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Lege Artis Medicinae - 1993;3(12)
Content
Lege Artis Medicinae
DECEMBER 29, 1993
[The significance of vasodilator drugs and angiotensin converting enzyme inhibitors in the treatment of congestive heart failure]
[The significance of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure is outlined. The results of multicenter, randomized trials are summarized confirming the beneficial effect on survival of vasodilator therapy and/or angiotensin converting enzyme inhibitors in the treatment of patients with congestive heart failure.]
Lege Artis Medicinae
DECEMBER 29, 1993
[Medical management of inland catastrophes]
[The author details the medical consequences of disasters and mass casualty situations. The concept of disaster is definied and compared with that of mass accident. It is pointed out that in principle there are no essential differences between them since both disasters and mass accidents require the application of compromise medicine princliples at the site of the catastrophe and during the course of the hospital treatment. The main point of medical support at the site is the triage based on a numeric system of classification. In hospital treatment it is of great importance to adopt uniform (doctrinarian) principles and practice in order to prevent or decrease complications occurring in almost every extreme situation. Further co-operation of our medical organizations and development of common disaster plans may improve the effectiveness of coping with a possible emergency in our country.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The value of colposcopical and cytological examination in the screening of cervical intraepithelial neoplasia]
[ From 1980 to 1991, 1379 women with abnormal colposcopic and/or cytologic findings were examined at the Department of Gynecological Oncology at the National Institute of Oncology, Budapest. The sensitivity and specificity of these screening tests were studied retrospectively. All women underwent either cervical excision or conisation. Cytological and colposcopical findings were compared with the histological findings. Sensitivity and specificity of cytology were 49% and 77%, retrospectively. The corresponding figures for colposcopy were 88% and 12%, and for cytology and colposcopy together, 96% and 14%. 1. The low sensitivity of cytology suggests that as many as 50% of CIN lesions will be missed if cytology alone is used for screening. This finding probably justifies our screening policy (i. e., colposcopy should be used as a primary tool). 2. We found 194 asymptomatic patients with carcinoma in situ, 40 with microinvasive and 8 with frank invasive carcinoma. This finding emphasizes the importance of cervical cancer screening. 3. To decrease the false positive and negative rates, the introduction of new scientific results into the every day screening practice is urgently needed. 4. Our data suggest the superiority of a colposcopical screening method to a cytological one; however histological examination must be done independently of a screening method if the suspicion of cervical dysplasia arises. ]
Lege Artis Medicinae
DECEMBER 29, 1993
[Digoxin 2 days a week; Can what is wrong be safe?]
[The last 20-25 years have seen significant advances in the use of medication. Blood levels of drugs can now be measured using available laboratory methods, and many effects can now be accurately measured in addition to general clinical monitoring. This has created the basis for the everyday use of pharmacokinetics and pharmacodynamics and a separate discipline, clinical pharmacology.]
Lege Artis Medicinae
DECEMBER 29, 1993
[Coronary Angioplasty Versus Excisional Atherectomy Trial]
[Atherectomy reduced coronary stenosis 50% or more often (89%) than angioplasty (80%, p<0.001), and the acute increase in vessel diameter was more pronounced (p<0.001). Atherectomy was associated with more early complications (11%) than angioplasty (5%, p<0.001) and hospital costs were also higher ($11 904 vs $10 637, p<0.006). After six months, the restenosis rate was 50% for atherectomy and 57% for angioplasty (p<0.06). However, the probability of infarction or death at six months was higher in the group treated with atherectomy (86%) than after angioplasty (4,6%, p<0,007).]
Lege Artis Medicinae
DECEMBER 29, 1993
[Correspondence]
[Hospitals and clinics that perform operative laparoscopy do not have a consensus after surgery on whether and which drain should be inserted to drain the pelvis and abdominal cavity. A review of the literature shows that the use of a drain is almost mandatory after surgery for inflammatory diseases (1, 2). The insertion of a drain is also recommended for laparoscopies for ectopic pregnancies, one of the highest risk groups (3, 4, 5).]
Lege Artis Medicinae
DECEMBER 29, 1993
[Preoperative staging of nodal status in non-small cell lung cancer]
[ Exact preoperative staging according to the TNM classification is a prerequisite for establishing an adequate treatment plan for patients with lung cancer. The presence of tumor in N1 nodes influences the extent of resection, while its presence in N2 nodes determines the type of surgical resection, or sometimes excludes exploration of the chest. The correlation between pre- and intraoperative nodal staging based on pathological findings was analysed in 227 patients with non-small cell lung cancer after CT examination and thoracotomy. The sensitivity of CT for mediastinal nodes (N2) was 80%, with a specificity of 87%, while the sensitivity for N1 was 55%, with a specificity of 67%. CT is the only noninvasive diagnostic tool that is relatively suitable in the mapping of all accessible metastatic lymph nodes before mediastinoscopy and thoracic surgery. In the case of a negative CT finding no further preoperative staging is necessary, while a positive finding is an indication for sampling and histological evaluation.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The role of protein S deficiency in thromboses of young persons]
[ Inherited dificiency of anti coagulant proteins increases the propensity for venous thromboses. There is an increasing evidence that inherited deficiency of tissue inhibitors plays a role in arterial thromboses as well. During the past two years 130 thrombophilic patients were investigated. Routine chemical and hematological laboratory examinations, the quantification of protein C and protein S activity and the measurement of their antigen concentration, as well as the euglobinlysis time and the measurement of tissue type plasminogen activator and plasminogen activator inhibitor were performed. Of the 130 patients 13 proved to have partial protein S deficiency (the antigen concentration were 30–70%, mean 50%). Among them 4 arterial, 7 venous and 2 arterial and venous thromboses were found. It is recommended to search for the etiology in the cases of thromboses in young patients, because the use of anticoagulants and the examination of relatives may prevent further thromboses.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The intestinovesical fistulas - diagnosis and surgical treatment]
[The authors present a literature review and summary about vesicoin testinal fistulas. They report their diagnostic and treatment experience in 10 cases of vesicointestinal fistula. The patients having been operated for inflammatory fistulas were healed except one case, and the patients having got a tumor died of the malignant progression. Symptoms of fistulas are various. In the diagnosis urography was helpful, cystography and cystoscopy allowed the observation of a fistulous orifice, while barium enema confirmed or removed probable doubts about the nature of the intestinal pathology. Patients with intestinovesical fistulas are usually treated by operation. The authors suggest primer radical surgery for treatment.]
Lege Artis Medicinae
DECEMBER 29, 1993
[Treating high blood pressure in New Zealand]
[Our report, commissioned by the New Zealand National Advisory Committee on Core Health and Disability Support Services, focuses on the management of hypertension. Our recommendation is that when deciding whether to start medication for hypertension, we should consider primarily the estimated absolute risk of cardiovascular disease and not just the blood pressure value. Treatment should generally be initiated in patients with a systolic blood pressure of 150-170 mm Hg and/or a diastolic blood pressure of 90-100 mm Hg if the risk of major cardiovascular events within 10 years exceeds 20%. Results from clinical trials show that at this level of absolute risk, 150 patients would need to be treated to reduce the number of cardiovascular events by 1 in 1 year. By implementing the proposal, it is possible to reduce the number of people under 60 receiving medication (mainly women) and increase the proportion of older people receiving treatment. Treatment should start with low doses of diuretics or beta-receptor blockers, unless there are contraindications, because these two groups of drugs alone have been shown to reduce the risk of stroke and coronary heart disease in patients with hypertension. ]
Lege Artis Medicinae
DECEMBER 29, 1993
[Performance funding: dream or reality? Part I]
[Today is a time of almost unbelievably rapid change. For decades our main concern has been that nothing has happened, nothing has changed. Now all our energy and knowledge is needed to adapt to at least one of the most fundamental and serial changes. Even those in the health sector who have been waiting, advocating and developing reforms for decades are somewhat surprised at the changes that are unfolding in response to fundamental influences. Only now are we beginning to sense the scale of the risk: the chances of health care's survival in an environment of a collapsing economy. The dream we are waking up from has not been easy (our Mother did not promise us this...), but the reality is surely even harder. Because it takes not rosy dreams, but often sweaty ones, to wake up to something other than disillusionment.]
Lege Artis Medicinae
DECEMBER 29, 1993
[On the draft budget of the social security funds for 1994]
[The use of public funds is planned in the general government balance. The general government balance is made up of four subsystems: - the central budget, - the budget of the earmarked public funds, - the budget of the local (regional or local) governments, - the budget of the social security system, which consists of two separate funds (pension and health insurance). The management of public finances is governed by the Public Finance Act, which requires each subsystem to prepare an annual budget. The budget appropriations include the cash requirements for the tasks to be performed by each subsystem and the expected revenue to be collected. It follows that behind the dry figures in the budgets are all the important context of the area concerned. The budgets of the subsystems of general government are approved and finalised by Parliament. In recent years, the budgets presented by the government have become law through the adoption of a number of amendments by Members of Parliament and committees.]
Lege Artis Medicinae
DECEMBER 29, 1993
[Advent reflections]
[Around Christmas, the concepts of new beginnings, peace, family... with all their positive connotations make us think. Is there a new beginning in Hungarian healthcare? There have been staff changes before. In the past, deputy ministers, today deputy state secretaries, are the better-off colleagues whose main task is to attend meetings and 'specialise', explain the inexplicable, smile and shake hands, inspire hope, knowing that there is little hope. And they chair the committees whose long, long meetings are risk-free, because no proposal becomes reality. More often than not, no proposal is made. ]
Lege Artis Medicinae
DECEMBER 29, 1993
[On the reform of inpatient care]
[Before I share my thoughts on the first experiences of the introduction of the hospital reform, allow me to say a few words about the relationship between the Ministry of Public Welfare and the Hungarian Hospital Association. I consider the role and the participation of the Hospital Association very important in the professional work related to the preparation of the legislation and the everyday practice, and therefore we invite the representatives of the Association to more and more meetings, forums and workshops at the Ministry. Recently, for example, the members of the association participated in the evaluation of the applications for the 1994 social security surplus funding claims. Soon, we will be summarising the first experiences of the reform of specialised care with the senior managers of the Ministry, and here too we are counting on the opinions expressed at the General Assembly and the active representation of the association. The hospital management model developed by the association will be presented to the ministerial meeting in the near future. The first steps have been taken in the Ministry of Public Welfare to prepare a hospital law. We consider the Hungarian Hospital Association as our most important partner in the preparation of this law.]
Lege Artis Medicinae
DECEMBER 29, 1993
[What we heard at the LAM club; Tools for reconciliation in the health sector]
[In addition to an interested participation of professionals, "Tools for reconciliation in the health sector" was the topic of the LAM Club meeting in early October. The topicality of the subject was the events at the intensive care unit of the Imre Haynal University of Science - the nurses' strike. The evening was hosted by István Kamenitzky, a member of the Board of the Health Insurance Self-Government. Invited guests were Endre Bor dán, Head of the Department of the Ministry of Public Welfare, Judit Gulyás, President of the EDDSZ, József Kovács, one of the best experts in medical ethics in Hungary, and Erzsébet Rozsos, Head of the Ethics Committee of the Nursing Association. ]
Lege Artis Medicinae
DECEMBER 29, 1993
[3rd International Conference on Preventive Cardiology]
[After Moscow (1985) and Washington (1989), the Norwegian capital hosted the third international conference on cardiovascular prevention. It is no coincidence that the organisers chose this Scandinavian country, which boasts not only excellent epidemiological studies but also a commitment to health as a government policy.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The first Hungarian pathologist teacher]
[In April 1844, a twenty-six-year-old medical student successfully defended his thesis in Vienna, which was appended to his treatise De vita plantarum in genere (The Reproduction of Plants). The sixth of the ten theses read: Fons floritionis medicinae modernae in Anatomia pathologica quaerendus est, i.e. the source of the flowering of modern medicine is to be found in pathology. The young doctor-designate's mother died just before the inauguration, so he went to his hometown of Buda, postponing his graduation until later. Ignác Semmelweis - because it is about him (1) - if his great grief had not prevented it, would certainly have been delighted that modern medicine could now flourish in his native land as well.On 11 April 1844, Lajos Arányi, the first professor of pathology at the Faculty of Medicine in Pest, was inaugurated in front of a "bright assembly".]
Lege Artis Medicinae
DECEMBER 29, 1993
[More than a hundred million gesture for the health sector]
[The main planned expenditure of the 1994 state budget was HUF 1 057 billion 468 million. This amount increased by HUF 130 billion 226 million as a result of amendments adopted by Parliament. More than one third of the increase was allocated to the Ministry of Public Welfare, whose budget, according to experts, was planned more generously than usual.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The doctors' duel]
[The Persian poet Gandjevi Nizami (c.1140-1209) probably never imagined that the stories in his great work, the Khamseh, would later be turned into lavishly decorated codices.]
Lege Artis Medicinae
DECEMBER 29, 1993
[Leonardo's Madonna of the Rock is the intercessor Mother of God]
[The Madonna in the Rocks is undoubtedly one of Leonardo's most important works. Just as the artist himself is a transition between the Quattrocento, which was increasingly able to deal with vivid details, and the more summary Cinquecento, which spoke the language of solemn, large forms, so this work belongs in some ways to the early Florentine period, which was more meticulous and not exactly but richly exploited in its variety of colours, but on the other hand it is most easily related to the later ones, which can be most easily described by the Mona Lisa.]
Lege Artis Medicinae
DECEMBER 29, 1993
[The importance of the arts in the life of a doctor]
[Mihály Bálint (1) is credited with the introduction of the concept of "medical medicine". The word expresses the everyday experience that the most commonly used 'medicine' in medical practice is the medical personality itself. The doctor uses this 'medicine' mostly unconsciously, with an instinctive naturalness, yet its use is an important element in every doctor-patient encounter, and the quality of this 'tool' and the professionalism with which it is used have a significant influence on the healing of patients. ]
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