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Lege Artis Medicinae - 1993;3(01)
Content
Lege Artis Medicinae
JANUARY 27, 1993
[Hospital reconstruction, oh!]
[During the preparation of the 1992 draft budget law - in the context of the assessment of the needs of local governments - there was a clear contradiction between the earmarked subsidies and the ideas and plans of local governments and the financial resources of the central budget for this purpose. While the number of applications for targeted aid was very high, there was virtually no demand from municipalities for earmarked aid. While some of the health reconstruction projects, which are technically justified and duly prepared, have been delayed for years due to a lack of resources, some of the other applications were not technically and economically prepared, sometimes unjustified, and sometimes impossible to evaluate. Although there was no realistic chance of starting new developments and reconstruction projects this year, the professional and development policy priorities for the modernisation of the health sector were defined after a review of the institutional structure and in the context of the reform. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Introducing the PSP]
[Postsynaptic Potential (PSP) is the journal of the Student Council of the University of St. George Albert Medical School. The predecessor of the newspaper was the KISZ organ "Synapsis", hence the name, which some people might find strange. The predecessor was nothing more than a 16-page publication of well-typed pages, in which the reader could not find any graphics even with a magnifying glass, except for the symbol of the KISZ Committee on the front page... ]
Lege Artis Medicinae
JANUARY 27, 1993
[The beta-adrenoceptor blocking drugs]
[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. Therefore, 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. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Vasocilator - Heart Failure Trial 1.]
[After one year, the mortality rate was 12.1% in the hydralazine + isosorbide dinitrate group and 19.5% in the placebo group, representing a 38% reduction in mortality in those receiving active treatment, and 25.6% (hydralazine + nitrate) and 34.3% (placebo) after two years, and 36.2% (hydralazine + nitrate) and 46.9% (placebo) after three years. Over the entire follow-up period, there were 91 deaths in the prazosin-treated group (49.7%), 72 (38.7%) in the hydralazine + isosorbide dinitrate-treated group and 120 (44%) in the placebo group. In the hydralazine + nitrate group, left ventricular ejection fraction increased significantly at week 8 and at 1-year follow-up, but did not change between patients treated with prazosin or placebo.]
Lege Artis Medicinae
JANUARY 27, 1993
[Primary non-hodgkin's lymphoma of the thyroid]
[Three cases of primary non-Hodgkin thyroid lymphoma from the past 30 years are reported, with particular regard to the diagnostics, staging, differential diagnostics, treatment, follow-up and survival. In stages IE and the relatively localized II E, surgical intervention (bilateral intra- or extra capsular thyroidectomy with selective neck node dissection) is indicated, followed by postoperative radiotherapy to the regional lymphatics (neck and upper mediastinum). Adjuvant chemotherapy is recommended be cause this is the only mode of treatment capable of reducing the occurrence of the distant relapses responsible for the majority of tumour-related deaths. The therapy in the advanced stages II E, III E and IV E does not differ essentially from the treatment of other nodal lymphomas: cytostatics are the main pillar of the therapeutic plan. The complementary use of irradiation is generally indispensable, but radical surgical intervention is no longer indicated.]
Lege Artis Medicinae
JANUARY 27, 1993
[The role of nitrogen-monoxide in the regulation of certain physiologic processes and in the pathogenesis of diseases]
[In the recent 10 years more and more data have been available concerning to the physiologic and pathophysiologic role of nitrogen monoxide. In this study on the basis of literature data the effects of nitrogen-monoxide are summarized, especially on immunobiological processes and the pathogenesis of certain diseases.]
Lege Artis Medicinae
JANUARY 27, 1993
[The microlithiasis as an "idiopathic" etiological factor in recidivous acute pancreatitis]
[The authors report two cases of unknown etiology of multiple acute recidivous pancreatitis. The long established diagnostic procedures such as intravenous cholangiography and ultrasonography did not reveal any pathological, correctable etiological factor. Therefore in a symptom free period ERCP was perfor med, in which microlithiasis was found as a floating layer in the gallblader. Three years after cholecystectomy, the patients were symptom free, and recidivous pancreatitis has not occured. In connection with these cases the authours review the other possible etiolo gical factors, diagnostic procedures and the rapeutic possibilities in the „idiopathic" group.]
Lege Artis Medicinae
JANUARY 27, 1993
[Chronic thromboembolic pulmonary hypertension: diagnosis and treatment]
[More than half of the cases of primary pulmonary hypertension belongs to the thromboembolic form which can successfully be treated by pulmonary thromboendarterectomy. The aim of the study was to demonstrate the selection of surgical candidates and the results of first operations. 22 patients were studied in the last 2 years in whom pulmonary systolic pressure was over 50 mm Hgby Doppler-echocardiography, and no cause could be identified and in whom transesophageal echocardiography was performed. Per fusion lung scan was carried out in 14, venous Doppler in 10 and pulmonary angiography in 7 cases. Out of 22 patients with suspected PPH an atrial septal defect (ASD) was found in 4 cases, chronic thromboembolic pulmonary hypertension (CTH-PH) in 10 patients and major vessel disease suitable for surgery was established in 6 of them. Acute pulmonary embolism was documented in the history of 2 and deep vein thrombosis in 6 out of the 10 cases. Patent foramen ovale was revealed in 5 of the 10 patients 2 of which led to fatal paradoxic embolism. ASD was closed in 3 cases. Two patients had successful pulmonary thromboendarterectomy followed by complete hemodynamic recovery. CTh-PH should be considered in any patient with effort dyspnea or signs of right ventricular overload for which no cardiac cause can be found, as successful surgical treatment may be possible. A diagnostic algorithm is proposed for the selection of surgical candidates. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Vasocilator - Heart Failure Trial 2.]
[After two years, mortality was significantly lower among those treated with enalapril (18%) than in the hydralazine + nitrate group (28%; p<0.016). The beneficial effect of enalapril therapy was due to a reduction in the incidence of sudden cardiac death and was predominantly in less severe patients (NYHA I-II). The reduction in blood pressure during the first 13 weeks was significantly more pronounced in the enalapril group. Ejection fraction increased significantly with both treatment regimens, but the increase was greater after week 13 in the hydralazine + nitrate group. Oxygen consumption at peak exercise was higher only in those treated with the hydralazine + isosorbide dinitrate combination. As a side effect, hydralazine + isosorbide dinitrate treatment was associated more frequently with headache, while enalapril therapy caused hypotension and cough more frequently. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Endopyelotomia]
[Authors were the first in Hungary to initiate endopyelotomy in 1986. The operation is performed in local anaesthesia and a 8–12 Ch size transrenal drain is left in the kidney for 6 weeks. This hardly troublesome operation makes the patient able to leave the hospital soon and to work within 5 days. After the removal of the transrenal drain, ultrasonic control is performed in every three months. We perform later open pyelonplastic operations in case of pyelectasies causing complaints and persisting for more than 6 months, and provable persisting stenoses. At a rate of 83% in our cases sole endopyelo tomy has proved effective. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Handrails]
[I spent many years on the medical fringes of justice. I have been questioned in an enormous number of civil and criminal proceedings, always as an expert witness. I got used to being called upon to give my expert opinion when and if the question "WHAT HAPPENED?" had to be answered. When I had to investigate the workings of the soul to find out who and how did they get to "UNTIL NOW"? What abnormal and healthy psychological functions were hidden in his actions and behaviour? How did the system which we called the human soul, the personality structure, and which, if we want to be very scientific, we are trying to decipher by means of the most varied machine-laboratory measurements, work? ]
Lege Artis Medicinae
JANUARY 27, 1993
[Relaxation and symboltherapy]
[The author gives a survey about the relaxational and symboltherapeutical methods. After defining the notions (relaxation, meditation, imagination), the author refers to the roots, the origins of psychotherapies. Presents the physiological effect-mechanisms of the relaxation. Introduces the psychophysiology of the anxiety controll into the complex regulation system of the behaviour. Points out the basic role of the neurotical and psychosomatic symptomatology, being the same work-level of the meditative-imaginative (pictural, imagery) psychotherapies. The author uses the given classification system of psychotherapies. Among the main schools of methods, the author follows the dynamic (psyhoanalitical) survey. In the case-history she illustrates the effects of a rapid therapy using relaxation and imagination. These methods with wide indicational sphere (health-protection, increasing self-knowledge, neurotical symptoms, psychosomatic disorders, immunology-training, etc.), suggests their wide-spread application. It is being the ,,fashion-method" of nowadays, needed professional protection and keeping clean. The author presents the situation of these therapies: international and national levels as well. ]
Lege Artis Medicinae
JANUARY 27, 1993
[4H Health]
[President Clinton's reform plan, released before his election, is a well-tailored policy paper a work of art: the important and desired goals are crystal clear from the thoughtfully ambiguous and nebulous wording, but the reader feels as if he is looking for a hidden treasure, about which he has learned exciting secrets, and would like to get hold of it as soon as possible, but he must realise that he has not been told where to find the way.]
Lege Artis Medicinae
JANUARY 27, 1993
[The Clinton health programme]
[The US healthcare system has the potential to provide the best care in the world for all its citizens. Yet, because of the way it is currently financed and organized, the system is plagued by two problems: spending is growing at an unsustainable rate, while Americans cannot be sure they will have access to health care when they need it. We cannot afford four more years of political stalemate. We must reform our health care system to ensure that affordable, high-quality health care is available to every American family. My platform provides a framework for this reform, and as President, I will work closely with providers, consumers, employers and government to achieve our shared goals.]
Lege Artis Medicinae
JANUARY 27, 1993
[Background: Efforts to introduce universal health insurance in the US]
[Proposals for (various forms of) universal compulsory health insurance have been a recurring theme in American political struggles since the early 1910s. After the failure of President Truman's attempt in 1948, in the mid-1960s Johnson managed to push through the adoption of Medicaid and Medicare - in effect a compromise to the political debate on universal health coverage in the early 1960s. (Medicare is health insurance for the elderly paid for by the federal government, Medicaid is health insurance for the poor, jointly funded by the individual states and the federal government.) This compromise, however, did not satisfy the advocates of universal health coverage.]
Lege Artis Medicinae
JANUARY 27, 1993
[Civil servants law: a mindless mess]
[Zoltán Ajkay, representative of the Municipality of Budapest, presented an analysis of the Public Employees Act as one of the LAM Club's programmes. He summarised the nodes and legal aspects of the law that are important but also controversial, and that healthcare institutions and their employees need to be prepared for.]
Lege Artis Medicinae
JANUARY 27, 1993
[Management training with the help World Bank ]
[From January 1993, a postgraduate management training group is launched, with 7-15 students. This training, and others to be developed in the future, will be made possible by a grant awarded following the TEMPUS call for proposals, which will provide financial support for three years. The programme aims to develop health management training institutes and networks in Hungarian medical universities. The Semmelweis University of Medicine was the birthplace of the proposal in 1990, but rural universities (Pécs, Szeged, Debrecen) are also involved. It is organised with partners abroad: King's Fund College, London; the Hogeschool van Amsterdam, and the Universita Bocconi, Milan. Semmelweis Medical University is the coordinator of the programme and a contractual partner of the European Community Tempus Office in Brussels. The programme will run under this framework until 1992-1995. It will be free of charge for participants. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Public health network in the USA]
[Malcom Randall, quarter century director of the Veterans Affairs (VA) Medical Center in Gainensvillie, Florida. He is also a Fellow of the American Academy of Medicine and a Professor of Hospital Administration and Hospital Management at the University of Florida. We asked him about this network during his three-day visit to Hungary. ]
Lege Artis Medicinae
JANUARY 27, 1993
[The beginning of institutional thinking about eye care in Hungary]
[As Francis of Paris writes in 1690 in his Pax Corporis: "For as the eye... is made up of a few membranes... and between them of the humours which are rent between the membranes; so every one of them may have a complaint, which may or may not be remedied; and which may be remedied, requires all the more a barber's hand, a laborious and artificial preparation, a lake, a cut, and the rest as well as no doctor's drink or bandage."]
Lege Artis Medicinae
JANUARY 27, 1993
[What will happen to us by the year 2000?]
[Generally speaking, all practitioners and all health care institutions are constantly striving to meet two main objectives: - to provide the highest possible (acceptable) quality at the lowest possible (acceptable) cost. In theory, for didactic reasons, these two objectives are separable, but in practice they interact very closely. ]
Lege Artis Medicinae
JANUARY 27, 1993
[Hospitals in the fine arts]
[The quote in the title, which is from the Würzburg Juliusspital, needs some explanation. This is all the more so since the word 'hospital' as we use it today evokes quite different associations from what the word meant at the time of the above text, around 1588. We can get closer to the meaning of the word by examining some of its Western equivalents. The German words Hospital, Spital, Spitel, Spytl, the French Hopital, Hospice, Hotel, and the English Hostel and Hotel are probably derived from the Latin nouns hospes and hospitium. The former means primarily 'guest', but can also be translated as 'stranger', and the latter is perhaps best rendered by the words 'hospitality, hospitality'.]
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