Lege Artis Medicinae - 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Diagnosis and treatment of acute obstetrical DIC]

RÁKÓCZI István

[Modern management of acut obstetrical diffuse intravascular coagulation (DIC) was evaluated. A large variety of obstetrical conditions are associated with acute DIC such as amniotic fluid embolism, abruptio placentae, intrauterine infection (septic abortion), dead fetus syndrome and prolonged shock of any aetiology. Typically, acute obstetrical DIC is associated with haemorrhage (mainly vaginal bleeding) and shock. The whole blood coagulation time, platelet count and fibrinogen level are the most clinically useful indicators in evaluating the patient with acute DIC. Management of acute DIC includes prompt treatment of precipitating factors (delivery of fetus in placental abruption, evacuation of the uterus in septic abort union plus administration of antibiotics, delivery of a dead fetus by induction of labor). Careful attention to fluid and blood cell replacement is needed to prevent and treat hemorrhagic shock. The coagulation failure is treated with fresh-frozen plazma or cryoprecipitate and platelets. In acute obstetrical DIC complicated by hemorrhage heparin has no use and will only cause the bleeding to worsen. Recently several clinical studies indicate that antithrombin III concentrates are efficacious in DIC.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Disseminated intravascular coagulation in the newborn]

GOLDSCHMIDT Béla

[A review is given on disseminated intravascular coagulation in the newborn period. DIC is not a single disease entity, but a complication of several underlying diseases. The author summarizes the physiologic and pathophysiologic conditions which promote the development of this blood coagulation disorder in this age. Further on the clinical symptoms, the difficulties of laboratory analysis as well as of differential diagnosis are discussed. Finally a detailed description of the treatment of the neonatal DIC syndrome is given. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[The risk of ischemic heart disease in patients with ischemic cerebrovascular disease]

HORVÁTH Sándor

[A strong association is supported between ichemic cerebrovascular and heart diseases by several studies. Death is more commonly caused by myocardial infarction than by stroke itself in patients with asymptomatic carotid stenosis, amaurosis fugax, transient ischemic attack or ischemic stroke. Signs and symptoms of ischemic cerebrovascular diseases or asymptomatic atherosclerosis of the arteries of the neck are harbinger for both myocardial and cerebrovascular infarction. Patients suffering from ischemic cerebrovascular diseases should be routinely investigated, treated and cared for coronary artery disease in order to prolong survival. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Results and perspective of gene therapy in the treatment of primary immunodeficiency]

SÓFI Gyula, MARÓDI László

[During the last decade research has been directed toward gene-replacement therapy of genetic disorders, including primary immunodeficiencies. Efficient methods for gene transfer were developed to correct the gene defect in adenosine desaminase deficiency, leukocyte adhesion deficiency and chronic granulomatous disease. Somatic gene therapy in a patient with ADA deficiency was performed two years ago. This paper summaries inicial clinical applications of gene transfer and gene therapy in primary immunodeficiency and the future prospects of gene therapy in cohort of patients. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Third International Study of Infarct Survival]

MATOS Lajos

[There was no significant difference in 35-day mortality between the aspirin + heparin and aspirin-only groups. The incidence of re-infarction was slightly lower with aspirin plus heparin (2p <0.09). When patients also received heparin in addition to aspirin, transfusion was needed more often and non-cerebral haemorrhage was more frequent (2p < 0.01) Combining the results of ISIS-3 and GISSI-2, mortality was significantly reduced during the treatment period (p < 0.01). There was no appreciable difference in mortality or re-infarct incidence between the use of streptokinase or APSAC, but there were more allergic events in the APSAC group. There was no difference in 6-month survival between the two groups. There was no difference in the efficacy of streptokinase and tPA treatment at either 0-35 days or 6 months survival. Allergies were less frequent with tPA, but non-cerebral haemorrhage was more frequent. Treatment with tPA led to stroke significantly more often than streptokinase (2p < 0.01). Combining the data from the similar GISSI-2 trial and ISIS-3, no difference was observed between streptokinase and tPA in either mortality between 0-35 days or survival at 6 months. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[The physiological and pathophysiological role of selenium]

TARKOVÁCS Gábor

[ Recent research and clinical observations have made the topic of the relationship between trace elements and free radical reactions, the unavoidable corollary of aerobic life, come to the fore. Based on the data of more recent literature, the author attempts to provide a concise review of the biological function of selenium, one of the trace elements, and emphasizes some aspects of its clinical importance. Selenium, being an essential component of selenium dependent glutathi one peroxidase plays a central protective role in the antioxidative processes of the cells and any damage to this function may entail several pathological consequences. Results of animal experiments and observations on human subjects refer to the role of selenium deficiency in the development and outcome of a certain type of cardiomyopathy but its relationship to atherosclerotic cardiovasular disease, im munological disturbances, inflammatory disorders and anticarcinogenesis remains to be fully elucidated. Selenium should be taken into account when treating patients confined to chronic total parenteral nutrition and its possible antineoplastic effect might be benefical in certain conditions. Although the clinical application of selenium in well-establis hed deficiency states is justified, and as a prophylactic measure or even as part of an antitumour strategy appears to be promising, wanton administration of this important trace element can be hazardous.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[The role of computed tomography in the diagnosis of bronchiectasis]

STAUSZ János, MONOSTORI Zsuzsanna, REPA Imre

[The aim of the study was to determine the role of the computer tomography in the recognition of bronchiectasis. 17 patients with clinically suspected bronchiectasis were investigated with high resolution computer tomography. In every case the bronchiectasis was recog nized by computer tomography. In 7 cases either bronchography and/or the surgical specimen confirmed the diagnosis. The effectiveness and the non-invasive characteristics of the computer tomography further limit the indication of the bronchography.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[A new ultrasound method for the examination of the circulation: color velocity imaging (CVI)]

HARKÁNYI Zoltán, DANIEL Morton, JI-BIN Liu, BARRY B. Goldberg

[The newest ultrasound method for the exa mination of the peripheral and abdominal vessels is Color Velocity Imaging (CVI) or time domain correlation method. In contrast to the widely accepted color Doppler imaging technique CVI is based on a different principle. Blood flow velocity is displayed using time-shift measurement ins tead of frequency-shift. This paper is brief summary of the principle of CVI method with a special emphasis on the new features. Improved special color resolution, direct velocity measurement from the color images and blood flow volume calculations are the most important new features. Authors preliminary clinical experience with this new ultrasound method is positive. A few illustrative cases demonstrate CVI and CVI-flowmetry in clinical practice. CVI is a promising new ultrasound method for imaging and quantification of human blood flow. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Inpatient psychotherapy as a psychotherapeutic system]

BLÜMEL Ferenc

[The problems of inpatient psychotherapy as a psychotherapeutic system should be worked out extra as a special therapeutic method among psychotherapeutic approaches. The integrated conception of inpatient psychotherapy developed through coordinating different approaches. That means the adaptation of psychoanalytical and sociopsychological theories of diseases and therapies. With its help a group of therapists do psychotherapy with group of patients, where different therapeutic methods are put into a certain system. The conditions for the therapeutic function of the system should be created in the integration of real and therapeutic fields in large groups and team conferences. Inpatient psychotherapy is needed when psychotherapeutic problem is different from usual cases and adapted ways. This system is the very way of getting deep and comprehensive psychotherapeutical clinical practice.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Theses]

[I. General definition of voluntary mutual insurance funds; II. Pension funds; III. Definition of self-help funds; IV. Health insurance funds; V. Formalities of funds; VI. State supervision of voluntary mutual insurance funds]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[APSIM]

MATOS Lajos

[The rate of artery reopening leading to infarction was 77% after APSAC treatment and 36% after heparin (p < 0.001). The left ventricular ejection fraction was significantly higher in the APSAC group (0.53 + 0.13) than after heparin (0.47 + 0.12, p<0.002) and this was true for both anterior and posterior wall infarcts. APSAC treatment also significantly reduced infarct size by 31%. There was a strong inverse correlation between left ventricular ejection fraction and infarct size (p < 0.01). At three weeks of follow-up, seven of the APSAC group and six of those treated with heparin died. As a side effect, bleeding occurred in eight cases after APSAC and one after heparin (p < 0.01), and transient hypotension occurred in 12 cases in the APSAC group and one in the heparin group (p < 0.01). ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Sports sports medicine medical training]

FRENKL Róbert

[We who have lived most of our lives in the 20th century must slowly and inevitably face the fact that man, with all the means at his disposal to the contrary, or perhaps because of it, has made this period a terrible century in history. Sadly, despite the glimmer of hope in the late 1980s, there is little likelihood today that the last decade will make a significant difference to the century's balance sheet.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[From the top it would still be there]

LÁSZLÓ András

[For those of you who have never been to the LAM Club - those who have been to the Hotel Agro will know that the large fifth-floor terrace of the restaurant offers a more beautiful and spacious view of Budapest and the Buda Hills than you could imagine. It's quiet, the smoke, dirt and noise of the city don't reach here anymore, only occasionally a Csepel truck or an Ikarus bus wanders by and breaks the silence, spewing its stench. It's good that they come, without them we would imagine ourselves out of time and space, perhaps we would forget where we came from and where we are going back to. On this terrace, facing this panoramic view, in pleasant - still pleasant - summer weather, invited guests and members of our club gathered to exchange ideas on the present and future of our patient care. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Definitely forward]

ANDRÁS László

[Lecture by András Jávor, State Secretary - especially for doctors visiting from abroad at the III Hungarian Medical Meeting; The health status of the Hungarian population is incredibly lagging behind the developed regions of Europe. It is very sad, but it is a fact that other countries in Central and Eastern Europe are facing similar problems. In the 1960s, it became known in Hungary that average life expectancy at birth was decreasing and that the number of illnesses was rising in certain age groups.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Lucky source of money]

[In creating the Gambling Act, Parliament decided that the lottery and the lottery, casinos, bingos, bongos and other proliferating games of chance to the permanent losers of the central budget - health, social policy, culture, education and sport. This is no small sum, with some HUF 1.2 billion available this year alone for the Gambling Fund set up by Szerencsejáték Rt.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Intellectualism in a white coat]

ANDRÁS László

[Interview with István Mikola, Director of Szent László Hospital, member of the Health Insurance Supervisory Committee.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Ethical principles of modern medicine]

[The analysis and discussion of ethical issues plays an increasingly important role in modern medical thinking and practice. Although ethical issues have been raised in medicine for a very long time and have influenced its development, their study has not yet been carried out in an organised, institutional framework. Today's medical technology and its consequences have forced us to pay greater attention to ethical issues, particularly in the fields of infant medicine, geriatrics and organ transplantation, as well as in health care. Their study has given rise to a new discipline: biomedical ethics or bioethics. The most important development in this thinking is the shift in emphasis in modern medicine from the obligations of the doctor to the rights of the patient. But the society within which medicine operates is also changing. Health care bodies are showing increasing interest in ethical issues, but in many cases those involved lack the theoretical preparation and knowledge to deal with such issues. In this paper, we attempt to shed light on the two main ethical theories in this area, with a particular focus on the medical ethics aspects. ]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[Slowed horse watching]

SZŐKE Annamária

[Bertalan Székely's studies of movement; When writing about art in a medical journal, the first thought is often that the relationship between these two sciences, their interrelationship, their possible effects on each other, is worth looking for. Sciences, I write in connection with the Renaissance tradition, especially the Leonardian idea that art is a science if it deals with the laws and ultimate principles of visible things.]

HUN 1992;2(10)

Lege Artis Medicinae

OCTOBER 28, 1992

[The history of the development of physical education and physical culture in Hungary]

KAPRONCZAY Károly

[The importance of physical education was recognised in ancient Greece and Rome. The importance of regular exercise was passed on to later ages - it was considered important in the Middle Ages - not to mention the Renaissance, which not coincidentally became the heyday of anatomy, the basic science of physical culture.]

HUN 1992;2(10)