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Lege Artis Medicinae - 1993;3(06)
Content
Lege Artis Medicinae
JUNE 30, 1993
[The role of angiotenzin converting enzyme inhibitors in the treatment of hypertension]
[The role of the renin-angiotensin system in the regulation of blood pressure is outlined. The mechanism of action as well as the role of angiotensin converting enzyme inhibitors (ACEI) in the treatment of various forms (primary, secondary, uncomplicated, complicated) of hypertension is discussed. The individualized , stepped care" approach is detailed, therefore the advantages of the therapeutic combinations of ACEi-s are emphasized. Interactions with other antihypertensive agents and with other drugs are also described, and side effects are also briefly addressed]
Lege Artis Medicinae
JUNE 30, 1993
[Postmenopausal hormone replacement therapy]
[Over the past year, a number of summary publications on postmenopausal hormone replacement therapy have been published in the UK (1-3). Therefore, in this review we focus on areas that, although often controversial, may be of interest to practitioners. We will discuss the effects of postmenopausal hormone therapy on the risk of ischaemic heart disease, osteoporosis and cancer and present some observations on the concept of oestrogen tachifilaxis and dependence. Our conclusions are summarised in our recommendations on hormone therapy in menopause.]
Lege Artis Medicinae
JUNE 30, 1993
[Immunohistochemistry of atherosclerotic lesions]
[Cellular interactions within the arterial wall are considered to be essential in the development and progression of atherosclerotic lesions. This paper is a review of the actual knowledge about the role of the macrophages in the process of atherogenesis. The cellular composition of atherosclerotic changes – aligned in a possible consecutive order in which they may progress – are presented and discussed from the author's own immunohistochemical investigation. 108 aortic specimens obtained at autopsy performed within 12 hours following death from young people (20–34 ages) were examined. The Factor VIII positive endothelial lining was well preserved, no desmin content could be demonstrated. In contrary the presence of vimentin was noted in almost all the cells of the aortic wall. The foam cells reacted with different anti-macrophage antibodies, and most of the non-reacting cells of the different lesions proved to be smooth muscle cells. A considerable part of the intimal cells showed HLA-DR positivity as well. The quantity of the T helper lymphocytes in the lesions did not bear any significance. There was relationship between clinical data and types of (early) atherosclerotic lesions in the aorta. It is suggested, that the atherogenetic process starts in the intima with the appearance of smooth muscle cells and an increase in the lipid content. Thereafter macrophages accumulate and lead to the development of foam cells and at the same time they cause tissue damages leading to further smooth muscle proliferation and to classic atherosclerotic changes within the arterial wall.]
Lege Artis Medicinae
JUNE 30, 1993
[Genetic counselling service at the congenital diaphragmatic defect]
[Recurrence risk of congenital diaphragmatic defect in a genetic counselling service has been investigated. Based on the investigation of 78 cases the risk of recurrence proved not significant. The families who have already had a newborn with congenital diaphragmatic defect may be suggested to bear subsequent pregnancies with the support of genetic counselling and intermittent ultrasonography. ]
Lege Artis Medicinae
JUNE 30, 1993
[Studies of left ventricular dysfunction]
[510 patients (39.7%) in the placebo group and 452 patients (35.2%) in the enalapril group died. The reduction in cardiac mortality was mainly due to a reduction in progressive heart failure (placebo: 251, enalapril: 209; risk reduced by 22%). There was no appreciable reduction in mortality from arrhythmias without pump failure. However, fewer patients died or were hospitalised due to worsening of circulatory failure (placebo: 736, enalapril: 613; risk reduction 26%; p<0.001).]
Lege Artis Medicinae
JUNE 30, 1993
[United Kingdom transient ischaemic attack study]
[Patients took the drug with about 85% reliability. The four clinical endpoints - non-fatal myocardial infarction, non-fatal stroke, vascular death or non-vascular death - were 18% less frequent in the two aspirin-treated groups than in the placebo-treated groups (2p = 0.01). The overall incidence of brain haemorrhage with permanent damage and vascular death was reduced by only 7%. There was no appreciable difference between the efficacy of the higher and lower aspirin dose, except that the lower dose was significantly less gastrotoxic.]
Lege Artis Medicinae
JUNE 30, 1993
[Percutaneous treatment system of pancreatic fluids]
[Ultrasound-guided puncture of pancreatic pseudocysts developed in the past 20 years into a well applicable clinical system. There were the pancreatic fluid collections of 266 patients examined and treated within ten years. Internal and external drainage procedures were utilized in 56 and 210 cases, respectively. Introducing any catheter samplings of the fluid contents was the first step in all interventions followed by bacteriological, cytological and laboratory investigations. Complementary methods were also elaborated. The pseudocysts were irrigated with flavonoid solution and with antibiotics, when they were infected. Hydroxy-rutozides were administered also parenterally in 56 cases. There were brush-cytological samplings carried out in 26 fluid collections as well as forceps biopsies from the irregular walls. The walls of pseudocysts were stuck with Tissucol adhesive in 22 cases. Ten multicular cyst were opened together by septotomy thereby treating them as a single cyst. Sandostatin was administered in 12 cases to increase the safety and effectivity of the interventions. Utilizing the complementary methods diagnostics became more accurate and therapy more effective. The methods listed above comprise a „set of tools” that must be applied on uniform clinical grounds.]
Lege Artis Medicinae
JUNE 30, 1993
[Morphological features of the partial hydatidiform mole]
[The distinction between the partial and complete forms of the hydatidi form mole is very important for the risk of a malignant transformation is higher in the latter type. Biopsy samples were studied from 32 hydatidiform moles previously examined clinically and cytogenetically. The purpose was to find out the most important morphological differences between the complete and partial forms of this disease. Comparing with the literature it was established that admixture of normal and hydropic villi, pre sence of fetal elements in the biopsy material focal and moderate proliferation of trophoblastic cells, scalloped outline of the hydropic villi and trophoblastic inclusions in the stroma of the villi could call the attention of the pathologist to the existence of partial mole even in lack of clinical and cytogenetical data. ]
Lege Artis Medicinae
JUNE 30, 1993
[New psychiatrical nosology: the composite diagnostic evaluation (code) system]
[CODE stands for Composite Diagnostic Evalu ation: and the CODE system is a methodology in psychiatric polidiagnostical nosology. It renders nosologic concepts accessible for validation and allows for the comparison of different systems of diagnostic classifications. In contradistinction to other methodologies the CODE system has the unique capability for comparing different systems of diagnostic classifications on the basis of the same interview. The CODE system has 12 main and 12 suplementary CODEs as CODE-DD (for Depressive Disorders), CODE-HD (for Hyperthymic Disorders), CODE-SD (for Anxiety Disorders). The polydiagnostical CODE system as a nosological method might also play a significant role in bridging the increasingly widening gap between psychiatrical, first of all neuropsychopharmaco logical research and its psychiatrical and psychopharmacological applications. The computerised versions of the CODE system are easy to use at the psychiatrical practice and also as a research tool. For this reason, the CODE system is a useful nosological method for multicenter international psychiatrical and psychopharmacological studies.]
Lege Artis Medicinae
JUNE 30, 1993
[Application of the "homogeneous disease groups" patient classification system in hospital care analysis]
[In our previous communication, we described the principles and basic concepts of a patient classification system based on the formation of "homogeneous disease clusters (HBCs)", which allows a multifaceted analysis of hospital activity (1). In the same paper, we also reported our first methodological experience with the application of the HBCs classification system for the analysis of length of stay and hospital performance. In our next paper, we described the methodological possibilities offered by the HBCs patient classification system for retrospective and prospective analysis of the relationship between hospital performance and hospital budgets and for the design of performance-based internal financing (2). In this paper, we demonstrate how the HBCs patient classification system offers additional complex analytical possibilities for hospital management in terms of inpatient flow and inpatient performance by studying acute inpatient care in the clinics of a medical university and the wards of a county hospital. ]
Lege Artis Medicinae
JUNE 30, 1993
[Reform or pseudo-reform? Points and codes]
[The question is not really a theoretical one: is there real reform in health care, or are we witnessing a pseudo-reform that, at best, does not add to decades of contradictions, does not further distort the system, but does not bring closer the resolution of tensions that have been felt for quite some time. ]
Lege Artis Medicinae
JUNE 30, 1993
[The voluntary mutual fund is the winner]
[The Parliament held a general debate on the draft law on Voluntary Mutual Insurance Funds in early May and it is likely that by the time this article is published, the House will have gone through the detailed debate. We have asked Mr. Paul Kovács, Vice-Chairman of the Parliament's Committee on Social Affairs, Family and Health Protection, to explain to LAM readers the essence of the insurance fund, which was still around before the war but is now a novelty in our country. ]
Lege Artis Medicinae
JUNE 30, 1993
[Information on contentious issues in the draft law on voluntary mutual funds]
[The bill on Voluntary Mutual Insurance Funds comes to you after about two years of preparatory work. With the emergence of mutual funds, a completely new institution of self-sufficiency is being introduced in some areas of social care, in particular in the basic social insurance services, which can be well integrated into the emerging market economy. At the same time, a new business area is opening up in both the financial and capital market service systems, and a new institutional player is emerging among investors.]
Lege Artis Medicinae
JUNE 30, 1993
[S.O.S.! Hospital in critical condition]
[According to reports from health and economic experts, of the slightly more than 100,000 hospital beds in the country, only 70,000 can be maintained by social security. 30,000 beds will have to be cut. The hospitals throughout the country are in a difficult financial situation, with the counties in the lowlands, especially the hospital in Békéscsaba, being in a critical situation. ]
Lege Artis Medicinae
JUNE 30, 1993
[Master surgeon Bertold's salary]
[The healing of the sick was brought to our country by the monks, along with the Christian faith. The first physicians came from the Order of St Benedict, which had a rule for the care of the sick (Cura infirmorum). This monastic medicine! came from the West. The secular doctors appeared in our country around the reign of Béla III, and their skill was often rewarded by princely grants. This is evidenced by numerous surviving contracts of sale in which they are listed as buyers. ]
Lege Artis Medicinae
JUNE 30, 1993
[Saint Elisabeth of the Árpádházy]
[Saint Elizabeth (1207-1231), revered as the 'House of Árpád', known by the Germans as 'Thuringian' by marriage, while further west and south of them, in France and Italy, she was known as 'Hungarian' by her birthplace, was one of the most curious figures of the Middle Ages.]
Lege Artis Medicinae
JUNE 30, 1993
[The principle of "informed consent" to medical interventions in modern medical ethics Part I]
[There are few concepts that have gained as much popularity in the bioethics literature over the last 30 years as the concept of informed consent. However, in the Hungarian literature, with a few exceptions (1), the term is hardly used, as is also indicated by the fact that the English term 'informed consent' does not even have an established Hungarian equivalent, for example, Hungarian health law generally speaks of consent to medical intervention, the physician's duty to inform or to inform the patient, in effect describing the principle of informed consent (2).]
Lege Artis Medicinae
JUNE 30, 1993
[About books]
[Book review Zsuzsa Gábor: Clinicopathological consultation Practical pathology for clinicians]
Lege Artis Medicinae
JUNE 30, 1993
[Healing in the service of mortality]
[Advances in science and medicine, social and economic changes have transformed the traditional doctor-patient relationship and inevitably lead to a rethinking of views on life and death. ]
1.
Clinical Neuroscience
[Headache registry in Szeged: Experiences regarding to migraine patients]
21. MAY
2.
Clinical Neuroscience
[The new target population of stroke awareness campaign: Kindergarten students ]
21. MAY
3.
Clinical Neuroscience
Is there any difference in mortality rates of atrial fibrillation detected before or after ischemic stroke?
27. NOV
4.
Clinical Neuroscience
Factors influencing the level of stigma in Parkinson’s disease in western Turkey
27. SEP
5.
Clinical Neuroscience
[The effects of demographic and clinical factors on the severity of poststroke aphasia]
18. JUL
1.
2.
Clinical Oncology
[Pancreatic cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up]
29. AUG
3.
Clinical Oncology
[Pharmacovigilance landscape – Lessons from the past and opportunities for future]
29. AUG
4.
5.