Lege Artis Medicinae - 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Value of laboratory tests in alcohol abuse and alcoholic organ injuries]

NEMESÁNSZKY Elemér, JUHÁSZ Péter

[Alcohol has a toxic effect on the whole body. Alcohol abuse must be considered as one of the risk-factors to be able to challenge a broad spectrum of organ injuries. Chronic alcoholism, however, is a disease. In order to take preventive measures and to discover the early stages of organ damage caused by alcohol abuse, it is important to conduct those laboratory tests which can help to reveal the under Tyingetiology. With regular alcohol intake, the activity of serum enzymes (GGT, SGOT) and the SGOT/SGPT-index become elevated and the mean corpuscular volume of red cells (MCV) will increase. On the basis of their own experiences and supported by data found in the literature, the authors point out that regular alcohol intake cannot be proved by a single test. To enhance the specificity as well as the sensitivity of the laboratory tests, a combination of parameters must be obtained and tests should be repeated after a certain abstention period.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Alcohol induced specific cardiomyopathy]

TÁTRAI Tihamér

[Alcoholic cardiomyopathy represents a serious public health problem in Hungary. The author describes the diagnostic criteria and three clinical types: Vitamin B, deficiency, arrhythmic form and congestive alcoholic heart disease. The importance of arrhythmias is emphasized with regard to pathogenesis and clinical features. Non-invasive and invasive diagnostic methods are discussed. The latest therapeutic possibilities are discussed, but emphasis is placed on the importance of prevention.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[The nomenclature of morphogenetic anomalies]

ÁDÁM Zsolt, PAPP Csaba, TÓTH-PÁL Ernő, PAPP Zoltán

[In spite of the unifying intentions on the nomenclature of congenital anomalies the problem is still considered to be unsolved internationally. Contradictions among each classifications are mainly based on the different viewpoints of practice and scientific researchers. The authors present here a proposition of nomenclature that fits the recommendations of the major international scientific committees but, as a synthesis, they are trying to give a role to etiopathogenesis as well as clinical presentation of congenital abnormalities in their classification. They intended to make this classification to give a proper nomenclature to everyday practice and scientific research work, too.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Position of the College of Respiratory Medicine on the care and screening of people with chronic pulmonary diseases]

[The Professional College, on the recommendation of the Epidemiology and Care Section of the Society of Lung Physicians, discussed the above topic at its meeting on 5 February 1993. After a lengthy discussion, and after the clash of opposing views, a compromise resolution was reached, summarised in the following points.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Pro-urokinase in myocardial infarction trial]

MATOS Lajos

[The patency of the vessel leading to infarction at 60 min was 71.8% in the rscu-PA group and 48% in the streptokinase-treated group (p < 0.001). At 90 min, the same values were 71.2% and 63.9%, respectively (p = 0.15). Between 24 and 36 h, reocclusion of the vessel occurred in 6/121 cases treated with rscu-PA and 5/114 cases treated with streptokinase. At the end of thrombolytic treatment, fibrinogen concentrations decreased to 0.44 g/l for rscu-PA injection and 0.17 g/l for streptokinase administration. The incidence of bleeding complications was significantly lower after rscu-PA treatment than after streptokinase (p<0.01).]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[The prevalence of microalbuminuria in patients with insulin-dependent diabetes mellitus and hypertension]

BIBOK György, TAMÁS Gyula, KERÉNYI Zsuzsa, BALÁZS Ottó, TÓTH Jenő

[The aim of this study was to evaluate the prevalence of albuminuria in patients under age 60 with insulin dependent diabetes mellitus (IDDM) complicated by hypertension. Among 469 patients regularly being followed for IDDM 76 were found with treated/un treated hypertension (16.2%). 62 patients from this group were investigated for urinary albumin excretion rate (AER) (24-hour timed urine collection, three times, immunoturbidimetric method). Microalbuminuria (AER 30–300 mg/day) was detected in 15 cases (24%), macroalbuminuria (AER>300 mg/day) in 11 patients (18%), whereas in 36 cases no abnormal albuminuria (AER<30 mg/day) was found. No significant differences have been found in age, duration of diabetes or metabolic control (HbA1c) among the investigated groups. The longest duration of hypertension though not statistically significant, was observed in the normoalbuminuric group. The ratio of treated/untreated patients with hypertension in normo-, micro- and macroalbuminuric groups were as follows: 23/13, 12/3 and 11/0 respectively. The maximal systolic and diastolic blood pressure values in the macroalbuminuric group, however, significantly surpassed that of the normoalbuminuric group (p<0.01). One third of normoalbuminuric patients with hypertension had no alteration in their eye-fundi. The prevalence of proliferative retinopathy and blindness rose with increasing albuminuria. These results suggest that hypertension developing in IDDM is pathogenetically heterogenous. In a significant number of IDDM patients, hypertension does not follow but rather preceeds development of incipient nephropathy. Hypertension without micro albuminuria in IDDM probably represents essential hypertension with a better prognosis related to the late complications of diabetes.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[The role of esophagectomy in the management of esophageal perforations]

ALTORJAY Áron, KISS János, VÖRÖS Attila, SZIRÁNYI Endre, VIMLÁTI László

[The authors give an account of their experiences with esophagectomy and immediate reconstruction in the management of the esophageal perforations. Twenty-two adults with intrathoracic esophageal perforations underwent esophagectomy. There was only one hospital death (4.5%). It has been found that the more major initial operation is more reliable and therefore safer therapy in the long run. It eliminates the source of the intrathoracic sepsis as well as the diseased esophagus. The authors hold a high opinion of restoration alimentary continuity in a single stage. They suggest that esophagectomy is one of the best opportunities in the management of delayed spontaneous esophageal perforation as well.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[To do business or not to do business... Is that the question?]

GYENES Géza

[A wild, stormy night raged along the southwest coast of the New Hebrides. The gloomy cliffs braved the sea's renewed onslaught, sometimes lost among the darkly churning wave crests. Otherwise, the above was of no particular significance for our story, which took place not on the south-western shores of the New Hebrides but in Hungary, although it is true that the weather conditions there were not very good at the time.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Antiarrhythmia Drug Evaluation Group Study]

MATOS Lajos

[After two years of follow-up, 60 of the 76 patients (54%) who responded to treatment (49% for amiodarone, 46% for flecainide and 30% for propafenone) did not require a change in therapy. 50 patients had to discontinue therapy due to side effects (amiodarone: 17%, flecainide: 21%, propafenone: 35%). Heart rate variability with frequent ventricular arrhythmias can be reliably estimated by 24-h Holter monitoring. The presence or disappearance of arrhythmia alone does not affect heart rate variability. Antiarrhythmic agents of the lc group may significantly alter cardiac variability and this effect may contribute to the mortality-influencing property of these agents.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Jejunal feeding of pancreatic patients with cosilat nutrient]

BÁLINT László, STER Lászlóné, PAP Ákos, HAMVAS József

[14 patients with acute pancreatitis and 24 patients with pancreatic pseudocysts were treated by jejunal feeding with Cosilat via an endoscopic drainage of the second jejunal loop for an average of 2 weeks. The nitrogen balance became positive on the second day, the body weight was stabilized, and the general condition of the patients remained satisfactory. Amylase levels and the clinical picture of acute pancreatitis ameliorated gradually and no complications occurred. One patient with a pancreatic pseudocyst healed during jejunal feeding. The diameter of other pseudocysts significantly diminished, and in 9 cases they disappeared spontaneously in several weeks. In 9 patients endoscopic drainage of remaining cysts was performed. No complications related to jejunal feeding were observed. This new method of nutrition seems to be beneficial in pancreatic diseases.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[William Waldegrave on science policy]

RICHARD Smith

[William Waldegrave has been in charge of science since the last elections. He is currently preparing a discussion paper on science, which will be published next spring. Richard Smith spoke to him about his new job, his ideas on science and his plans for the material. ]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[The International Society of Medical Ethics is founded]

[In October 1992, the largest and most prestigious medical society in the world was founded in Amsterdam. ]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Application of the "homogeneous disease groups" patient classification system in hospital care analysis]

BOJÁN Ferenc, BELICZA Éva

[In our previous communication, we described the principles and basic concepts of a patient classification system called "homogeneous disease clusters (HBCs)", which allows a multifaceted analysis of hospital activity (1). In this paper, we also report our first methodological experience with the application of the HBCs classification system to the analysis of length of care and hospital performance. Using the HBCs classification system, we analysed the average length of stay and the case mix of inpatients in the clinics of the University of Debrecen Medical School (DOTE) for the period 1 July 1990 to 13 February 1991. Some of the average lengths of stay per clinic and/or per HBCs were longer and some shorter in DOTE clinics than expected from national normative data. Overall in the clinics, the average time between admission and the first intervention was 3.5 days, which varied significantly from clinic to clinic. The clinic and national average lengths of stay for patients with HBCs were usually much longer than the lengths of stay for patients covered under US MEDICARE. We found large, sometimes very large, differences between clinics in the case-mix index, standardised output per bed or standardised output per 100 days of care.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Our health expenditure and international trends]

BONDÁR Éva

[When considering the urgent need, ways and means of changing our health care system, it is often said in the widest circles what we can do, when the average person in our country spends around USD 150 and in the US over USD 2,000 on health care, or when the share of health care in the gross domestic product has been stagnating at around three percent for decades, and in the US health care spending (which is growing very steeply) is 12% of GDP. This argument seems to be so decisive in defining the key issues that it is worth taking a closer look at its veracity. In this article, I will try to explore the issues of international comparisons of our health expenditure. In doing so, I have the help of a computerised database of OECD countries, which not only provides long trends for many countries at different conversion rates, but also allows me to reconstruct the internal composition of aggregate health expenditure. For the comparison, I have selected 19 of the 24 countries in the database, and the date is the latest year for which international data are fully available: 1990.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[From Pásztó to Nairobi]

FRENKL Róbert

[I didn't know - I was too benevolent, in other words naive and simple-minded - that only I V was not hopeless. It should have created a real dialogue between doctors and journalists, not as part of a primary prevention programme, thus also promoting the success of health promotion efforts. If not the most decisive, then a decisive element in the impact of lifestyle programmes is the attitude and example set by doctors and health professionals. If the press reports on this mostly on the basis of negative examples and negative sensationalism, this also reduces the chances of prevention. But a small number of "positive articles" is not really desirable either. Articles that avoid conflict, that present only the good things, the doctors who have faithfully and successfully cured patients over a long life, are not realistic.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Musical doctors for children]

[In 1992, Jenő Tarján, the chief physician of the Markusovszky Hospital in Szombathely, wrote a circular letter on behalf of the Heart Foundation to the chief physicians and hospital directors asking them to recommend colleagues who were interested in music and who would also perform at concerts. The first such concert was held in Szombathely and the proceeds were donated to the Heart Foundation.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[Vision to be realised The harmony between solidarity and the insurance principle]

KRASZNAI Éva

[At the request of the Health Insurance Supervisory Commission, Deloitte and Touche and the consultancy Noble Lownds PX set up a working group of experts last July. It included health and medical experts, economists, lawyers, organisational and management experts, a mathematician, a sociologist and a political scientist. Their task was to develop a flexible organisational system for the management of the future local health insurance authority, based on an overview of the organisational, legal and financial conditions of the supervisory board. ]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[A model for a separate comprehensive insurance sector within the OTF]

[In order to ensure a smooth transition to the new organisational model, the OTF should and can take action in the following areas:]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[We heard in forums]

ANDRÁS László

[The 1993 Social Security Budget Act and, as part of it, a series of provisions setting out the way forward for the reform of primary care and initiating the reform of specialised care. However, the government and ministerial decrees implementing the provisions and setting out the technical details are not yet known. Health professionals are still full of uncertainty and doubt. The time has come once again for forums in which the leaders of health policy - the authors of the laws and the drafters of the expected regulations - give presentations explaining and justifying what has already happened and informing about expected developments. At the same time, of course, they "sound out public opinion". The huge interest that greeted the speakers at the first forum of the "season" of the complementary event of the International Medical Technology Exhibition in the Theoretical Block of the SOTE Oradea Square, was not so much a sign of the organisers' success as of the doctors' lack of information, their uncertainty and their hunger for information.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[The praise of transience]

PELLEI Ilona

[You know, you're all going to die! - I began my lecture on death to the medical students sitting peacefully in the lecture theatre. The statement was greeted with a broad smile. The reaction was not unexpected, as I had "brought to their attention" something that all children are aware of. Or rather! Of course not! ]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[On the centenary of the death of Lajos Markusovszky]

KAPRONCZAY Károly

[Lajos Markusovszky, an outstanding personality in the history of Hungarian medicine, a highly influential organizer of the medical school in Pest, who for decades led the Hungarian health care system as a grey eminence, died a hundred years ago, on 21 April 1893. He was born on 25 April 1815 in Csorba, in the Highlands, into a Lutheran clergyman's family.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[On the Moreno psychodrama]

BALÁZS István, TAKÁCS Péter

[The psychodrama created by Jakob Levi Moreno, which is a hallmark of his work, occupies a prominent place in the group method. Its importance is growing rapidly, as shown by the increasing number of professionals, drama groups, group leader training centres and national and international psychodrama associations using this method and its variants.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

[About books]

GRYNAEUS Tamás

[Herbalism - the basics of phytotherapy - Gábor Rácz, Erzsébet Rácz-Kotilla, László Gy.]

HUN 1993;3(04)

Lege Artis Medicinae

APRIL 28, 1993

["Character heads" by Messerschmidt]

HÁMORI Katalin

[Franz Xaver Messerschmidt (Wiesensteig, 1736 Bratislava, 1783) was a sculptor of German origin, but worked mainly in Vienna and Bratislava. He painted numerous portraits of Maria Theresa, members of the royal family, noblemen, scholars and artists serving at the Viennese court. Yet it was not his portraits that made him popular, but his works known as 'character heads'. The heads attracted a great deal of attention during the sculptor's lifetime, and the debate about their definition is still a lively topic of interest. ]

HUN 1993;3(04)