Lege Artis Medicinae - 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Ceftazidime - over ten years in the clinical practice]

SZALKA András, PRINZ Gyula

[This review discusses the principal features of ceftazidime based on the ten years experience since the introduction of the drug in the clinical practice: its broad antibacterial spectrum including Pseudomonas aeruginosa, favourable pharmacokinetics, wide range of indications, excellent clinical efficacy using empiric treatment or elective therapy and safety profile. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[What to expect of PTCA today?]

MAJOR László, MOLNÁR Ferenc, BERENTEY Ernő, KÉKES Ede

[This article is a review of the changing indications for percutaneous coronary angioplasty during the last decade. The role of revascularisation and especially of PTCA in the treatment of coronary heart disease is explained. Coronarography is the most important morphol gic diagnostic tool for coronary artery disease. The importance of the topic of this article is enhanced by the position of Hungary at the top of morbidity and mortality statistics, and by the infrequency of revascularisation procedures, especially PTCA. PTCA proved to be a real alternative to a surgical procedure in about half of the patients indicated for revascularisation. PTCA is less invasive, requires less time for recovery and is less expensive compared to bypass surgery. This article should draw attention of the family practitioner to the importance of this method. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Myocardial contrast echocardiography]

TEMESVÁRI András, LENGYEL Mária, PAOLO Voci

[Symptoms of ischemic heart disease will occur when myocardial perfusion diminishes below a critical level. Coronarography will disclose the anatomic stenoses, but there is no direct correlation between the grade of stenosis and the change of myocardial perfusion. Myocardial contrast echocardiography is a new technique to analyze the myocardial perfusion. The contrast agent contains micro bubbles which have nearly the same dimensions as red blood cells. The microbubbles increase the „whiteness" of the perfused myocardium during the echocardiographic examinations. The change in „whiteness" of the myocardium correlates with myocardial perfusion. Intracoronary injections delineate the perfusion area of the coronary artery, and Thus the coronary flow reserve and the collateral flow area can be measured. The cardioplegia fluid distribution and the graft perfusion area are examined intraoperatively. Bedside myocardial perfusion studies will be possible through the transpulmonary passage of intravenously injected contrast agents. Myocardial contrast echocardiography can be applied both in the diagnosis and treatment of ischemic heart disease.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Randomised assessment of (the effect of) digoxin on inhibition of the angiotensin-converting enzyme study]

MATOS Lajos

[Circulatory failure worsened to the point of discontinuation in 23 patients in the diuretic + ACE inhibitor + placebo only group, compared to only four patients in the digoxin group (p<0.001). The relative odds of worsening circulatory failure with placebo compared with digoxin was 5.9. All measured parameters of functional capacity (maximal exercise capacity, submaximal exercise capacity, NYHA grade) worsened with digoxin withdrawal. Similarly, quality of life (p=0.04), ejection fraction (p=0.001), heart rate (p<0.001) and body weight (p<0.001) decreased with digoxin instead of placebo.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Investigation of uterine circulation by transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The circulatory changes and the characteristics of blood flow in certain uterine vessels can be detected by transvaginal color Doppler in early pregnancy. The uterine circulation of 53 patients with normal intrauterine pregnancies at 4–14 weeks of gestation and 104 non pregnant patients were investigated. The main uterine artery, arcuated and spiral arteries were demonstrated by color Doppler in all patients in early pregnancy and characteristic flow velocity waveforms were obtained in 94% of the cases. The impedance to flow in the main uterine artery was significantly lower and the mean velocity was significantly higher in early pregnancy than in non pregnant patients. The indices of impedance to flow decreased with gestation in the uterine branches and there was a progressive fall in these indices from the uterine artery to the spiral arteries. Mean blood velocity in the uterine artery increased with gestation. The hemodynamical changes which are proportional to gestation age give an indirect evidence of the adequate maternal blood supply for the growing embryo.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Health insurance chances]

FRENKL Róbert

[Every Hungarian citizen has the right to the highest quality of health care free of charge.This was the basic tenet of the socialist health care system, which, with its hypocrisy and lies, made all reform efforts hopeless from the start. Worse still, for successive generations of doctors, unreality became the defining feature, and the only protection against its demoralising effects was the closeness of a few worthy individuals, their professionalism and human decency. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Right arterial thromboembolism revealed by echocardiography in acute myocardial infarction]

TÓTH Csaba, VADNAY István

[The authors report on a case of right ventricular infarction associated to inferior left ventricular infarction. Right atrial thromboemboli were revealed by echocardiography. The mobile thrombi of extracardiac origin, through pulmonary embolisation caused the death of the patient. In connection with the case, the authors discuss the difficulties of diagnosing the joint incidence of right ventricular infarction and pulmonary embolism and the role of echocardiography. They emphasize the indications for surgical intervention, by which, according to the literature pulmonary embolism can be prevented.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Public health priorities in Hungary until the turn of the millennium; Annex]

KERTAI Pál

[Current situation: the Public Health Service currently employs 1878 university graduates (of whom 1175 are doctors) and 4131 college graduates. In 1991, there were 635 public health-epidemiology, 23 public health-laboratory and 643 social medicine specialists, most of them employed by the Public Health Service. Their training and further training were provided by the four departments of the University of Postgraduate Medical Education (Public Health, Occupational and Industrial Health, Radiological Health, Public Health in Medicine), while the college training was provided by the College of the same university. The introduction of the medical officer service created a new situation, as many professionals with clinical training entered the service. To ensure the same level of knowledge, a regulation requires medical officers to complete a course in medical officer training within three years and medical officers within five years. Further training is organised by the National Centre for Public Health and the three-month courses culminate in an examination. It is unfortunate that neither the examinations nor the courses are accepted in Western European countries. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Quo vadis health?]

GYARMATI László

[Unfortunately, the question asked in September last year whether the planned health care reform could be implemented within the current framework of the Health Care System (2) has not received many positive answers in the past. I would like to contribute to the dialogue proposed by the Minister with the ideas presented here.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Two yes, one no; Amendment against over-education]

KRASZNAI Éva

[Gyula Kincses, MDF MEP, has tabled several amendments to the recently adopted Education Act. As a doctor and a key figure in the management of the health sector, he tabled a number of health-related motions in the House of Representatives. He did not dispute the intention of the draft law to give preference to training in general and to set the resources in proportion to the number of students. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[The hospital as a service provider; pitfalls of German reform]

KRASZNAI Éva

[The 18th German Hospital Congress and Interhospital '93 took place at the International Hospital Trade Fair in Hannover. The four-day prestigious event focused on the German health care reform, which aims to bring hospitals into the market economy alongside compulsory insurance. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Established; Roundtable discussion at the LAM club]

ANDRÁS László

[The organisers of the LAM Club had a lucky hand in setting the date for the discussion, as some of our guests had come to Hotel Agró from the inaugural meeting of the Health Insurance Municipality. Róbert Frenkl, István Mikola and András Szepesi were among the board members. Gyula Kincses represented the Social Committee of the Parliament and Csaba Huszár the MOK Board. Ágnes Gusztonyi was welcomed as head of the National Health Insurance Fund, following the timely separation of the OTF apparatus. ]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[A 19th century uomo universale]

HOLLÓSI Éva

[Karl Gustav Carus (1789-1869) graduated in medicine and philosophy at the same time, aged 25, but also studied other fields of science, including physics, chemistry, botany, zoology and geology.From 1811, he worked as an obstetrician and practising physician and teacher throughout his life. Carus became court physician to the King of Saxony in 1827, and later became a member and even president of several medical and scientific bodies. One of the first stages in his wide-ranging scientific activities was his textbook on gynaecology; he was one of the first to study and teach comparative anatomy. He published several works on the nervous system and the circulation of the blood.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Additions to the history of breast drainage]

MOLNÁR Tamás, ALFÖLDI Ferenc, BENKŐ István

[Opening the chest and operating on the lungs was taboo for surgeons until the end of the 19th century (1). Although scattered successful cases were reported (2, 3), the lucky outcome remained a curiosity, and general experience (4) justified the fear that the opening of the pleural cavity to the circular air was fatal. As in so many other cases in the history of surgery, a solution to this problem was found on the basis of the experience of military medicine, notably the American Civil War of 1861-65 (5).]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Communication in hospital]

LÁSZLÓ Klára

[The rules of everyday communication apply differently in different situations. If we accept that communication is nothing more than the communication or exchange of information, which takes place in "spaces" of different types and sizes, then when analysing communicative situations we must make the actors involved in communication and the place, i.e. both components, the object of our analysis.]

HUN 1993;3(09)

Lege Artis Medicinae

SEPTEMBER 29, 1993

[Do we have the right to die?]

SÁNDOR Judit

[We have historical evidence that in ancient times a distinction was made between curable and incurable patients. The doctor had to relieve pain, but preparing for a dignified death was no longer part of his job. Even in later centuries, accompanying and assisting the dying was not considered a medical activity, but with the advent of pain relief and the possibility of artificial life support, this activity, like so many others (such as childbirth), became medicalised. The fear of death was accompanied by a fear of artificially sustained life.]

HUN 1993;3(09)