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Lege Artis Medicinae - 1993;3(10)
Content
Lege Artis Medicinae
OCTOBER 27, 1993
[The surgical treatment of shoulder instability]
[The author briefly reviews the static and dynamic stabilizing system and the biomechanics of the shoulder and describes his principles and techniques of the surgical treatment of instability. A modified Bankart procedure is used for recurrent anterior dislocation. Bone blocks are implanted in cases of locked posterior dislocation. Different forms of cranial instability are described as well as partial and total superior glenoidal lesions. The author discusses surgical procedures used in the treatment of these instabilities. Cranial instability leads to impingement syndrome, which results in rotator cuff lesions. These lesions increase instability and the increased impingement leads to further rotator cuff damage. This vicious cycle can be interrupted by surgical intervention.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Clinical application of specific antibodies in immunotherapy of transplantation]
[In organ and tissue transplantation practice as well as in the therapy of autoimmune, haematological, immunological and oncological diseases, the possibility for applying immunotherapy is occuring more frequently. The paper deals with all those reagents which are primarily of polyclonal or monoclonal immunglobuline origin and play a significant role in the various cell-bound immune reactions on the surface of lymphocytes. In addition to the anti-lymphocyte or/rather anti-thymocyte globuline as well as the Orthoclone (anti-CD3 monoclonal antibody) reagents well known in clinical practice, it also refers to other lymphocyte surface anti-marker monoclonal anti-bodies (anti CD4, -CD8; anti TCR, anti-LFA reagents) under clinical trial. The article reviews the possible uses of the group of immunotherapeutical reagents in the clinical practice of Kidney and bone marrow transplantation. The pharmacological mechanism, side effects, and prospects for a wider use of these reagents in the future are discussed.]
Lege Artis Medicinae
OCTOBER 27, 1993
[The origin of serum catalase in healthy subjects and in some diseases]
[The activity of serum catalase is highly increased in acute pancreatitis, hemolytic disorders and in some liver diseases, but there is no data on its tissue origin. The serum catalase activity was determined by a spectrophotometric assay in healthy subjects (n = 4275) as well as in increased erythropoesis (n = 424), in hemolytic diseases (hemolytic anemia = 12, megaloblastic anemia = 28, Zieve syndrome = 8, hemorrhage = 38), in acute pancreatitis, (n = 111), in liver diseases (fatty liver = 21, alcoholic hepatitis = 42, acute yellow atrophy = 18, toxic hepatitis = 15), and in liver congestion due to cardiac circulatory failure (n = 28). These diseases yielded increased serum catalase activity. This enzyme has no tissue specific isoenzymes, therefore mathematical and statistical approaches were used. The correlation between serum hemoglobin and serum catalase was analysed. The catalase release was estimated from the time activity curves of serum catalase and compared to its tissue equivalent. In healthy subjects about 60 percent of serum catalase derived from the erythrocytes and the rest from other tissues. During enhanced erythropoesis and in hemolytic diseases, similarly to hemoglobin, its source was the erythrocyte pool. In acute pancreatitis also the erythrocytes might be responsible for the increased serum catalase level. in some liver diseases as well as in liver congestion due to cardiac circulatory failure the increase of serum catalase derived from the liver cells. The diagnostic analysis of serum catalase requires the consideration of its increase as well as its origin. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Prenatal follow up of a complex cardiac malformation complicated with complete AV block]
[In a congenital disorder of heart development where the complex cardiac malformation is pared with complete atrioventricular block heart rate is stabile between 50–60 beats/min. Transfer of atrial impulses through the AV node is fully blocked and the slow rhythmic heart beat is maintained by a ventricular pacemaker. In a case of such a complete cardiac malformation recognized in week 32 of gestation and the AV block complication caused stabile 57–58 beat/min bradycardia. 2-di mensional, pulsed and color Doppler ultrasonography was used to identify the disorder and to follow up the intrauterine condition of the fetus. Cardiotocography (CTG) could not generate appreciable results at such a low heart rate. During observation no centralization of fetal circulation causing intrauterine hypoxia was recorded. Updated knowledge on the pathogenesis and obs tetrical management of the fetal third degree AV block is also presented. In this case ultrasonography allowed clear-cut identification of the disorder and also ensured correct evaluation of the intrauterine status of the fetus when other diagnostic methods for evaluation were not applicable. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Eurpean Concerted Action on Thrombosis and Disabilities Angioma Pectoris Study]
[Patients with more than 50% stenosis in one or more coronary arteries had significantly higher fibrinogen levels (p<0.0001). Reduced fibrinolytic activity was also observed in patients with coronary artery stenosis, mainly due to higher levels of plasminogen activator inhibitor-1 (PAI). Decreased fibrinolytic activity was strongly associated with diabetes, elevated triglyceride levels, smoking and impaired left ventricular systolic pump function. Cholesterol levels correlated mainly with protein C and plasminogen levels.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Ticlopidine Aspirin Stroke Study]
[The 3-year incidence rate of all-cause mortality and non-fatal stroke was 17% in the ticlopidine group and 19% in the aspirin group. This means that compared with aspirin, ticlopidine reduced the risk of the events studied by 12% (p = 0.048). The incidence of fatal and non-fatal stroke was 10% with ticlopidine and 13% with aspirin, a 21% reduction in risk in favour of ticlopidine (p = 0.024). As side effects, ticlopidine caused diarrhoea (20%), skin rash (14%) and reversible neutropenia (1%), whereas aspirin caused diarrhoea (10%), skin rash (5.5%), gastritis (2%), gastrointestinal ulcer (3%) and haemorrhage (1%). Total cholesterol levels increased by 9% in the ticlopidine group and 2% in the aspirin group (p < 0.01).]
Lege Artis Medicinae
OCTOBER 27, 1993
[Correspondence]
[In your esteemed journal, I saw a publication on a topic that I thought was outdated, since it has been discussed so many times in the Hungarian medical literature. The evergreen topic is acupuncture, on which information was last published on pages 1387-89 of this year's issue of the Medical Weekly. Now you have published a paper on this subject in the July issue of LAM, by Paul Zmiewski, entitled "Questions and answers on acupuncture". Since the article was published without editorial comment, you must take responsibility for the contents, although it was obviously reviewed by a proofreader(s) or perhaps by some of the many members of the editorial board. For my part, I can only briefly criticise the communication in this letter, and will continue to do so until the acupuncturists' minds are finally open to the view of the 'other side'.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Swedish Ticlopidine Multicentre Study]
[The frequency of endpoints was lower in the ticlopidine group (89) than in the placebo group (99; p = 0.24). Mortality was reduced by 29.1% with ticlopidine (p = 0.015): this was mainly due to a reduction in mortality from ischaemic heart disease. The most common adverse event was diarrhoea and seven cases of reversible leukopenia or thrombocytopenia were observed. Due to side effects, 73 patients in the ticlopidine group and 26 in the placebo group discontinued treatment.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Laparoscopic herniorrhaphy]
[The successful development of laparoscopic surgery has made it possible to treat of inguinal hernias endoscopically. The technique is based on the principle of preperitoneal inguinal herniorrhaphy and is performed by internal dissection of the musculofascial defect. Mersilene mesh is placed into the defect and fixed with a special stapler to obliterate the space, and then the edges of the peritoneum are reapproximated. As the history of laparoscopic herniorrhaphy is rather short, long term follow-up data are not yet available. A review of the literature and the authors' initial experience indicate that the method is promising. Details of the surgical technique are presented.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Lymphocytic mastopathy]
[The authors intend to call attention to a possible new autoimmune disease, lymphocytic mastopathy and its therapeutical consequences. This is the first report on this subject in Hungary. A case history of a woman suffering from lymphocytic mastopathy is presented. In 1982 the histology of the tumor in the right breast showed the so-called pseudolymphoma. There was no therapy. In February 1991 therapy was started because of recidiva with azathioprin and prednisone. After this therapy we did not find any tumor. The improvement of the disease after administering these two drugs is further evidence of its possible autoimmune origin.]
Lege Artis Medicinae
OCTOBER 27, 1993
[An experiment in modern specialist training]
[At the time of writing this article, the Minister of Public Welfare had not yet published Decree 6/1993 (II. 19.) of 19 December 1993 amending the legislation on the acquisition of the qualification of medical specialists (1). Our original intention was to stimulate the new regulation by describing our experiences and attempts. We could not have hoped that this codification of the legislation would be completed so soon, as we have been waiting for years. The achievement of most of our objectives may make this communication superfluous, but we believe that identifying some of the problems that can be considered general, looking back and setting out the challenges that our new opportunities will bring us can be useful for the future.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Determining the number of cases required at the basic level]
[It is a serious disadvantage for an applicant - and this is particularly true in the case of health services research - if a grant application does not include an estimate of the number of cases required. Panel members need to be reassured that there is a high likelihood that a clear answer to the question posed can be given at the end of the research. An easy-to-understand explanation of the concepts involved in determining the number of cases, supported by diagrams, may encourage the more timid to pay more attention to this increasingly important issue in the evaluation of proposals.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Quality assurance in general medical practice]
[Quality Assurance (QA) has become a focus of increasing interest in the healthcare sector in recent years. This trend has also become increasingly evident in relation to general medical work. The outstanding work in this area in individual countries, with perhaps the most important results in England (1) and the Netherlands (2), has also laid the foundations for a coordinated strategy. This effort led to the creation of the European Working Party on Quality in General Practice under the auspices of WONCA (World Federation of Family Doctors) in 1991, with the participation of 15 countries, including Hungary. The aim is not to standardise but to raise the quality of quality assurance work to the highest possible level by exchanging experience (3). As Hungary is still at the very beginning of this task, although several major initiatives have been taken (4, 5, 6), it may be useful to briefly discuss the main issues involved.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Making way for pseudoscience?]
[In June 1993, the Royal British Medical Association decided that the subjects of paramedical medicine (naturopathy) would no longer be treated with disparaging disapproval, but would be taught in medical schools. This decision came as a surprise to most doctors, although chiropractic (osteopathy), herbal therapy (herbal medicine) and acupuncture have held their position in medicine for quite some time. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Quality and economy in Hungarian healthcare]
[Three institutions from Eger: the County Social Insurance Directorate, the Markhot Ferenc Hospital-Rendering Institute of the Heves County Municipality and the Heves County Institute of the State Public Health and Medical Service of Heves County organised a high level and very pleasant seminar on health quality assurance in Eger, in the Hotel Flora. The number of participants reached 400, with nearly 40 speakers and guests from 12 countries sharing their experiences.]
Lege Artis Medicinae
OCTOBER 27, 1993
[Not a crying word in the wilderness]
[According to Gyula Kincses, chairman of the Reform Committee of the Ministry of Public Welfare, the three-day meeting of the College of Gastroenterology held in Dávod Püspökpuszta, Hotel Fortuna, in mid-August, under ideal conditions, was exemplary and even historic.]
Lege Artis Medicinae
OCTOBER 27, 1993
[General practitioners yesterday, today and tomorrow]
[In Selmec, the Mining Academy was founded in 1770 by Maria Theresa. Among the first teachers of this institution was János Antal Scpoli. For fifteen years, the doctor worked as a plant physician in the cinnabar mine and mercury extraction plant in Idria. In this capacity he was the first full-time plant physician in the Austro-Hungarian monarchy from 1774 to 1769. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Universal health coverage]
[In the political wrangling over the Public Education Act, less attention was paid to the Higher Education Act, which was negotiated and adopted in parallel. Attention has also been diverted from the paragraphs that define the future of medical education and training in Hungary and the patient care activities of clinics. Yet we believe the law opens the way for major changes, which is why we recall the debates leading up to the final decision. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Alcoholism: a national habit or a national disease?]
[Johan van Beverwijck, the eminent Dordrecht physician and theoretician, published in 1636 in his "Schat der gezondheid" (The Treasure of Health), he wrote a chapter on the harmful effects and dangers of excessive alcohol consumption and drunkenness. The author of this handbook, which was intended for a general audience and acted as a kind of health advisory, did not devote such special attention to the issue by accident, since, according to numerous contemporary sources, the Dutch citizens of the 17th century were very careful about their drinking. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Stephen d'Irsay]
[In the medical history literature of the inter-war years, I was struck several times by an unusual name: Stephen d'Irsay. I suspected that behind the name was an author of Hungarian origin, but this suspicion was confirmed only recently, and at the same time the outlines of an interesting human destiny, a not insignificant medical career, began to emerge. ]
Lege Artis Medicinae
OCTOBER 27, 1993
[Reflections on the Praxis-manadgament]
[Despite the bright weather, a large audience enjoyed listening to the Dr. Stefan Böhm, a young family doctor who has moved from Hungary to Germany, gave a lively, Hungarian-language account (autobiography) of the launch of his practice. After graduating from university, he obtained the compulsory qualification as a general practitioner, which is a prerequisite for practising as a general practitioner (there too).]
Lege Artis Medicinae
OCTOBER 27, 1993
[Bioethics debates in Poland]
[Medical ethics has a long tradition in Poland. Jagiellonian University in Cracow, a modified version of the Hippocratic Oath was adopted and doctors practised medicine in its spirit. At the turn of the 19th and 20th centuries, medical practitioners were required to listen to traditional medical deontology. ]
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