Lege Artis Medicinae - 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[The beta-adrenoceptor blocking drugs]

KÉKES Ede

[The beta-blockers have been primary in cardiovascular pharmacology since the 1960's. Clinical experiences in the last 25 years have confirmed that the beta-adrenergic blockade is essential in treating the different forms of angina pectoris. Hypertension, hypertrophic cardiomyopathy, and all situations including acute myocardial infarction and some rhythm disturbances qualified by sympathetic overdrive. The beta-blockers have been shown in large scale clinical trials to reduce the cardio vascular morbidity and mortality associated with hypertension and post-infarction period. The possibility of using them as a combined therapy with a great number of other drugs without any difficulties, is very important. Toxicity is rare with beta-blockers and the side effect profile is generally good. There fore, there is no question that the risk/benefit ratio is weighted toward the benefit. Nevertheless there are some problems such as hemodynamic profile, and effects on lipid metabolism, etc. Research has advanced from the first generation to the third generation with direct or indirect effects on the vascular bed, producing strong vasodilation. Because of the above mentioned facts, it is essential to know correctly the pharmacological effects and precise pharmacokinetics, of the beta-blockers.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Calcitonin-secreting ovarian strumal carcinoid]

ÉSIK Olga, NÉMETH György, SZEPESHÁZI Károly

[On the basis of a case report, the clinical picture, pathologic characteristics and possible histogenesis of ovarian strumal carcinoid are discussed. A 3 mm strumal carcinoid, i.e. thyroid tissue intimately mixed with a calcitonin-secreting neuroectodermal tumour, was found in a mature ovarian cystic teratoma of a 38 year old woman. Although the thyroid component demonstrated a typical normal light microscopic appearance, no thyroglobulin and thyroxine were found immunohistochemically. Immunoreactive calcitonin was demonstrated within the tumour cells, even in the transitional zone of the biphasic tissue elements. No amyloid was detected. The argentaffin and argyrophilic reactions were negative. The close relationship between functionally imperfect thyroid tissue and a neuroendocrine marker-secreting tumour seems to be concordant with the theory of the existence of a pluripotential stem cell capable of differentiating multidirectionally.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Plasma Exchange]

JÁKÓ János, SCHOPPER János

[As a technique, is one of the indispensable means of supportiv therapy. Possibilities and approaches representing new trends of up to date therapy are offered by its application. Such approaches are, the nonsubstitutive application of IVIG, or exploiting the advantages of the functioning LAK and TIL cells. However, the authors also point out dangers of this technique, therefore plasma exchange should be applied only after thorough consideration. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[A new operative technique in the internal carotid artery surgery]

ENTZ László, MOGÁN István, JÁRÁNYI Zsuzsa, PAPP Sándor, NEMES Atilla

[The primary author spent one year at the Vascular Department of Nurenberg Town Hospital where an opportunity presented it self to get acquainted with a new surgical method. The eversion endarterectomy of the carotid artery has been developed by the Nurenberg team in 1985. Since that time more then 1500 operations of this type was performed. Using the experiences gained in Nurenberg, the author introduced this new method at the Budapest Cardiovascular Surgery Clinic as well, and from January 1, 1991 until June 30, 1992, 213 operations were performed. Concerning short term results the new method is acceptable compared to the traditional methods. Owing to the method being a new one, long term results can only be read about from 2 authors. After a five year postoperative period restenosis of 1,3 percent was found after 212 operations by Kieny and after 105 operations, a 1.9 percent was reported by Kasprzak. These results seem to be encouraging if they are compared to the 10–25% restenosis rate of traditional operations. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[APSAC Intervention Mortality Study]

MATOS Lajos

[Within 30 days of the infarct, 12.2% of the placebo group and 6.4% of the APSAC group had died. The active agent reduced mortality at 30 days by a mean of 47.5% (21-65%) within a 95% confidence interval. Side effects and adverse effects were rare.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Evaluation of Verapamil for Efficacy, Safety and Tolerability in the management of Hypertension]

MATOS Lajos

[Once-daily administration of IsoptinSR tablets reduced diastolic blood pressure below 90 mm Hg in 74.4% of patients, and diastolic pressure normalised in 85-87% of patients taking one and a half tablets daily. Quality of life, according to the six-item scale used by the authors, was markedly improved by the end of the treatment period. Side effects were noted as constipation (5%), oedema of the limbs and headache (1-1%). Treatment had to be discontinued in 4.3% of cases due to manifest side effects. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Ren multicysticus fetalis]

SILHAVY Mihály, CSAPÓ Zsolt, ÁDÁM Zsolt, PAPP Zoltán

[Seven cases of renal dysplasia are reviewed. Prenatal ultrasound diagnosis was based on the lack of normal renal structure. The renal tissue was replaced by cystic formations of different sizes which did not communicate with each other. In addition severe oligohyd ramnios and empty bladder was seen. Mac roscopically the amorph kidneys resembled a bunch of grapes. On cross sections, the cystic formations were numerous in both cortical and medullary tissue. Histologically typical fetal ducts were seen, and in one case hemopoetic focus could be documented. No embryonic cartilaginous tissue or single umbilical artery was found. The importance of the search for other malformations is emphasized, in order to determine the precise risk of recurrence.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[On the non-enforcement of a medical resolution]

[The national press has given due prominence and coverage to the Health Scientific Council's (HSC) resolution of December last year on the use of naturopathic medicine and the use of unproven, unapproved medicines. It was well received, and it is not surprising that its spirit is not yet always reflected in practice. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Deep vein thrombosis and its consequences]

WINTER Miklós, TÖRÖK István

[The patient, whose medical history is described below, was hospitalized in the hospital of the Beaver Field in 1988. His treatment did not allow the use of all modern diagnostic procedures. The case is presented here both for its interest and to illustrate that a likely diagnosis can be reached by "traditional" methods. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[A method of computerization data of hospitalised psychiatric patients]

MOLNÁR Gyula, SARLÓS Ferenc

[A computerized system for data of hospitalized psychiatric patients is described which has been operating for more than 10 years – now ready for further development. The basic hospitalization statistics have been completed with a wider database including international coding of symptomatological and diagnostical categories (AMDP, ICD-9). The individual coding of pharmacotherapy and later the standardized anamnesis code system (AMDP anamnesis categories) have made it possible to evaluate complex correlations from authorized statistics to elaborated specialized distribution studies (seasonal factors, socialpsychiatric parameters of pathogenetic roles, etc.). Concerning the requirements for building up a hospital network of computer technique, the system described here is open for multidimensional, central-decentral escalation of computerization.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Family therapy, a therapeutic paradox? Part I]

KURIMAY Tamás

[The author outlines the theory and practice of family therapy including Hungarian and international experiencies. He gives an overview of the structure of family therapy and its terapeutic possibilities in medical practice. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Performance measurement, financing and rehabilitation]

KULLMANN E. Lajos

[The high growth rate of health (and social) expenditure in the developed half of the world, which exceeds GNP growth, and the scarcity of financial resources in the economically less developed countries are causing increasing problems in financing health services. It is therefore understandable that politicians representing consumers and users, as well as those who bear the costs, are seeking both to halt or at least curb the growth in costs and to establish some form of measurement and control of the performance and quality of the services provided in return for these costs (1,2). Performance-based financing is in the interest of all those service providers who did not benefit from some form of advantage under the previous system of 'base funding'. These include rehabilitation services.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Praise for the damaging publicity]

NAGY N. Péter

[I represent the "harmful public" as the title suggests. In a normal situation, this qualification does not bother me, I am used to the situation of a journalist being similar to that of a policeman. Everyone recognises the need for journalists and police officers, but no one wants to meet them. It usually means bad things, or at least the risk of bad things. If this natural state of affairs is not the cause of this discomfort, what is?]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[A hopeless but heroic fight]

LÁSZLÓ András

[These are the only words to describe the struggle of the Parliament's Committee on Social Affairs, Family and Health to fulfil its lofty task. This committee and its members take responsibility for ensuring that the social and health care system remains functional, that the citizens of the state receive pensions and good medical care, that the parliament makes good decisions in the field of legislation, that the government creates an appropriate economic environment, and that the Ministry of Public Welfare develops and implements a policy strategy to ensure their social and health welfare.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[One month's carry]

KRASZNAI Éva

[At its sitting on 8 September, Parliament debated the report on the final accounts of the social security system for the past year (the government's submission and the report of the State Audit Office of Hungary are not presented below, as they were published in full in the September LAM Supplement.) On the same day, Gyula Kis, the chairman of the committee, this time the MDF's keynote speaker, said, among other things, that the Social Insurance Fund had been given the new task of managing pensions and the costs of financing health care independently for two years. However, the Social Insurance Fund still lacks an organisation capable of fulfilling its new tasks, just as the legal status of the National Social Insurance Directorate General is still uncertain. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Speech by Dr László Surján, Minister of Welfare]

[Parliament in the debate on the final accounts of the 1991 social security budget: The bill on the final accounts of the 1991 social security budget was submitted to the House with a heavy heart. The reason for this is that there is in fact no good solution to the 22 billion forint deficit it contains. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Fire and water]

[Today's political struggles are usually visible in battles over specific issues of the day - more recently in the form of street demonstrations. Those who read the newspapers can only read about the uproar over the dismissal of Hankiss, Gombár, G. Pálffy, the obstruction of Miklós Izsó's mandate as a member of parliament, the removal of printing house directors and bank presidents. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Who is in favour?]

LÁSZLÓ András

[It turns out that the concept of a state guarantee is a confusing, almost elusive one. The Constitution, and subsequently the 1991 Parliamentary Resolution on social security and health care, define social security as a social benefit system "guaranteed by the state", but do not say what the state guarantees. The government, and subsequently the 1992 Social Security Budget Act of 1991, interpreted it as guaranteeing the benefits themselves, i.e. the payment of pensions and health services with vaguely defined limits. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[The travelling meetings of the Transylvanian Museum Association in the service of medical education]

PÉTER H. Mária, PÉTER Mihály

[The Transylvanian Museum Association (EME), founded in 1859 in Cluj-Napoca, had a threefold aim: to establish and maintain a museum; to process museum material scientifically and to disseminate science in Hungarian in the service of education (1, 2)]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Ars Moriendi, the good death]

VÉGH János

[There is no period in history in which everyone was so desperately concerned with the idea of his death as in the fifteenth century. In every walk of life, at every hour of the day, it was on people's minds. Life on earth, it was believed, could be interesting and attractive, or on the contrary burdensome, even barely bearable, its main purpose being either way to prepare for a meeting of immense importance.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[The human image of psychoanalysis and medicine]

BÁNFALVI Attila

[If we want to understand the relevance of the approach offered by psychoanalysis for the future of medical practice, we must first of all outline the paradigmatic situation that defines the dominant practice today. ]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Voluntary organisations in the health sector, American experience]

VERESS Katalin

[The international organisation "Universities for Democracy" was founded in Budapest in November 1990. The aim of the cooperation between the American and Central and Eastern European universities participating in it is to increase the role of universities (higher education institutions) in the democratic changes in Central and Eastern Europe, in the creation of institutions of democracy, in the development of the economy, and in the promotion of intellectual and cultural exchange between these two regions of the world.]

HUN 1992;2(11)

Lege Artis Medicinae

NOVEMBER 30, 1992

[Social network and health]

ZÁM Mária

[A systems approach to health strategy for local authorities]

HUN 1992;2(11)