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Lege Artis Medicinae - 1993;3(11)
Content
Lege Artis Medicinae
NOVEMBER 30, 1993
[Management of extremity injuries in mass catastrophes]
[The author details the characteristics of the management of extremity injuries in extreme conditions and describes the significant differences of injury management between extreme and peacetime circumstances. The theme is of great significance these days, owing to the rapidly rising frequency of military and civilian mass casualties and the parity of extremity injuries that reach up to 60%. The ideal devices, mental approach and organizational reflexes also differ from the traditional surgical routine to achieve an effective health service in catastrophe. Therefore preparation and training must be done in peacetime. The role of intuitions, improvisation and flexibility is very important, because there have not been two similar catastrophe situations yet and compromising management replaces the routine medical care. For fracture management special external fixators are preferable that have been developed and deviced for war injuries and that respect the budgetary and logistic aspects of catastrophe management.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Application of cytokine therapy in haematological diseases]
[The clinical applications of cytokines playing a role in regulation of haematopoesis are summarized. The potential clinical use of human cytokines can arbitrarily be ramified into 4 strategies: 1. Stimulation of the immune response in order to enhance immunosurveillance of neoplasms. 2. Prevention of chemotherapy and tumour related immuno- and myelosuppression and improvement of non-specific mechanisms of host resistance. 3. Increase of maximum tolerated doses of conventional antitumour chemotherapeutic regimens. 4. Direct influence on tumour cell growth and differentiation via cytotoxic, cytostatic or regulatory mechanisms. Three interferons, almost 6 different interleukins, erythropoetin and three different colony stimulating factors are presented. The potential benefits of cytokines in haematological malignancies and also the difficulties in realising this potential are discussed. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Natural alfa interferon in the treatment of oral viral and virus associated diseases]
[A native natural alfa interferon was applied in the treatment of 35 patients. The patients were suffering from oral virus infections (herpetic gingi vostomatitis, recurrent herpetic infections) and viral associated diseases (herpetic ulceration, recurrent aphthous ulcer, Sutton aphthous ulcer and postherpetic exudative erythaema). The patients received 1 or 2 million IU of alfa interferon im. daily for ten days. Laboratory investigations were carried out before and 10 days after the treatment. In addition to routine laboratory tests, we counted the number of absolute lymphocytes, LGL cells and immediate and late SRBC rosettes. In ten cases we noted the changes of the following surface markers: CD 2, CD 3, CD 4, CD 8, CD 11b, CD 14, CD 20, CD 25, CD 45, CD 45R and HLA-DR. There were no significant differences in the routine laboratory parameters before and after the treatment, whereas there were statistically significant increases in the number of LGL cells and in the count immediate and late rosettes. A significant increase in the expression of CD 8, CD 11b, CD 14, CD 25, and CD 45R also occurred. There were no adverse side effects interrupting the treatment. Alfa interferon seems to be useful in the treatment of these oral diseases. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The role of ultrasonography in the detection of hip joint pseudoarthrosis infection]
[In the background of rest pain in pseudoarthrosis of the hip there may be synovitis of the pseudojoint, which can be infected as well. The author's aim was to examine what sort of help ultrasound can provide in clearing of the cause of rest pain occuring in pseudoarthrosis besides the other classical imaging methods. 14 patients undergone resection arthroplasty of the hip complaining of rest pain and 12 control subjects were examined. All of them had pelvic X ray and ultrasound examination of the pseudojoint. In two cases primer, in 24 cases secunder pseudoarthrosis had been formed. In the patient group with rest pain in 12 cases synovitis was detected by ultrasound and in 2 cases of the control group. Aspiration of the pseudo arthrosis was performed in 12 cases and in 8 of them synovial fluid was obtained. Two of them were infected originally. Synovitis was proved by arthrography in 4 cases. Ultrasound can help in the detection of synovitis of pseudojoint in patients under gone resection arthroplasty and therefore can help in making diagnosis of the infection and making decision of the therapeutic approach. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Randomised Intervention Treatment of Angina trial]
[There were 16 deaths in the PTCA group and 18 in the CABG group. There was already a difference in the incidence of myocardial infarction between the two regimens (PTCA: 33, CABG: 20), but this was not statistically significant. 4% of those treated with PTCA required an emergency repeat of the procedure and a further 15% required CABG surgery during follow-up. Within two years, 38% of those treated with PTCA and 11% of those operated on required revascularisation. Coronary angiography had to be repeated four times more often in patients in the PTCA group than in those in the CABG group (31% versus 7%, p<0.001). Angina was also more common six months after PTCA (32%) than after surgery (11%), and those treated with dilatation were taking more antianginal drugs. One month after CABG, however, patients' physical workload was lower than after PTCA, although this difference disappeared later. Patients needed longer rehabilitation time after surgery than after PTCA, but those who underwent surgery had significantly less angina within two years and were less likely to need further diagnostic or therapeutic intervention.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Application of the "homogeneous disease groups" patient classification system in hospital care analysis]
[To assess the quality of health care activity by measuring the time from admission to the first intervention. On homogeneous disease groups (HBCs) patient classification system provides hospitals with a range of options for evaluating the performance of active inpatient care at both hospital and ward level. In previous publications, we have presented methodological options for assessing length of stay and ward performance (1). We have also addressed the issue of the design of an internal financing system (2), the evaluation of bed structure (3) and the quality problems of data provision (4). In this paper, we focus on the evaluation of the time from admission to the first major intervention or surgery (ОFEB), which plays a significant role in the evolution of length of stay. The development of this indicator plays a significant role in the economic operation of the ward and the hospital, and is therefore an important quality indicator of the medical care activity of the nursing unit.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The pathology of AIDS-postmortem findings of 52 hungarian cases]
[Authors summarise their observations from autopsies of Hungarian AIDS patients. The morphological criterias determining the diagnosis of opportunistic infections and malignant tumors are presented in connection with the autopsies of 52 Hungarian cases. The diseases are listed according to their frequency and organ localisation. Among infections, the most significant are Cytomegalovirus infection, Pneumocystis carinii pneumonia and Mycobacteriosis, while from among the malignant diseases are the Kaposi's sarcoma and malignant lyphoma occur. Attention is called to the difficulties of diagnosis, and to the atypical morphological picture. This study points out that the Hungarian data are similar to those of the large American summaries. The importance of knowledge of these diseases is emphasized with special regards to the rare incidence of AIDS thus far in Hungary.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Swedish Angina Pectoris Aspirin Trial]
[In terms of primary endpoints (cardiac myocardial infarction, sudden death), the sotalol + aspirin group showed a 34% reduction compared with the sotalol + placebo group (p = 0.003). In terms of secondary endpoints (vascular events, vascular death, stroke, all-cause mortality), treatment with the active study agent resulted in a 22-32% reduction. Due to adverse events, 109 patients dropped out of the aspirin + sotalol group and 100 patients dropped out of the placebo + sotalol group. In patients with stable angina pectoris, low-dose aspirin added to the baseline sotalol antianginal regimen significantly reduced the incidence of myocardial infarction and the occurrence of cardiovascular events in general.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Dear Editorial Board]
[In September, it was just over two years since the Hungarian Medical Corps took the oath of office on the law which states, among other things, that "... the Service shall participate in the development and implementation of programmes for the population and for prevention". After two difficult years, fraught with inherited and emerging problems, the public health programme was drawn up after data collection and lengthy consultations with experts.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Guidelines for the management of spontaneous pneumothorax]
[Simple flowcharts with explanatory notes have been prepared to assist in the immediate and subsequent care of patients presenting to emergency departments with spontaneous pneumothorax. These will help you to make decisions on: which patients are appropriate for hospital admission; whether drainage is necessary and, if so, the appropriate method (including technical details); hospitalisation; pulmonary consultation for hospitalised patients; and the organisation of follow-up. The guidelines, which are designed to be incorporated into emergency and other departmental manuals, have already proved valuable in the practice of several area general hospitals and can form the basis for further training. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Aspirin Myocardial Infarction Study]
[Over the entire follow-up period, the overall mortality rate was 10.8% in the aspirin group and 9.7% in the placebo group. The three-year overall mortality was 9.6% in the aspirin-treated group and 8.8% in the placebo-treated group. The incidence of definite non-fatal myocardial infarction was 6.3% in the aspirin group and 8.1% in the placebo group. The incidence of coronary events (coronary death or definite non-fatal infarct) was 14.1% in the aspirin-treated group and 14.8% in the placebo-treated group. Symptoms suggestive of peptic ulcer, gastritis or gastric mucosal erosion occurred in 23.7% of those taking aspirin and 14.9% of those taking placebo.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The issue of dental care reform]
[After repeated consultations and amendments, the reform of dental care cannot be delayed any longer. A decision on a concrete target model must be taken soon to ensure that the reform can be implemented next year, and concrete, detailed professional work and data collection must begin to ensure feasibility in 1994. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Preliminary information on data collection by the Health Insurance Fund]
[In February 1993, the National Directorate General of Social Insurance launched a comprehensive survey for the introduction of performance-based financing at health care providers, based on the data provision ordered by Article 24 (1) of Act LXXXIIV of 1992. The primary objective was to rotate the expenditure data at the specialised function level into the cash registers. (See below for the definition of cashier.) This allowed the health institution to say for itself what proportion of the amount available to it it wished to recover from which type of funding. This, of course, had to be done in accordance with the appropriate rules. (For example, anyone who did not have an agreement for a GP service could not take it up.) Activities in wards and departments. It was permissible to display the same activities in different departments and to display different activities with the same name and the same coding in different departments. For example, in internal medicine II: general internal medicine, cardiology, etc. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Some data on the GP business, a quarter after the introduction of the new financing scheme]
[Since April 1992, it has been legally and financially possible to operate the GP services that replaced the former district medical services, either as a business or as a private practice. Also since then, it has been possible to do this without a territorial commitment or by entering into a territorial commitment, i.e. by taking over the old district in the old sense, by agreement with the municipality. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
["Advertisements in medical journals"]
[The International Committee of Medical Journal Editors (the Vancouver Group) agreed the following position at its meeting in Chicago last month: most medical journals contain advertising. Advertisements generate income for journal owners, but should not influence editorial decisions. The editor has full responsibility for advertising policy, and readers should be able to clearly distinguish advertising from professional content. Editorial and advertising of the same composition or topic should not be placed next to each other whenever possible. Finally, editors should not refrain from publishing a critique of the advertisement.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[We heard it - we'll pass it on]
[A good number of doctors are participating in the growing number of forums, attending doctors' club debates to ask questions of the people in charge, trying to get first-hand information... But it is not without risk if one wishes to broaden one's horizons, to get to know the thoughts of the moment, the questions of one's colleagues, the doubts of one's colleagues that need to be answered. Those who not only wish to use their knowledge and understanding among colleagues, but also wish to solve their existential problems and solve their dilemmas on the basis of the information they have just gained, may be at a loss.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The hospital in revolutionary transformation]
[The backbone of the congress was the hospital reform law and its implications. The regional councillor Konrad Regler spoke about new forms of hospital care, its opportunities and problems. The new law stipulates that insured persons are entitled to full inpatient hospital care as a service in kind only if the treatment goal cannot be achieved by partial (not full) inpatient care, pre- or post-hospital care or outpatient treatment, including home care.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The constitutional lawyer's view of the law on health data management]
[The Constitution, in force since 23 October 1989, establishes as a fundamental right both the right to the protection of personal data and the right to access and disseminate data of public interest, i.e. the right to public access to data of public interest. Following the Constitution, a two-thirds law lays down a uniform system of guarantees for the exercise of both fundamental rights.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Anniversary meeting of the SCH]
[On 17 September 1993, the Scientific Council for Health (SCH) commemorated the 125th anniversary of its foundation at an enlarged plenary session. All the members of the various committees of the SCH and almost 200 experts were invited to the plenary session. The session was opened by László Surján, Minister of Welfare, followed by a speech by Pál Kertai, National Medical Officer, on the past of the SCH, and by Kálmán Rák, Professor and President of the SCH, on the present and future of the SCH. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Aegri habent opus medico...]
[The period 1765-1790 saw a major transformation in Austrian architecture, the impact of which can still be seen in the 19th century. In addition to the Baroque tradition, whose main protagonists were Nicolaus Pacassi and Franz Anton Hillebrandt, French Classicism was also present from the 1920s onwards. Its spread can probably be explained by the activity of French master builders who came to Austria accompanied by the French husband of Empress Maria Theresa, Francis of Lotharingia, who was of French origin. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[What comes after Scotch whisky]
[The third leading cause of death in the UK, after heart disease and cancer, is alcohol-related death. In Scotland alone, around 150 000 people are seriously affected by some form of alcohol-related harm. Their treatment costs millions of pounds. The following paper briefly describes how the UK is trying to tackle this problem, stop the rise in the number of alcoholics and organise prevention in this not very wealthy part of the UK, which is similar to Hungary in terms of the prevalence of alcoholism. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[The beginning of domestic health education]
[Health culture, medical education and education for a good lifestyle are not a modern-day phenomenon. Its organisational forms have been consolidated in the last decades of the last century, but in fact they were created as part of the health policy of enlightened absolutism. Its roots go back even further, since medical literature has flourished in every age, although its scope was very limited until the advent of printing. ]
Lege Artis Medicinae
NOVEMBER 30, 1993
[About St. Ottilia]
[In the old days, saints were invoked to help with various ailments, with fervent prayers for their intercession when the then often uncertain science of medicine could no longer help. And because diseases could not be clearly distinguished from one another, patron saints were often attached to specific organs and could be called upon to help in the event of any malfunction. In the case of the most precious sense organ, the eye, the patron was St Ottilia, who was certainly a real historical figure, but to whom there are very strong associations of legend rather than history. Her patronage also has this explanation, which is linked to the birth of the little girl.]
Lege Artis Medicinae
NOVEMBER 30, 1993
[Sociological possibilities for studying oral health behaviour ]
[The change in the health care system has made it possible to integrate behavioural (human) science aspects into medical education and preventive, curative and rehabilitative medical practice. One component of this may be the application of sociology in medicine. This paper aims to highlight the potential for the application of sociological concepts and methods in dentistry, within a behavioural framework, based on examples from abroad, where there is a long history of this practice going back several decades. ]
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