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Lege Artis Medicinae - 1993;3(08)
Content
Lege Artis Medicinae
AUGUST 31, 1993
[The relationship between genetic polymorphism of apolipoprotein E and atherosclerosis and its relevance with clinical practice]
[The lipoprotein metabolism, having crucial role in atherogenesis is regulated by apolipo proteins, lipoprotein receptors and lipidtrans ferase enzymes. The genetic polymorphism of these proteins has been reported to be associated with lipid disorders. Beneath the rare forms (familial hypercholesterolemia, familial defective apo B syndrome) the most important monogenetic dyslipoproteinemia seems to be related to the apolipoprotein E polymorphism. The mean serum cholesterol concentration is influenced by the different apo E phenoytpes (E4 with high, E2 with low cholesterol level). In Hungary, the allele-frequencies (22 0,06, 22 0,80, 34 0,12) and the effect of apo E alleles on cholesterol concentration are very similar to the results found in other populations. Apo E polymorphism shows association with 1. hyperlipoproteinemia type III (E 2/2); 2. dyslipoproteinemia in familial hypercholeste rolemia (E2); 3. premature coronary heart disease (E4); 4. hypercholesterolemia in some populaton (E4); 5. insulin dependent diabetes mellitus in the Hungarian population (E2); 6. the rate of intestinal cholesterol absorption in some population (E4 with higher capacity). In such conditions the determination of apo E phenotype or genotype is very important to reveal the risks of the atherosclerosis and to asses the optimal hypolipidemic therapy.]
Lege Artis Medicinae
AUGUST 31, 1993
[Transvaginal color doppler in early pregnancy]
[The authors performed serial examinations using a transvaginal transducer with color Doppler facilities in normal and pathologic early pregnancies in order to examine the circulatory changes in the female genital tract and developing embryo. This is a preliminary study demonstrating the application of TVCD and summarizing the main circulatory characteristics in early pregnancy as a part of a detailed program investigating circulation in the first trimester of pregnancy. Parallel with the implantation as a result of trophoblast induction the branches of the uterine arteries can be visualized by TVCD, and characteristic ilus velocity waveform can be identified in each portion of this network. No diastolic flow can be detected in the embryonic arteries until 12–14 weeks of gestation. The fetal heart rate shows a characteristic change between the 5th and the 14th week of gestation. Examination of the circulatory changes in pathologic early pregnancies helps to establish an exact clinical diagnosis and to choose the proper treatment. The recent advent of the transvaginal probe with color Doppler imaging has permitted accurate studies of the circulatory changes in the female reproductive organs to be performed and provided more information about physiologic and pathologic processes in early pregnancy than all the non-invasive systems developed previously. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Correspondence]
[In the May issue of your newspaper, we published the musings of doctor Lajos Matos, who complained about the "pains of screening". It is feared that a supplement could be filled with not so much refuting the arguments put forward to justify his concerns, but rather adding to them. It is worth reflecting, however, at least at the level of the list, because the train of thought, which has forgotten important aspects (and facts), has led to a very depressing conclusion. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Relative antithrombotic effects of aspirin and of F(ab')2 fragments of an antibody blocking glycoprotein IIB/IIIA receptor]
[The antithrombotic effect of heparin (control group, 100 U/kg bolus and 50 U/kg/hr infusion), of heparin and aspirin (ASA group, 10 mg/kg bolus) and of heparin and F(ab')2 fragments of the murine monoclonal antibody against the platelet glycoprotein lib/Illa (GPIb/Illa) receptor (7E3-F/ab'/2 group, 0.8 mg/kg bolus) were studied in 3 groups of dogs with a 3 cm long everted (inside-out) segment of the carotid artery inserted into the femoral artery and a superimposed constriction which reduced blood flow to 35% of baseline.ASA and 7E3-F(ab')2 caused inhibition of ex vivo platelet aggregation with a decrease from 63 + 8 to 16 + 10% (mean + SEM, p < 0.001) in the ASA group and from 57 £ 5 to 0% in the 7Ė3-F(ab”)2 group. The template bleeding time increased in the ASA group (from 1.4 + 0.2 to 2.9 + 0.4 min, p < 0.05) and in the 7E3-f(ab')2 group (from 1.4 + 0.2 to 51 + 12.6 min, p < 0.001). In the control group the everted segments occluded and remained closed in 6 dogs and showed cyclic flow reduction phenomena in the 5 other dogs. In the ASA group inserted arteries occluded and remained closed in 5 dogs and showed cyclic flow reduction in 4 dogs; one segment remained open (p = 0.69 compared to control). In the 7E3-F(ab')2 group all segments remained patent (p < 0.001 compared to the control and to the ASA group). Thus, the GPllb/Illa blocking monoclonal antibody is significantly more effective than aspirin in the prevention of platelet mediated arterial occlusion. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Significance of intracranial lipomas in connection with a rare case ]
[Intracranial lipomas are rare lesions which are diagnosed in about 0,08% of autopsy cases. An intracranial lipoma in the left Sylvian area of a 93 year old woman was incidentally observed during autopsy. Histological findings supported the diagnosis based on the macroscopic characteristic features. Intracranial lipomas, which are predominantly localized in the median areas are presently considered as develop mental anomalies of the subarachnoid space and not as real tumors. The theory of their pathogenesis explains the other developmental brain anomalies that are often associated with the lesion, as well as the finding of intralipomal vessels and cranial nerves. Though such lipomas are usually asymptomatic, several cases were demonstrated to be associated with seizures. Other symptoms may include hydrocephalus, headaches, behavio ral disorders, focal neurological signs. Diagnosis is based on CT or MRI findings. Intracranial lipomas are usually treated symptomatically and surgical treatment is seldom indicated In most cases shunt operations are performed, since resection is difficult and complete relief of symptoms cannot be expected as a result. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Boston Area Anticoagulation Trial for Atrial Fibrillation ]
[With the exception of the first month, the prothrombin time was within the desired range for 83% of the study period. There were two "strokes" in the warfarin group (0.41%/year) and 13 in the control group (2.98%/year). The overall mortality rate was 2.25% in the warfarin group and 5.97% in the controls. Minor bleeding occurred in 38 patients on warfarin and 21 in the controls. Subsequent analysis of the control group according to whether and at what dose they were taking aspirin and the extent to which it protected against brain events showed that most brain events occurred among those taking 325 mg of aspirin per day (mean 3.9% per year). In the group taking neither aspirin nor warfarin, the incidence of "stroke" was 1.8% per year and in the warfarin-treated group it was 0.45%.]
Lege Artis Medicinae
AUGUST 31, 1993
[Diffuse primary lymphoma in the liver]
[ Primary lymphoma in the liver is extremely rare. The liver infiltration with lymphoma cells can be localized or diffuse. 3 cases of primary diffuse hepatic lymphoma have been recorded in the literature so far. The authors present a case of primary diffuse lymphoma in the liver with paraproteinaemia (IgG kappa), which histologically proved lymphoplasmocytoidal immunocytoma expressing monoclonal immunglobulin. Having reviewed the similar cases previously published, the authors summarize the symptoms, diagnostic and therapeutical possibilities of this rare disease.]
Lege Artis Medicinae
AUGUST 31, 1993
[Phenylketonuria due to phenylalanine hydroxylase deficiency - a revealing story]
[Effective neonatal screening for phenylketonuria and the availability of a lifelong diet have virtually eliminated the severe mental impairment that results from this disease. The risk of fetal harm to women with the disease remains high, and the possibility that the diet itself may be harmful cannot be excluded. Research into the preventive treatment of the disease has been greatly aided by advances in molecular genetics. For example, modified liver cells have been implanted into mice which not only corrected the phenylalanine deficiency but remained functional throughout the normal lifespan of the animal. However, prevention and treatment have not progressed as quickly as hoped and, given current thinking on the disease, research and development needs to continue apace. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Public health priorities in Hungary until the turn of the millennium]
[Hungary's population is falling year on year: if the trend continues at the same rate as in recent years, by 2010 there will be 10.2-10.4 million people living in the country, 250-400 thousand fewer than today. The population decline is due to a simultaneous fall in the number of live births and a rise in the number of deaths. The former phenomenon is regrettably obvious, while the rise in mortality needs to be examined more closely. ]
Lege Artis Medicinae
AUGUST 31, 1993
[NGOs in economic and social transformation]
[We are undergoing a profound economic, social and political transformation, which we only partially understand: we lack answers to serious problems and often even lack an analysis of the situation and a precise formulation of the problems. One such question that still needs to be answered is: what are the challenges of economic and social transformation for civil society organisations, and what role can they play in it? Do they have a function that goes beyond their specific objectives - health protection, environmental protection, etc.? I am not trying to present a fully developed concept, but simply to formulate some basic questions on which we should exchange views. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Open letter to an oncologist in Szombathely]
[It was out of compassion and sympathy that I took up the pen: you have suffered a serious injury, in front of the public of our million-strong daily newspaper. You were interviewed on the occasion of Cancer Awareness Days, which I was not able to hear. I was shocked to read the printed version. What may have happened was that the scissors of an editor who did not know the risks of medicine irresponsibly clipped your statement about curing your cancer patients. In doing so, he has robbed it of all its noble and truly honourable content, and has even given it a distinctly repugnant tone. In particular, it emphasises a particular point of view which is hardly comprehensible to a committed doctor.]
Lege Artis Medicinae
AUGUST 31, 1993
[The amendments are also modified]
[What public authority functions should the future chamber perform as a public body? If, as the opponents of the Chamber of Commerce Act wish, the Chamber will not have such functions, who will perform them? These questions, which are still not quite settled, were proposed to the guests of the LAM Club by Iván Sitkéry, who was introduced in the article "Founding Fathers" in the May issue of LAM. The title of the discussion was "How is the law on chambers?". Csaba Huszár, chairman of the MOK's Economic and Legal Committee, tried to answer both questions at the same time. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Possible ways of running a hospital]
[The Liberal Medical Club recently discussed possible ways forward for hospital management in Hungary. The choice of topic was motivated by the fact that the tripartite collegial management imposed from above leaves much to be desired in many places. Some kind of change in this area is long overdue. In his opening speech, Bertalan Andréka, Deputy State Secretary of the Ministry of Public Welfare, said that, unlike foreign practice, the Hungarian health care system is doctor-led. We are one of the few countries where it is not unusual for the minister to be a doctor; in fact, the profession would be offended if this were not the case. Three years ago, the Ministry of Public Welfare replaced the one-person hospital management with teams at the head of hospitals, i.e. a director of the economy and a director of nursing. In some places this has worked, but in others it has created tensions. One thing is certain: the idea of one-person hospital management is back on the agenda.]
Lege Artis Medicinae
AUGUST 31, 1993
[The insurer will also check]
[The health care system in Hungary is financed by the social security system - from the contributions collected. Until now, this has been carried out by the OTE, a public state agency, which was split into two institutions run by local government bodies following a decision by Parliament and successful elections. Health care is now financed by the National Health Insurance Fund (OEP). ]
Lege Artis Medicinae
AUGUST 31, 1993
[Euthanasia movements in Europe]
[The development of modern medicine has meant that the majority of people who are dying today die in hospital. Medicine has extended the life span of people, and we are living much longer. The period of terminal illness is also being prolonged and this dying process is often artificially prolonged. Dying people are forced to endure many painful, useless interventions at the end of their lives, often because they are not informed about their condition and cannot decide their own fate. Various devices are used to "keep alive" unconscious human wrecks for years or decades. The euthanasia movement has emerged in the world over the last decades as an alternative to artificial life support, the so-called 'rage to cure'. ]
Lege Artis Medicinae
AUGUST 31, 1993
[Epidemiological ideas in the 16th century]
[The epidemiological ideas of the 16th century were based on two different principles: knowledge gained through experience and views derived from a metaphysical picture. The former group includes knowledge about the spread of disease and the eradication of epidemics, while the latter group consists of explanations of the causes and development of epidemics. Iatrodemonology, iatroastrology, iatroteology and iatromagic, with their specific God-Evil-Ember image, the health-disease, life-death relations implicit in the world structure defined by creation myths, provided the most ancient epidemiological ideas and, in the 16th century, the ones that flourished during the religious renaissance. Disease or epidemic, God's punishment, the Devil's revenge, or a particular stage of existence. ]
Lege Artis Medicinae
AUGUST 31, 1993
[The dance of death]
[In a narrower sense, the term death dance refers to representations of people of different ranks and ranks dancing, each paired with a skeleton representing death. In the Middle Ages, a text often accompanied the scene: a dialogue between the dancers and death. From the Renaissance onwards, any representation in which death is present in some context is increasingly called a death dance.]
Lege Artis Medicinae
AUGUST 31, 1993
[About books]
[Review of the book Breast Surgery in General Surgical Practice written by Dr. Keszler Pál, Dr. Szabó Győző János]
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.