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Lege Artis Medicinae - 1993;3(05)
Content
Lege Artis Medicinae
MAY 26, 1993
[The prerequisite of T cell recognition: antigen processing and presentation]
[Multiple regulatory mechnanisms are activated wit hin the immune system to maintain the homeostasis of the organism. A key element of these processes is the specific recognition of antigens mediated by T and B lymphocytes. This is the basis of clonal selection and antigen specific activation of the immune system (LAM 1991. 1(18):1308–1314.) which results in the most efficient elimination of the antigen. T cells play a predominant role in the discrimination of self and non-self structures. Antigen specific activation of T cells results in the expression of cell surface molecules and in the production of different lymphokines of high biological activity, which define the possibilities for cell to cell interactions and influence the function of different cell types affecting the outcome of the immune response. The appropriate activity of functionally distinct T cells enables the most efficient mobilization of effector mechanisms leading to the elimination of the antigen without destroying self components. In order to exert their regulatory and effector functions they require a well regulated collaboration with antigen presenting cells. This review summarizes our present knowledge on the intracellular degradation and transportation pathways occuring on in antigen presenting cells determining the antigen specific functions of T cells. It is well established that these events influence the efficacy or protection against pathogens and have a basic influence on the normal or pathological outcome of autoimmunity.]
Lege Artis Medicinae
MAY 26, 1993
[Thoughts on radical hysterectomy]
[Radical hysterectomy and pelvic lymphade nectomy have been used for the treatment of carcinoma of the uterine cervix in most Western countries for decades. These surgical procedures, however, have rarely been advocated in Hungary. Advantages and disadvantages of radical hysterectomy with pelvic and paraaortic lymph node dissection are discussed. Emphasis is placed on patient selection. It is the author's view that radical surgery does have a place in the management of cervical cancer. The patient should be informed about the possible treatment modalities available such as radical surgery, radical radiation therapy or a combination of surgery and irradiation, and she should be involved in the decision making process. Radical hysterectomy with pelvic lympha denectomy is a major operation with potentially significant intraoperative and postoperative complications. A dequate surgical skill and sufficient experience are required and this procedure should be regularly practiced. For these reasons, it is probably best performed in cancer centres.]
Lege Artis Medicinae
MAY 26, 1993
[The Social Security Health Insurance Fund's Mental Hygiene Board of Trustees]
[The Board of Trustees of the Social Insurance Health Insurance Fund for Mental Hygiene invites applications for the implementation of mental health promotion and mental hygiene programmes from the fund allocated by Parliament from the 1993 social insurance budget, pursuant to Act LXXXIV of 1992. ]
Lege Artis Medicinae
MAY 26, 1993
[The role of computed tomography in tumor staging of bronchogenic carcinoma]
[Operability of lung cancer is based on the size and local extension of the tumor as well as the presence of lymph node and distant metastases. Agreement and disagreement between CT and surgical tumor staging was investigated for 197 cancer patients after surgery. Sensitivity and specificity of CT prediction ranged 57–93% and 71–100% ac cording to tumor stadium. CT diagnosis has been relatively unreliable in describing tumor propagation along the pulmonary veins (less frequently arteries) towards the atrium and in recognizing a discrete tumor invasion of the mediastinum. Local thickening of the parietal pericardium, and small pericardial effusion have been considered as indirect signs of pericardial tumor infiltration. MR examination have been found to be a supplemental technique for assessing tumor spread to the great vessels of the mediastinum. The authors believe on the results that new techniques, such as MR angiography and indirect CT signs will help in making a more accurate preoperative diagnosis of lung cancer.]
Lege Artis Medicinae
MAY 26, 1993
[Report on gastroenterological endoscopic activity in Hungary in 1992]
[At the request and on behalf of the Endoscopic Section of the Hungarian Gastroenterological Society, we have compiled the main data of the Hungarian endoscopic activity in 1992. We received responses to our questionnaire from 117 endoscopic laboratories and one private endoscopic practice. The responses received were summarised in a table.]
Lege Artis Medicinae
MAY 26, 1993
[Heparin-Aspirin Reperfusion Trial]
[Treatment efficacy was first assessed 7-24 hours after the start of rt-PA infusion: at this time, the coronary artery leading to the infarct was patency in 82% of patients also receiving heparin therapy, compared to 52% of patients receiving aspirin supplementation (p<0.0001). Vessels that were patency-free at the first test remained open in 80% of those also treated with heparin after one week, the same was 95% in those treated with aspirin (non-significant). Bleeding was observed in 18 patients in the heparin group and 15 in the aspirin group. Ischaemic events were observed in eight cases in the former group and in two cases in the latter group - these were not statistically significantly different. The mortality rate was 1.9% in the heparin group and 4.0% in the aspirin group. ]
Lege Artis Medicinae
MAY 26, 1993
[Gastroenterology in general practice]
[Report on the training course organised in Hatvan on 19-20 March 1993 by the Hungarian Gastroenterological Society, the Hungarian College of Gastroenterology and the Education Committee of the Hungarian Medical Chamber with the support of MEDICOM-Glaxo.]
Lege Artis Medicinae
MAY 26, 1993
[Angioplasty Compared to Medicine]
[PTCA was actually performed in 100 patients, 80 of whom were successful (average stenosis of 76% reduced to 36%). Two patients required immediate surgical intervention. Within six months, PTCA had to be repeated in 16 patients. Myocardial infarction occurred in 5 cases in the PTCA group and in 3 cases in the drug-treated group. After six months, 64% (61/96) of those receiving PTCA therapy were angina-free, compared with 46% of the drug-treated group (47/ 102; p<0.01). Members of the intervention group had better exercise tolerance (p<0.001) and could tolerate exercise for longer (p<0.01). After PTCA, angina relief was achieved faster and the exercise tolerance was better than with drug therapy, but the intervention was more costly and had more complications.]
Lege Artis Medicinae
MAY 26, 1993
[Risk of BCG immunotherapy for superficial bladder tumours: sideeffects and complications]
[The treatment of superficial bladder tumours cannot be confined to surgical removal of the malignancy, due to the high rate of recurrence. The prevention of tumour recurrence is also an essential part of the treatment. Side effects and complications of BCG immunotherapy mounted on 152 patients are summarized. Diagnostic procedures and prevention of failures are discussed. Although the side-effects cannot be ignored, the authors express that the therapeutic advantage to adjuvant bladder treatment rises over the hazard of the toxic side-effects. A yearly repeated treatment cycle leads to not more complications than a single six-week course itself. ]
Lege Artis Medicinae
MAY 26, 1993
[One stage procedures in the cardiac surgery]
[ During the last 47 months 2357 extracorporeal cardiac operations have been performed at the Cardiovascular Surgical Clinic of the Semmelweis Medical University. In 37 of these cases (1.57%) the cardiac procedure has been combined with a non-cardiac one. Concomitant carotid artery endarterectomy was performed in 30 cases. Endarterectomy of the popliteal artery, reconstruction of the innominate artery, embolectomy of the popliteal artery, reconstruction of the pseudoaneurysm of the common femoral artery, cholecystectomy and two lobectomies have been performed on the rest 7 patients. There was no hospital lethality. During the majority of these one-stage procedures the cooperation of well experienced cardiac and vascular surgeons has been substantial. ]
Lege Artis Medicinae
MAY 26, 1993
[H2 test for diagnosis of bacterial overgrowth in chronic pancreatitis ]
[ Increasing H2, content of exhaled alveolar air is the indicator of small bowel dysbacteriosis. 43 patients with chronic pancreatitis were examined by H2 test using lactulose and lactose loading. Increased content has been found in 32.6% of cases. In patients with alcoholic chronic pancreatitis bacterial overgrowth was somewhat more frequent, than in nonalcoholic cases. There was more bacterial over growth in non-calcifying than calcifying, in non-diabetic than diabetic, and in non-insulin requiring, than insulin requiring groups, although these differences were not significant. Extended abdominal operations and pancreatic surgery did not influence frequency of bacterial overgrowth. In patients with mild or moderate pancreatic insufficiency, however bacterial overgrowth was significantly more common than in patients with severe chronic pancreatitis. Symptoms of chronic pancreatitis generally attributed to pancreatic insufficiency and meteorism might be caused more by the well treatable bacterial overgrowth, than by pancreatic insufficiency itself. ]
Lege Artis Medicinae
MAY 26, 1993
[Trial for a difficult clinical decision]
[Many clinical decisions have to be made without adequate scientific information. One possible solution is to seek agreement between experts. Another method, detailed below, may be to conduct a legal procedure to analyse the difficult issues. This was a trial - involving lawyers, expert witnesses and a jury - on whether bone marrow transplantation should be recommended for all children with symptomatic sickle cell anaemia. With transplantation, the cure rate is around 90%, in a disease that causes 15% of children to die before the age of 20. However, transplantation has a 10% risk of death or serious harm, and doctors cannot predict which children's sickle cell anaemia will become severe and which will be mild or asymptomatic. In the end, the jury decided by majority vote that bone marrow transplants should not be recommended for all symptomatic children. ]
Lege Artis Medicinae
MAY 26, 1993
[Comparison of performance-related revenue and actual expenditure costs]
[In the introduction I would like to talk about why we consider internal allocation to be an important issue, how contingency theory can be used to describe and understand the processes that are taking place, 2. accounting as a tool for decision making and process-driven management, 3. finally, the financing field test in our institution I will illustrate the practical problems by analysing the monthly factual data for January-February 1993 and the total costs for 1992. ]
Lege Artis Medicinae
MAY 26, 1993
[Experience of the inpatient and outpatient financing trial]
[At the end of last year, the Ministry of Public Welfare asked all health care institutions in Zala County to carry out a trial run under the new financing system for both inpatient and outpatient care for 2 months from 1 January. The present summary is about the experience of the Zala County Hospital, but similar information was also collected in the Municipal Hospitals of Nagykanizsa and Keszthely and the State Spa Hospital of Hévíz. The aim of the article is, among other things, to make our own experiences public, thereby providing hospital managers with information that will help them to implement the many tasks of the change in institutional financing as successfully as possible. I will first highlight some of the new elements of the recent draft government decree on certain issues of social security financing of health care, firstly in relation to inpatient care, then in relation to outpatient care (showing the WHO performance measurement and its relation to the different professional profiles), and finally I will describe the possible and proposed methods of using computer technology.]
Lege Artis Medicinae
MAY 26, 1993
[Screening pains]
[First, a subjective note: in the past year I have had the opportunity to meet several British, American health economists and organizers who were invited to Hungary at the beginning of the regime change and since then to help improve the truly sad public health situation. Without talking to each other, each was surprised and even a little amused to be told that when asked what they thought the most important things to do were, the decision-makers in the Hungarian health administration, whether in the ministry, the medical officer's office or the OKI, were told enthusiastically that "we will now screen everyone for everything..." ]
Lege Artis Medicinae
MAY 26, 1993
[Founding Fathers]
[Many of the founders of MOK tell their story in different ways. There are many versions of the story. I asked Dr. Andreas Veér about this.]
Lege Artis Medicinae
MAY 26, 1993
[Information of the Presidency of the Hungarian Medical Chamber on the Chamber Act]
[After 57 years, Parliament is once again debating the law on the Hungarian Medical Chamber. At that time it took 60 years to come before the Parliament, in this case 4 years. ]
Lege Artis Medicinae
MAY 26, 1993
[Document on the organisation of the Medical Chamber]
[In the 19th century, as a result of capitalist development, medical work gradually shed its mythical, magical character and the elitist activity of the guild became more and more social. The fact that, in developed countries, the doctor actively accompanies every individual from birth to death has led to a higher degree of generalisation, which has made the doctor's activity a priority in the conflict of interests of social groups and in the assertion of particular group interests.]
Lege Artis Medicinae
MAY 26, 1993
[OLADOSZ general assembly]
[The National Association of Medical Laboratory Workers held its March general assembly in a desperate atmosphere. On the agenda of the meeting was a draft government decree on the "New system of social health insurance financing". ]
Lege Artis Medicinae
MAY 26, 1993
[Witch doctors and witches in 18th century dentistry]
[Dentistry has always been a branch of general medicine that has developed separately. Despite common origins, from prehistoric times in the history of mankind until recently, 'doctors' were reluctant to treat teeth (1). ]
Lege Artis Medicinae
MAY 26, 1993
[Magic against the "black death"?]
[Among the epidemic diseases that have terrified and frightened mankind for centuries, the plague, also known as the "black death", is the most common. Even today, many of us shudder at the mere mention of its name, although fortunately we have little personal experience of the disease. What was the constant experience of successive generations in the Middle Ages is almost unimaginable to 20th century man: an epidemic that regularly appeared and claimed huge victims. In the old chronicles, we often find descriptions of plague epidemics which, although they tend to exaggerate the number of victims, give a vivid picture of the shock of the devastating power of the disease in the minds of the people of the time. ]
Lege Artis Medicinae
MAY 26, 1993
Lege Artis Medicinae
MAY 26, 1993
[Ethical and legal issues in organ transplantation]
[I want to examine the medical ethical and legal issues of organ transplantation practice in Hungary from the clinician's 1 . perspective. The development of diagnostic and therapeutic methods, resuscitation procedures, and the everyday practice of organ transplantation repeatedly place the physician in a situation in which medical ethical, legal and social traditions come into conflict with the physician's professional experience, conscience and scientific aspirations. Organ transplantation is an area of medicine that has recently generated much controversy. In our country, this is partly because it is no longer an experimental procedure: there is a growing need for more and more transplantable donor organs, one of the conditions for which is the cooperation between the doctor and civil society. ]
Lege Artis Medicinae
MAY 26, 1993
[Report from the first European Botox Symposium]
[On 23-24 January 1993, the European Botox Symposium was organised in Barcelona by the Dystonia Society of several European countries to present the method and to discuss the experience accumulated over a decade. ]
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