerated as saints, Cosmas and Damian, goes back more than a millennium. They lived early in the spread of Christianity, in Syria, then part of the Greek-Latin culture, and were martyred for their faith during the persecution of the Christians by Diocletian at the end of the 3rd century AD.]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Fine Art Column]

MATIS Ferenc

[The work of Béla Horváth]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Healthy life expectancy in Central and Eastern Europe]

MOLNÁR László

[In Central and Eastern Europe, life expectancy has fallen over the past few decades, becoming shorter than it was three decades ago. Women in East-Central Europe also live longer than men, but at a more modest rate than in developed countries. But it is not just the length of life that matters, but also its quality. It also depends on people: how much of their lives they live in good health or ill health. In the mid-1960s, life expectancy in Hungary was close to that of the world's most developed countries, but there was a certain degree of under-achievement. The disconnect intensified from the second half of the 1960s. Life expectancy at birth in 1986-87 was the lowest in Hungary of 33 developed countries. The last 8 places among the developed countries were occupied by countries that attempted to build a socialist society on the basis of Stalinism. In Hungary, and in East-Central Europe as a whole, the health of the population under the Stalinist regime had two basic characteristics: 1. low life expectancy and high premature death, 2. early onset of chronic diseases during the life course, with a consequent deterioration in quality of life. So it is not only that the life expectancy was shorter in the last decades, but also that the population lived fewer years with diseases and a lower quality of life. ]

HUN 1992;2(09)

Lege Artis Medicinae

SEPTEMBER 30, 1992

[Oxford Pocketbook of Clinical Specialties]

NÉMETH Éva

[In medicine today, two opposing trends can be observed: on the one hand, scientific curiosity inevitably drives researchers to penetrate into the smallest corners of the body's structure, into the most hidden secrets of its functioning, and to learn about what is happening at the molecular level in the course of research into disease processes. This is leading not only to a sharp separation between disciplines, but also to an increasing specialisation of knowledge in ever narrower areas within each discipline. ]

HUN 1992;2(09)